Decided after years of trying to persuade others to do ‘it right’ for people time to bite the bullet and have a go Doreen had run a person-centred organisation but wanted to work out how to transfer the ‘model’ to other organisations.
A registered domiciliary Care Organisation Service Design then mini tender for long term support Working Policy with Beyond Limits or coaching other Organisations to implement the detail and reshape the way they provide support
The Service Models Jim Mansell recommends underpin the project
Home, Good Support, Money, Direction, Contribution, Authority – Rights and Duties – Simon Duffy Services with the person with power and in control and a life that makes sense to them
But on the person’s own terms Often torn away from home, family, connections and communities where they were known and valued
Resilience – keeps families fighting, keeps people fighting. These are what we need to have a good life.
Family members, neighbours, taxi driver, advocates, friends, professionals, support workers People who knew them before systems kicked in Got to see the strengths, gifts and skills – the potential and the way forward Meet in a place comfortable for the person – more likely to contribute For every person so far we have been told they won’t contribute, they won’t be able to stay the full day, - for every person they have because it is a positive day about them and about a positive future.
Examples Person 1. 2:1 24/7 support reduced to 1:1 73 hours. She now she spends some time on her own early evening and first thing in the morning. Her service costs have reduced from £211,000 per annum to £85,000 per annum. Person 2. reduced from 1:! 24/7 reduced to 40 hours per week with an on-call service for emergencies. In just over 2 years his service reduced from £109,000 to £71,000
What people had in their lives, how they were in different situations, what experiences they had good and bad, what support worked and didn’t. Authority – how will they remain in control of life, what support is required with communication, is representation required Direction – persons desires, hopes and dreams, how can we support them to reach their goals Money – what money is available Home – what kind of house, where does it make sense to live, sharing or alone, equipment AT adaptations. Support – what kind of support, how often and when is it needed, what kind of person Contribution – how will the person live, what relationships need to be maintained or strengthened, what interests, job do they want, how can they contribute to their community Concentrating on the positives – starting from the positive not the negative behaviours.
What has worked in the past Lost hopes and dreams Things people used to be good at and liked to do Support that didn’t work in the past Routines are often made to fit the staff, building and others in Hospital (cigarettes breaks, meals, getting up and going to bed) What they do in Hospital is often ‘service-land led’ or things that they would do everyday that is labelled ‘activities’ and lots of groups.
This then becomes your job ads and job specifications.
Really detailed planning including especially what to do when someone is having a hard time. Looking at what has worked in the past and working with current provider to drill down into recent situations. This usually gives us big clues to what is going wrong!
Nd ti presentation-2012-sam-sly
Sam SlyBeyond Limits (Plymouth)
Social Worker for people with learning disabilities and mental health needs CSCI (CQC) Change Team Cornwall (changing housing and support that had gone badly wrong) Cornwall PCT continued to improve quality Bournemouth Campus re-provision United Response improving quality Developed ‘Hands Off Its My Home – a path to Citizenship’ Director for Beyond Limits with Doreen Kelly Columnist for Learning Disability Today
3 year project with NHS Plymouth Personalising Commissioning Using Individual Service Funds Using Service Design & Working Policy 20 people currently in Hospital placements 20 people with big reputations 20 people who will get a tailor made service 20 people who will get a life that makes sense to them
‘People often end up in expensive out of areaplacements because local systems have not theflexibility to develop suitable personalised responses.This leads to people being over-supported and cut offfrom their own communities. There are currently10,000 people with mental health problems supportedin out of area placements and research suggests atleast 5,000 of these are without significant clinicaljustification. The use of individual budgets as part ofintentional programme to bring people back to theirown communities with personalised support could save£100 million a year.Vidhya Alkeson & Simon Duffy ‘Health Efficiencies - the possible impact ofpersonalisation in Healthcare ‘ 2011
