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S u p p o r t ,
Your
Yo u r Way. u p p o rt in the
r e c t e d S
t o ry s o fa r of Self Di h ames
The s o n d u p o n T
o n B o r o u g h of Richm
Lon d
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The London Borough However, performance figures alone do not A surprisingly large number of people in our all providers of health and social care services in
convey the impact personalisation has made community need some form of help in their day-to England.
of Richmond upon on individuals’ lives. That is why I am delighted day-lives. Almost one and a half million adults in
Thames is at the to introduce this report which describes our England receive support from the state. They may CSCI the national body previously responsible for
the regulation of social care, regularly published
forefront of the journey implementing SDS and documents how require help for a number of reasons including:
reports demonstrating how the social care system
Personal Budgets are working for our residents. poor mental health, learning and physical
personalisation of We want to learn from our experiences to date, to disabilities and/or age-related conditions. The struggled to deliver good outcomes for individuals
Adult Social Care. ensure that people who need support can access kind of help required can cover personal care, and their families.
services which offer independence, choice and managing household affairs and getting out and
‘Time to Care’ (published by CSCI in October
We made an early commitment to empowering, quality care. about safely.
2006) and looked at home care services and
enabling and supporting individuals to exercise noted:
This report clearly shows that SDS is making a In addition, about six million people offer care
choice and control over the care services they
big difference to people’s lives and that there is and support to their disabled or older family
receive. Our position, as one of the leading
councils in the country in the development of Self more that we can do to ensure everyone needing members, often at the expense of their own health Most councils restrict the help
support benefits from this approach. and wellbeing. Despite this high level of support they offer to a list of prescribed
Directed Support (SDS) and personalisation is
from informal carers, approximately £17.5 billion
demonstrated by the fact that over 1,200 people
I would like to thank all the staff involved in this is spent from the public purse on social care activities. Care Managers draw
(41% of those who are eligible for support from
the Council), have had their social care needs
work, including Council officers, the Richmond services each year. up individual care plans that
Users Independent Living Scheme (RUILS),
assessed using the SDS approach and have
residents and the Personal Budget holders who Nationally, one and a half million people work in tightly specify both the tasks to
been allocated a Personal Budget. We believe
have shared their individual experiences of SDS social care across some twenty five thousand be undertaken and the time to be
this is the highest in London. organisations in the public, private and voluntary
with us. devoted to these tasks.
sectors. Given this scale, decisions made by the
Since August 2008 all new people approaching
Government and councils impact not just those In one of its last reports entitled ‘Cutting the cake
the Council for help, and existing service users
Councillor Denise Carr – Cabinet Member for who currently need support but also their carers fairly’ (October 2008), CSCI reviewed the existing
undergoing a review of their care and support,
Adult Services, Health and Housing and the wider community. arrangements for people accessing state-funded
have been assessed using the SDS model. We
have achieved the ‘Putting People First’ target of social care and criticised the approach for the
Care Quality Commission
30% of people receiving a Personal Budget two following reasons:
years ahead of the target date. In addition, 14% The Care Quality Commission CQC was formed • A lack of clarity and transparency
of the Adult and Community Services budget in April 2009 merging three previous regulatory • A lack of fairness
is spent on personalised services, making bodies – the Commission for Social Care
Inspection (CSCI), the Healthcare Commission • The continuing influence of service-led,
Richmond one of only six authorities nationally
and the Mental Health Commission. It is rather than needs-led approaches
spending more than 10%. And we have been
assessed by the Care Quality Commission as responsible for the registration and assessment of • Insularity and fragmentation.
performing excellently in offering increased
choice and control to residents needing support.
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The Government’s 2006 White Paper, entitled SDS puts the individual, their family and their Richmond Council has been working closely with exercised through the following options: taking the
‘Our Health, Our Care, Our Say’ set the strategic community at its core. It is underpinned by the belief local people using services and In Control to money as a Direct Payment; arranging for a third
direction for the personalisation of services that people with health and social care needs and develop and implement a new approach to social party to spend the money and put in place the care
which should be easily accessible, flexible and their families have both the capacity and the right to care. This new approach is made up of seven (an Individual Service Fund); or leaving the Council
responsive to local needs. This was followed control the support required to live full and active lives. steps: to manage the budget and organise the support
up in 2008 by ‘Putting People First’ in which the Instead of simply placing a person into an existing agreed in the Support Plan.
Department of Health laid out the ambitions for the service, SDS is designed to allow the person and Identifying needs – Through the self assessment
delivery of personalised health and social care – their family to choose the kind of support they want, questionnaire, with support if required. Organising the support – The individual will be
putting real power in the hands of individuals and making it much more personalised. This is achieved encouraged to take as much control as they can
Establishing the indicative Personal Budget to over choosing and monitoring the support they
their carers; giving real choice and control to the through the best possible information and advice
– Using the Council’s RAS (Resource Allocation need and achieving the outcomes in the Support
people who know best what support and services available to all residents, and for those who are eligible
System). The RAS is based on the responses from Plan.
they need and how, when and where these should for support from the Council, a Personal Budget and
the self-assessment questionnaire and provides an
be delivered. individual Support Plan which reflects the personal
estimate of the funds required. This lets the person Reviewing the process – At least once a year
circumstances, needs and wishes of each individual.
In the London Borough of Richmond upon Thames know early on how much money is available to the Council will review the Personal Budget and
(LBRUT) there has been a long tradition of working fund their support. Support Plan with the individual and their family.
In Control is a social enterprise, a charity and This is to ensure it is delivering the care, choice
in partnership with people to help them take
an independent company. Developing a personal Support Plan – This is and control envisioned and to identify whether any
control of their support arrangements. The Council
drawn up by the individual, with help from their changes are required.
has been a leading authority in the field of Direct It works in partnership with people and family, a care manager or voluntary organisation
Payments and is now at the forefront of SDS and Government, with charities and with if required. The plan sets out what support is
Personalisation. commercial companies, to change the needed, how it is to be put in place and the
social care system in England through the outcomes to be achieved through spending the
In 2008/9 9,600 people living in the borough
implementation of Self Directed Support. It Personal Budget.
received some form of state funded social care,
aims to put people in control of their support
and the Council and its partners spent just over
and their lives. In Control draws heavily on the Agreeing the Support Plan – The plan has
£42.5 million on social care.
voices of disabled people themselves. to be agreed by the Council which needs to be
assured that it meets the needs identified; that
The evidence in this report provides some early In Control has been working with us to help any risks have been clearly addressed; and that it
proof that if the Council and its partners stay ensure people who need care and support are can be delivered within the resources available. At
committed to developing personalised solutions in able to lead full and active lives as members of this stage the indicative Personal Budget can be
partnership with individuals, carers and the local their communities.
community, we can together build sustainable adjusted if necessary.
support networks that work well for the people In Control has highlighted the benefits of Taking control of the Personal Budget – Once
they serve. Our ongoing shared commitment is to open and transparent resource allocation and
the Personal Budget has been finalised and the
strengthen these partnerships and to continue to Personal Budgets - innovations which offer the
Support Plan agreed, choice and control can be
improve the support we offer. potential for wider welfare reform.
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• The individual is in control of their own As part of Richmond Council’s implementation


