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Surviving or Thriving in a Consumer Directed World - Governing and Leading Organisational Change in Social Care
The document discusses the challenges and opportunities of personalisation in social care within a consumer-directed framework, emphasizing the importance of co-production and the voices of service users and carers. It outlines the shifting policy landscape, the role of organisational leadership, and the need for strategic planning to navigate funding and operational changes. Furthermore, it highlights the necessity of reflective practices and engaging all stakeholders to foster adaptable and person-centred care services.
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Surviving or Thriving in a Consumer Directed World - Governing and Leading Organisational Change in Social Care
- 1. Surviving or Thrivingin a Consumer Directed World? – Governing and Leading Organisational Change Shaping Our Future National Respite and Community Care Conference, 23 October 2014, Sydney Director Carrie Hayter Consulting 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 1
- 2. 22/10/2014 Surviving orThriving in a Consumer Directed World? © Carrie Hayter Consulting 2
- 3. Workshop Outline •Personalisation of Social Care – Narratives and Research – Perspectives of different stakeholders and actors • Challenges – Chief Executive Officers, Managers and Boards – Questions for the future • Opportunities – Creating Personalising Services – Co-production or Co-design – Service User Organisations 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 3
- 4. About Carrie HayterConsulting • Personalised Support 22/10/2014 – Translation Research and Evaluation – A Handbook for community care services , Empowering People, enhancing independence, enriching lives with Alt Beatty Consulting for NSW Government – Education, Coaching and Mentoring – Person Centred Practice and Thinking (managers and support workers) – Cultural Diversity and Cultural Competence – Ageing and Sexuality (managers & front line workers) – Consumer Directed Care (Managers and Support Workers) – Living Life my Way (Service Users) – Strategic Planning Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 4
- 5. 22/10/2014 Surviving orThriving in a Consumer Directed World? © Carrie Hayter Consulting 5 What is a personalised service ?
- 6. Source: downloaded fromhttp://lwdp.org.uk/more_info.asp?current_id=296 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 6
- 7. Shifting Policy Landscape– Personalisation Passive Clients Active Service Users Block funding Individualised funding Rigid large inflexible, bureaucratic services Flexible responsive services 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 7
- 8. The rise ofthe ‘Consumer’ Consumer as Purchaser Client Citizen – Citizen Social and Economic political rights purchasing power Relationship between client and professional Consumer Active or passive subjects? Mechanisms for enacting ‘choice’ and ‘voice’ Market mechanisms via competition (LeGrand, 2007) Managing self interest (LeGrand, 2007) and voice mechanisms Enable ‘choice’ through ‘voice’ mechanisms (Simmons et al 2011) Diversity of policy mechanisms 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 8
- 9. Personalisation Narratives •Personalisation works, transforming people’s lives for the better. • Personalisation saves money. • Person- centred approaches reflect the way that people live their lives. • Personalisation is applicable to everyone. • People are the experts in their own lives (Needham, 2011: pg 7). 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 9
- 10. The Lucky Ones Source: downloaded from https://au.tv.yahoo.com/x-factor/# Surviving or Thriving in a Consumer 22/10/2014 page1/? _s_ref=9JI102jjS&Directed World? kw=x%© Carrie 20factor&creative=55215366484 10 Hayter Consulting
- 11. FEAR 22/10/2014 Survivingor Thriving in a Consumer Directed World? © Carrie Hayter Consulting 11
- 12. Personalisation for Organisations 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 12
- 13. What are thethree things about personalisation that wake you up in the middle of the night? 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 13
- 14. 22/10/2014 Surviving orThriving in a Consumer Directed World? © Carrie Hayter Consulting 14
- 15. Surviving or Thrivingin a Consumer 22/10/2014 15 Directed World? © Carrie Hayter Consulting
- 16. Transition Challenges •Block funded and individualised funded operating in parallel universes • How does our organisation navigate these two systems? – Can block funded services become more personalised? – Does a personalised budget mean personalised support? – How do we manage the self interest of staff? 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 16
- 17. How can wemake block funded services more personalised ? 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 17
- 18. Personalisation and Carers • Formal care system would not exist without informal carers • Access to personalised budgets – Conservatism of carers and the risks of personalisation (Needham, 2011) – The traditional model gives them security and comfort • Choice and comfort for service users may not necessarily bring choice and comfort for carers • Voices of carers not being recognised and heard (Carers NSW, 2014) • Mainstreaming of carer support funding – Access to appropriate support? – Planned and regular breaks 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 18