Individualised, local solutions providing good quality of life not those too large to provide individualised support, too far from their homes, and providing good quality of life in the home and as part of the local community. Direct payments and individual budgets should always be considered and be more widely available. Closer co-ordination between the commissioners paying for services, the managers providing services and the professional specialist advising on the support people need to ensure advice is both practicable and acted on. Commissioners should allocate a budget to be used to fund a much wider variety of interventions as an alternative to placement in a special unit.Jim Mansell ‘Services for people with learning disabilities and challenging behaviour or mental health needs’ 2007
All have been abused Have moved between 6-25 Institutions Youngest 26 Oldest 56 First admission to an Institution aged 14-22 All on MHA Section for between 5-14 years Most have moved to more and more secure accommodation as they have fought the system All families have felt loss of control, marginalised and physically unable to stay in touch All people have the same hopes and dreams as all of us
Key 6 – Giving something back (Community Life) What needs to be achieved? It is by giving back to our community that we can help other people understand our worth. This means working, learning and enjoying leisure pursuits with other fellow citizens whilst making friends along the way. Why is it important? To overcome prejudice To make a contribution to the community To make relationships and friendshipsSimon Duffy (2006) Keys to Citizenship
The resources to enable people with learning disabilities to achieve a good life. Strengths – skills, gifts and abilities Connections (relationships) – family, friends, community networks and organisations Community (Access) – information, emotional and physical support Control (Assets) – income, property, savings, benefitsPippa Murray, Simon Duffy, Nic Crosby (2008)
Service Design (Partners for Inclusion/Beyond Limits)‘Every service is designed, from scratch, with only the person in mind, and modified in the light of experience and as things change. Individual service design in rooted in the organisation’s commitment to help everyone achieve citizenship for themselves’.Personalised Support – Julia Fitzpatrick (2010) Published by the Centre for Welfare Reform
A good facilitatorThe personFamily andsignificant people intheir lifePeople who knowand care about thepersonPeople with strongrelationship withperson
Planning and pre- move transition is funded (one off payment clawed back through reductions from years 2 onward) Post move transition is funded On-going budget flexible in first year Greatest reductions after year two and three
Take time getting to know person and significant others In a comfortable environment Telling their story Being in control Direction Money Home Support Contribution (Giving something back)
What does the person do with their time now (routines)? What should we keep doing? What should stop happening? What should they start doing? What should we start doing?
What hours of paid support do they need? What will happen in those hours? What support could help the person become more independent or develop more natural support? What do we need to do to keep them and others safe? (risk mapping and enabling is a natural by- product of service design)
Who worked well in the past and who didn’t and why? What kind of person – quiet, busy and lively? What knowledge, skills and experience? What contracts are needed? Leadership skills needed? What hobbies interests should they have? Man or woman? Age?
Being seen as a fellow citizen by others Controlled by the person Provided by who you choose Enables you to do what you want and does not control what you do Invisible Simon Duffy (2006)
It enhances the person’s dignity and respect in the community It helps the person be present in the community It helps the person participate in community life It helps the person develop and learn new skills It gives the person choice and control
Many great plans are made and fall down because they are not followed up by a detailed ‘how to’ bit. It is fundamentally important that once a service is designed a ‘how to’ plan is written. Partners for Inclusion and Beyond Limits call this a Working Policy. Involves the person (if they wish), present and past professionals and family
Aged 28 25 different placements furthest was 349 miles away from home Went through Criminal Justice System Sectioned for 6 years Physical Intervention from aged 17 Family seen as a problem She was seen as a big problem Always wanted to come home to be part of family
Part of the family (highs and lows!) Has own home Interviews for her team Health problems stable Been to Bristol to visit friends twice Tickets for Peter Andre! Ice skating lessons Been Clubbing twice (first times in 11 years!) Says she never wants to go back to Hospital
Hospital doesn’t work long or medium term Being away from family and community is destructive Planning for a normal life has to start from day one Matching teams makes the difference Individual flexible budgets Cultural change is required People want lives
Hospitals Hostels and Campuses Residential Care Homes Don’t let ‘supported living’ be the next institutions People want to live in their own homes just like you and me
Sam Sly Beyond Limits email@example.com@enoughisenough.org.uk 07900 424144 www.beyondlimits-uk.org