budget, therefore they have a vested of SDS we have undertaken an evaluation of our
interest in ensuring that the money is The experience of implementing SDS in work to identify good practice, highlight areas
well spent. Richmond upon Thames for improvement and share our progress with
partners. This has been done through listening to
• Each step can be led by the individual The Council began implementing SDS in Autumn the views and experiences of people who have had
with support from their family and 2007, building on our experience of the benefits Personal Budgets and those who have worked with
drawing on professional support only if of Direct Payments and giving people more them through the SDS process.
needed. control over the support services they required.
We have used In Control’s evaluation framework,
• Professional staff are able to dedicate Two fundamental principles have guided our (which was developed in partnership with the
their time towards those who most need approach. These are: University of Lancaster) in order to identify how
their help. people have spent their Personal Budget, what
• eople with care needs are the experts
P
help they needed to plan their support and what
• As people have control over their money, in how their needs should be met
impact having a Personal Budget has had on
they are able to choose existing services,
• e should work in partnership with
W their lives.
or design their own bespoke support and
avoid being slotted into services that are people to co-design, co-deliver and
Our partner in SDS – Richmond Users
not able to meet their unique needs. support the services they require.
Independent Living Scheme (RUILS) – has
Over the last two years we have achieved some undertaken 19 in-depth interviews with people who
• Social Workers/Care Managers are not
real benefits: had a Personal Budget for six months or longer.
seen as ‘gate keepers’ of the public
The interviews were carried out by people who had
purse (a role that the previous social care
• ver 65% of people tell us that
O disabilities themselves and by RUILS staff.
system required of them).
Personal Budgets are making a positive
difference to their lives. Interviewees were asked to complete a
• Social Workers/Care Managers are able
questionnaire covering the SDS process and the
to form trusting relationships and to help
• Over 1,200 people are now receiving a impact their Personal Budgets had on various
people organise their support plans
Personal Budget. aspects of their lives.
creatively.
• Local organisations run by people who For each section people were asked to indicate
• As resources are allocated on an
use services are working with us to their level of satisfaction on a simple three point
individual basis, it is easier to ensure that
provide people with the support they need descriptive scale of: worse, no change, improved.
people get resources that match the level
to take control of their Personal Budgets.
of their needs. As part of the interviews, there were also a range
• People coming out of hospital now have of open questions, providing an opportunity
access to a reablement service which is for the interviewee to talk generally about their
helping to maximise their independence. experiences of SDS.
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Who took part: People with learning disabilities How easy was the Self Directed Support process
Social Care Group were not included in the How easy was the self directed support proccess
14
evaluation because of the existing 16
12 evidence base around the 14
10 outcomes of SDS for this group 12