- 19. Hearing Carers’ andService Users’ Voices • Voice – Having more say in services and getting access to support – Individual or collective voice (Simmons et al, 2011) – Voice can go beyond the confines of choice • Relationships • Connections (Simmons et al, 2011) – Exit (Hirschman, 1970) • Voice mechanisms – Complaints – Surveys – Political activity through voting or lobbying – Participation in representative bodies or groups (Simmons et al, 2011) – Creating engagement frameworks and structures 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 19
- 20. Challenges for Organisations • Strategic Questions – How will we exist in the future? – What will our organisation look like? – How will we operate in a changing market of care? • Supporting Staff and Volunteers – Skills and Roles • Engaging the people who use services 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 20
- 21. Commissioning Services •Shaping services to meet service users interests and preferences – What if people want to keep attending group based programs? • Commissioning is a multi-agency function – Partnerships • Commissioning by service users – Co-operative Models 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 21
- 22. Financial Challenges •Individualised Budgets – Are the rates for units set by the NDIS going to cover all the costs? – Do we set our costs at this rate? – How do we monitor these costs? • Micro- Financing – What should the individualised budget pay for and what should be paid for by the service user? 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 22
- 23. Workforce Challenges •De-skilling of workforce (Cortis et al, 2013) –Exploitation of workforce • What skill sets do our workforce need in this changing space? • Managing Change –Education and reflective practice 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 23
- 24. Visionary Leadership CreatingShared Values and Beliefs Outcomes for individuals Community Focus Empowered and Valued staff Individual and Organisational Learning Partnerships Source:Williams and Sanderson (2005) 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 24
- 25. Personalisation – Opportunities • Co-production or Co-design • Working with people for planning and designing or co-producing services – Challenging how staff work and governance structures – http://www.ndti.org.uk/uploads/files/Personalisation_- _dont_just_do_it_coproduce_it.pd – http://homecaretoday.org.au/ • What does our organisation do well? – Marketing – Front-line staff selling your services – Management supporting front-line workers • Exiting the market – Managing transitions 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 25
- 26. People Leading theWay Village to Village Network Boston Beacon Hill Village • Grass roots movement created by older for older people • Member based http://www.beaconhillvillage.org Village to Village Network http://www.vtvnetwork.org/ • Australia -Waverton http://wavertonhub.com.au/ My Choice Matters • Ideas and resources for people to have more voice, choice and control • Run my projects • Become a leader http://www.mychoicematters. org.au/ • Community Disability Alliance Hunter – Planning Cafes Surviving or Thriving in a Consumer 22/10/2014 26 Directed World? © Carrie Hayter Consulting
- 27. Personalisation – Opportunitiesfor Boards • What skills do we have on our board? – What skills do we need on our board in the future? – How can we attract new board members? • How can we engage our boards in the change process? – How do we connect with service users and involved them in strategic planning? 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 27
- 28. Reflective Practice –What have you tried? – What have you learned? – What are you pleased about? – What are you concerned about? – What do you need to do next? 28 Source: Adapted from Helen Sandersonson and Associates http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/person-centred-thinking-tools.aspx 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting
- 29. Support for Organisations • NDS consultancy services – http://www.nds.org.au/ news/article/2745 • NDIS Pricing for Payment and Supports – Costings http://www.ndis.gov.au/ providers-5 • Home Care Today http://homecaretoday.org. au/ Education resources, information and audit tools • Benchmarking • http://www.nfpbenchmarki ng.com.au/ 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 29
- 30. Conclusion • Changingcultures of organisations – Start the conversation now – Strengths, Weaknesses, Opportunities Threats – Engage all stakeholders – Get support with the process and systems • Reflective Practice – Learning and reflecting on what we do 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 30
- 31. References Cortis, N.,Meagher, G., Chan, S., Davidson, B., & Fattore, T. (2013). Building an Industry of Choice: Service Quality, Workforce Capacity and Consumer-Centred Funding in Disability Care. Sydney Social Policy Research Centre Carers NSW. (2014). The NDIS One Year In - Experiences of the Carers in the Hunter trial Site Sydney Carers NSW Glendinning, C. (2008). Increasing Choice and Control for Older and Disabled People: A Critical Review of New Developments in England. Social Policy and Administration, 42(5), 451-469. doi: 10.1111/j.1467-9515.2008.00617.x Hirschman, A. (Ed.). (1970). Exit, Voice and Loyalty Responses to the Decline in Firms, Organisations and States Cambridge Massachusetts: Harvard University Press Le Grand, J. (2007). Choice and Competition In J. Le Grand (Ed.), Delivering Public Services through Choice and Competition - The Other Invisible Hand (pp. 38-62). New Jersey: Princeton University Press. 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 31
