Transforming lives and budgets - the Southwark Experience

• Charity and company limited by guarantee, established in 1984 • Work with people with learning disabilities, mental health problems, physical disability, autism, Asperger's syndrome, homeless • Turnover £40 million • Employs 1600 staff (approx.) • Support 1000 people • Operate in Wakefield, Mansfield, Oldham, Stockport, Congleton, Nottinghamshire, Bedfordshire, Milton Keynes, Buckinghamshire, Bracknell, Hampshire, Portsmouth, 9 London boroughs

Southwark 2010-15
“Choice Support were pushing at an open door when they suggested an Individual Service Fund approach for transforming their services in Southwark”……Chris Dorey, Commissioning Manager, Southwark Council • 152 people supported • 66 registered care, 32 supported living, 54 outreach support • Block contract - £6.5 million – 83 people

Summary of key achievements
• The old block contract has been converted to 83 ISFs with 83 personalised support plans created. • ‘Waking-nights’ have been removed from 11 services (29 people) making Southwark ‘waking-night’ free. • Increased use of Assistive Technology. • 18 care homes are de-registered. • Phased closure of a former PCT campus-like site has begun. • A Shared Lives service has been established. • Local authority offered a £1,795,073 reduction in price on a £6.5 million contract (29.75%)

Savings
FINANCIAL YEAR 2010-11 2011-12 2012-13 2012-14 2014-15 PER ANNUM £324,250 £310,750 £260,314 £250,041 £649,718 CUMULATIVE £324,250 £635,000 £895,314 £1,145,355 £1,795,073

How savings were achieved (i)

The key savings agreed included reducing: • the direct cost of hourly support rate • local and central overheads to 15% of ISFs • provision of support based on person centred plans (PCPs).

How savings were achieved (ii)

• deregistering existing homes • reducing the cost of each support hour i.e. changes in existing staff terms & conditions and management restructure • reducing direct support hours, including waking nights and increased use of Assistive Technology (AT) • reducing overheads and closure of the local office

Research and evaluation

Feeling Settled, NDTi (2011)

ISFs in Action: Personalising Block Contracts, CfWR (2012)
http://www.centreforwelfarereform.org/

Evaluation of Change from ‘Waking Nights’ to ‘Sleep in’ Night Support, Social & Health Evaluation Unit Bucks New University (2012)

Replacing waking nights
Research by Social & Health Evaluation Unit Bucks New University identified three key benefits

• Outcome 1:
• Outcome 2: • Outcome 3:

Cost reduction
Safety maintained Quality enhanced

Replacing waking night staff Outcome 1: Cost reduction
FINANCIAL YEAR COST OF NIGHT SUPPORT PER ANNUM £384,506 CUMULATIVE SAVING

2010-11

2010-12

£159,717

£224,789

2012-13

£127,604

£256,902

Replacing waking night staff Outcome 2: Safety maintenance

Three issues were identified as involving potential risks • The first was people having seizures and whether they would be detected and managed without regular observation. • The second was urinary incontinence and whether people would experience undetected discomfort. • The third was nocturnal activity and whether people might harm themselves or others. The research concluded that the change was well managed, risks were well assessed and that safety was maintained after the removal of waking night staff

Replacing waking night staff Outcome 3: Quality enhancement (i)

• Utility bills are cheaper because lights and electrical appliances are not working at night. • Cost in regards to each person’s ISF (individual service fund) is less for the individual. • People are more settled generally with a better sleep pattern. • There aren’t so many handovers which distracts staff members and is invasive. • There is more consistency of support due to new shift patterns

Replacing waking night staff - Outcome 3: Quality enhancement (ii)

• Everyone goes to sleep at the same time. • Staff have become more trusting of peoples’ abilities. People have more privacy and autonomy • There is no longer confusion around day or night. There is an end and a beginning to the day in regards to staffing so now people don’t seek to engage at night and sleep better therefore they are more productive and calm during the day. • A number of people have just developed the skills and confidence to go and do what they want to without support

Key success factors
• Public commitment by Southwark Council and Choice Support to work closely together and build relationship based on real trust. • A dedicated senior and experienced manager. • A simple process for the creation of ISFs • Council delegating assessment process to Choice Support. • Research and evaluation: external validation and scrutiny – NDTi, Centre for Welfare Reform, Social & Health Evaluation Unit Bucks New University.

Working with Choice Support

Chris Dorey Disabilities Commissioning Manager
www.southwark.gov.uk

Some Information about Southwark
• • • • • Population 287,000 10th smallest borough by area 3rd most densely populated 47% public sector housing 10th most deprived borough in London • 41st most deprived borough in England • 11% unemployment

Some Further Information..
• Diverse population • 75% school population from BME • 100+ languages spoken in schools • 3 MPs • Labour controlled

Money
Comprehensive Spending Review 2011-2014:

29%↓ Reduction in council’s funding
25%↓ 18%↓ 50% ↓ Savings from Adult Social Care Savings from Learning Disabilities Savings from Supporting People

Learning Disabilities Context
• 1385 Adults with severe/moderate learning disabilities known to council • £27.75m budget • Good spread of traditional services • Providers are mainly from voluntary sector • Strong on partnership working • Slow start to personalisation

Learning Disabilities Context
• Shifting the Balance project to move from a care model to an ordinary housing and personalised support model: • Deregistration programme • Decommissioning of block contracts • New services • Review of all out of borough placements • Better links with Housing & Regeneration • Change in social work practice

Learning Disabilities Context
Progress to date:
58% reduction in number of people living in care homes 2009
Spend on LD Residential & Nursing Home Care No. of PWLD living in Settled Accommodation

since

Year

2009/10 2010/11 2011/12 2012/13 (Projected)

£26.630m £20.907m £18.017m £16.857m

190 320 364 385

Work with Choice Support
Why? • Simple approach to ending complex block contract • Savings • Pathway to ordinary housing model • Personal budgets & better outcomes • Separation of housing from support

Work with Choice Support
How: • Trusted Choice Support with support planning and resource allocation • Choice Support accepted challenge & risk of major service/business change • Transitional funding to give time for service change & to maintain stability • Trust & respect

Work with Choice Support
Lessons: • Start looking forward, not back • Simple rules, but attention to detail • When stuck, go back to simple rules • You need good financial support • Structural change only- check outcomes/quality – e.g. Hearts & minds and NDTi tenancy test • New person centred commissioning approach • Keep Going!