8
of individuals nationally. 10

6 8
How people managed their
4 6
Personal Budget?
2
4
All 19 participants responded 2
0
Physical Disability Older people
to this question and overall 0
People 6 13
12 people said they held their Self Asssesment Find out about SDS Get the money Make a plan Get your support
Not Sure 3 3 3 3 3
personal budget as a Direct
Yes 13 11 15 13 13
Payment, and 7 people had asked
No 1 5 1 2 3
the Council to hold their budget.
We are committed to ensuring
SDS is working for everybody who People were asked to think about their Results
has a Personal Budget regardless experience of going through the SDS process
• Nobody found the whole process difficult.
of how their money is managed. and respond either: ‘yes’, ‘no’ or ‘not sure’ to
Length of time in receipt of a Personal Budget:
A priority for the coming year is the five closed questions about how easy the • Seven people found at least one part of the
to ensure people who ask the process was for them. process difficult.
10
Council or a third party to manage
their budget and arrange services • Nearly half the group found all parts of the
9
Was it easy to:
8 on their behalf can enjoy similar process easy.
benefits to those who take their • Find out about SDS?
7 • Finding out about SDS was reported as the
6
budgets as Direct Payment. • Do the Self Assessment? most difficult part by just a quarter of the group.
5
• Get control over the money? • Getting the money was reported as the
4 easiest part of the process by more than
• Plan the support you want? three quarters of the group who said this
3

• Get the support you want? part of the process was easy.
2

1 • The Self Assessment, getting the money,


0
making a plan, getting support were all
More than 3 years 1-3 years 6Months -Year >6 Months
Series1 3 9 6 1
reported as easy by more than two thirds
of the group.
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How people used their Personal Budget Outcomes for people


How people used their personal budget Outcomes for people
14 Volunteering
Paid work
12
Helping community
10 Relationships friends
Holidays
8 Who live with
6 Evenings
Close relationships
4 Neighbourhood
Money to get support
2
Safe at home
0 Social life
Family Short
Help in Personal Day Friends to Education Dignity in support
Transport Members A car Holidays Leisure breaks in
the house Assistants Centre help or training Safe out
to help reg home
Control over Support
People 12 6 5 5 5 5 5 4 3 3 1
Mental health
Physical health
Family Relationships
People were asked to identify, from a list, how Outcomes for people
Weekends
the money in their Personal Budget had been Weekdays
The questionnaire asked people about different
used. Nearly three quarters of the group Who supports you
aspects of their lives and the support they get.
used some of their personal budget to pay an Home
People were asked to identify for each area
individual to help them. Just over a quarter used The money you get
whether having a Personal Budget had made Control over life
some of their Personal Budget on traditional
things better, made no difference or made things
social care services (day care or residential 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
worse. See the table opposite for the issues
home). Over a third used money to get help
discussed. Helped No Difference Worse
from people close to them, family of friends.
Over half used some of their Personal Budget to
get out and about by car or other transport.
Areas of the questionnaire associated with choice The areas looking at making a contribution scored
and control all scored highly. For example: control relatively poorly: Volunteering, Paid work, Helping in
over your life, who supports you, control over the community.
support, what you on weekends and weekdays.
Four areas were reported by at least one person as
A notable positive impact was reported on being worse. Feeling safe was reported as worse
Relationships. Family, Close Relationships, Friends. both in and out of the home by two people.
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Quality of life monitoring

Paid work

Relationships

In addition to this one off evaluation the Council • The choice and control over the important Quality Social
of lifelifemonitoring
Quality of life monitoring
has also started a regular monthly monitoring things in their lives? Choice and Control
exercise where Quality of Life information is • Helping to get the support they want Well being
Paid work
collected from a random selection of people
• Their mental and physical wellbeing Respect in support
Relationships
who have taken control of a Personal Budget.
This ongoing monitoring exercise started in • Significant relationships (family and Quality of Life
Social life
August 2009 and to date the data has been friends) TheChoice
supportand
youControl
want
collected from 90 people. • Capacity to have a social life or participate Well being0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
in leisure activity
The Quality of Life monitoring involved asking Respect in support
• Capacity to undertake paid work
people with Personal Budgets about the effects Quality of Life
it has had on: • Whether support is provided in a
The support you want
respectful way
• Quality of Life 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Better Same worse

Social
Who responded to the quality Carequestionnaire?
monitoring Group
• Four people reported some negative
Responses have been collected from a wide range of people. The majority were over 70 years impact.
of age. The youngest was 19 and the oldest 100. • Three people reported a negative
Better Same worse
impact in one area.

5% Physical disability • One person reported a negative impact


14% in three areas.
15% • No-one reported improvements in all
Older People - Physical eight areas.
Disability
• Some people reported improvements in
seven out of the eight areas.
Older People - Mental Health • Nearly a third reported improvements in
at least six of the eight areas.

• Just over half of the group reported


66% Learning Disability an improvement in at least four of the
eight areas.
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Anna, a 31 year old young mother, is a trained Before I had the money I felt Pat and Chris Barbara
teacher and worked full-time in a local school How did you find the process when you sat down
quite trapped, there were several
before she left work to have her daughter. She is SDS has and did your plan? Did you find the process was
married and has a physical disability. things I couldn’t do. For example, easy to handle?
enabled us to
I couldn’t even go to mother and
She likes to get out to Play Group with her make decisions At first I thought it was difficult,
daughter, take her for walks and generally get out- baby groups because I needed
and-about to do the normal things people take for and choices but after reading all the papers left
someone else to carry my
granted, for example going to restaurants and to to improve Chris’s quality and with me, I had a clear idea of what
the seaside. daughter when she was a baby needed to be done to get to that
enjoyment of life. Managing our
or to help me with a pram. Just point and it’s dropped into place.
Anna spends her Personal Budget on employing own budget has given us much
a Personal Assistant, which enables her to get out knowing I can pay for someone
more control over how and when Michael
in the community as well as help to look after her to come with me and help me
daughter. She also uses the budget to socialise we spend the money allocated When Michael was asked what he would tell a
makes a big difference. friend about SDS, using his communications
with friends and go swimming, which helps her to us. Many disabled people board, he said:
relax. In addition, Anna has been able to purchase
a mobile phone which helps her to feel safe
Anna was asked what she would tell others themselves have had to give up
when she is on her own but enables her to stay in
about SDS.
work – carers often have had to Go for it, it will help you a lot
contact with friends and family. leave their own employment to
I would tell them that it can help Joan
RUILS helped Anna to prepare her Support Plan change the focus of your life from look after that person. This often Joan now employs her own Personal Assistant to
and find a Personal Assistant. provide the support she needs. When asked how she
feeling trapped and resentful leads to great financial difficulties. found this compared to using an agency she said:
When asked what had been the biggest change in towards any limitations you might As a carer, I feel I have more
her life, Anna replied:
have due to a disability, to being We are able to sort things out in our
choice and control over the kind own time and get things straight. It
I just feel there is even more able to see ways to mitigate of care that Chris is receiving
potential than what I am actually against any of the problems you seems to me with an agency you
– ensuring that he has the best just get swept off your feet, you
doing at the moment. But I think might have. possible care to suit his changing haven’t got a minute to yourself and
my personal budget has given Anna has recently started driving again. This has needs. SDS has also given us you never seem to get things done
me the freedom to clarify the really impacted on her life and she now feels more options to reinstate some properly. I have had two or three
support I need. I now try and do she has more freedom. In future Anna would
elements of his social life which
like to consider paid work again so that she can from the agency come here and
the normal daily activities that financially contribute to her family again as well as would otherwise be lost due to his none of them were satisfactory.
I felt before I just couldn’t do. meet people socially. disability.
*A false name was used to protect confidentiality
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The results of the RUILS evaluation show that there The current economic climate and the pressures
are areas to improve on as well to celebrate in on both health and social care budgets in the
There is no rule book that tells us how to do this and it is
implementing SDS. years ahead mean we will all have to ensure that really important we talk and work together in an open and
people needing care and support, and their carers,
Improving access to information, advice can access mainstream services in the borough, honest way to address issues and concerns as they arise.
and advocacy on how to make the most of as well as specialist service provision and support
Personal Budgets is key. Further work on the were necessary. We will also be looking to invest
We have learnt a great deal about what it takes to years. We are very grateful to the families and
barriers to people accessing paid employment in preventative services including assistive
ensure Personal Budgets are available to people who individuals who have worked with us to help us
and volunteering is a priority and developing technology such as Telecare and Telehealth.
need support, and we have seen the difference they learn from their early experiences.
community networks to support people living alone
can make to people’s lives. As we look to the future,
or feeling isolated continues to be important. Safeguarding and risk assessment have always Whatever the challenges we face we believe that the
we know that SDS is and will continue to be at the
played a key part in the assessment and provision principle of SDS is now established in the borough
Within the Council we are restructuring our staff heart of what we do. Our commitment to learning
of services for adults and older people. SDS offers and the strong partnership working across the
teams to better support SDS. A new Access is vital to the ongoing development of SDS. Joint
opportunities and involves changes to the balance board gives us a solid foundation to move forward.
Team will ensure that all people receive good working with local user-led and voluntary organisations
of risk, so the Council and it’s partners will continue
quality, information, advice and guidance whether is key to ensuring a range of services and support
to ensure that prevention, training, supervision,
they are self-funders or are eligible for support in the borough as well as working in partnership
support and effective reporting and responses to
from the Council. The Reablement Service with local people to ensure we stay on track.
issues and concems underpins all our policies and Cathy Kerr
will be extended to cover not only people being practice. Director of Adult and
The ‘Quality of Life’ questions in this report now
discharged from hospital but to all people eligible Community Services,
form part of every person’s review so that we can
for support from the Council. Supported Self By March 2011, the Council is committed to Richmond Council
really see how and where people are achieving
Assessment, resource allocation, Support Planning ensuring that everyone who needs ongoing
better outcomes as well as identifying gaps and
and Risk Assessment will be undertaken at the support has a Personal Budget.
areas for improvement.
most appropriate level to reduce delays. People’s
experiences of SDS and value for money will be We will continue to work closely with local The next challenge for our Adult Social Care Cathy Maker
used to directly inform commissioning decisions. residents, the voluntary sector and other partners Chief Executive,
services is to build on our work with service
to ensure the successful implementation of RUILS
providers in delivering more personalised services
Following a successful pilot of SDS for people with personalised care and support. and to ensure we are taking an active approach to
mental health needs, which clearly demonstrated help shape the local market. In addition we need to
the advantages, the Council and its partners make sure local people have consistent access to
are currently developing new mental health good information, advice and advocacy services to
commissioning strategies for adults and older Richard Kember
make informed decisions about their support. Chair of Trustees,
people which will embrace the SDS approach.
RUILS
We are immensely proud of what has been
achieved so far through the implementation of SDS
and we hope to build on this during the coming
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This report is an account of our work and what Acknowledgements


we have learnt through implementing SDS in the Thank you to all those people who have
London Borough of Richmond upon Thames. The contributed to this report. Firstly to the volunteers
findings are not intended to represent the results of from RUILS - Peter Majongwe, Robert Burgis,
an academic study. Rather they are an evaluation Jean Hamilton, Shireen Lam and Debbie Bloud -
of our progress to date and represent what some who contacted each interviewee and carried out
residents who have been through the process think most of the interviews. Also to Estelle Christmas
about their experiences. who picked up the baton to ensure that we were
In Control Partnerships able to learn from as many people as possible.
Tel: 0121 708 3031 Secondly to some key individuals: John Waters
Email: admin@in-control.org.uk from In Control and Cathy Maker at RUILS,
Website: www.in-control.org.uk Martin Cathermole and the Putting People First
team for supporting and funding this document.
In Control Support Centre
Carillon House Most of all, thank you to all the individuals and
Chapel Lane families who shared their personal stories with
Wythall us, including the challenges and achievements.
West Midlands, Your help has provided the basis for this report
B47 6JX and provided us with invaluable information
about developing SDS in the borough.
Telephone: In Control Support Line:
If you would like more information about SDS
0156 482 1650 Fax: 0156 482 4260 or want to know how you can get involved
please call 0208 831 6436 or email anthony.
zysemil@richmond.gov.uk