- 32. References Needham, C.(2011). Personalising Public Services Understanding the Personalisation Narrative Bristol, UK Policy Press Simmons, R. (2011). Leadership and Listening: The Reception of User Voice in Today's Public Services. Social Policy & Administration, 45(5), 539-568. doi: 10.1111/j.1467-9515.2011.00790.x Moran, N., Glendinning, C., Wilberforce, M., Stevens, M., Nettens, N., Jones, K., Manthorpe, J., Knapp, M., Fernandez, J., Challis, D., & Jacobs, S. (2013) Older people’s experience of cash-for-care schemes: evidence from the English Individual Budget pilot projects, Ageing and Society 33, pp 826-851 Needham, C. (2011). Personalising Public Services Understanding the Personalisation Narrative Bristol, UK Policy Press Simmons, R. (2011). Leadership and Listening: The Reception of User Voice in Today's Public Services. Social Policy & Administration, 45(5), 539-568. doi: 10.1111/j.1467-9515.2011.00790.x Simmons, R., Birchall, J., & Prout, A. (2011). User Involvement in Public Services: ‘Choice about Voice’. Public Policy and Administration, 27(1), 3-29. doi: 10.1177/0952076710384903 Williams, R., & Sanderson, H., (2005) What are we learning about person centred organisations?, downloaded from Home Care today www.homecaretoday.org.au 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 32
- 33. More Information CarrieHayter Email: Carriehayter@gmail.com Twitter@carriehayter Slideshare: Carrie Hayter Linked in http://au.linkedin.com/pub/carrie-hayter/ 34/536/517/ 22/10/2014 Surviving or Thriving in a Consumer Directed World? © Carrie Hayter Consulting 33
Editor's Notes
- #2 I would like to acknowledge the traditional owners of the land and pay my respects to elders past and present. I would like to thank the National Respite Association for the opportunity to present this paper and workshop. This workshop is based on the work I have undertaken in my consulting work in both the disability services, aged care and carer support service spaces over the last 10 years. In this work I have had the privledge of working alongside small, medium and large organisations , their staff and volunteers to transform them from being service centric to focusing on service users. As part of this journey I have also been privledged in working with service users including older people, people with disabilities and their carers and learnt many things from people I have worked alongside. It also based on research work that I completed as part of a PhD project which is currently being turned into a Personalisation in Practice book. In my research I explored some of the emergence of the rights of older people and some of the inherent tensions in the personalising of support for older people and their carers. This presentation is on slideshare www.slideshare
- #3 The policy landscape in social care including people with disabilities, older people and carer is changing. The campaigning and lobbying by people with disabilities and their allies through grassroots stories and the roll out of the NDIS is a significant reform. We are seeing the dismantling of block funding to a shift to highly individualised and personalised funding models. Similar trends are emerging in supports for older people and their allies. While in aged care we don’t have self-directed budgets we are seeing the mainstreaming of consumer directed care in packaged care programs. For carers there are individualised budget models developing, however, we are also seem some debates about whether the interests, perspectives and voices of carers are being recognised and reflected in the funding. Some say this is part of people exercising their rights as citizens and having informed choice and control. Others argue that it is driven by economic rights and people becoming customers. The policy narrative is evolving and shifting in this space
- #4 In this workshop I am going to explore what personalisation means for leaders of organisations and their boards. The external policy landscape for both carers, older people and people with disabilities is changing. We are going through a period of extroardinary change and transformation as part of personalising care and support for older people, people with disabilities and their carers. As part of these changes there are both challenges and opportunities for leaders, managers, chief executive officers and organisations. There are also significant
- #5 I have worked in the human services sector primarily in the ageing and disability service sectors for over 25 years. I have degrees in social work and economics. During this time I have worked at the front-line as a case manager, managed support staff, worked in the NSW Government in policy and funding of disability service programs, worked in the advocacy sector for people with disabilities, worked in the UK for 4 years for local service departments, for an aged care industry body. For the last 9 years I have run a consulting and training business that supports stakeholders to move to a more personalised world of social care. I do this through research, evaluation, training and education, strategic planning and mentoring. In that time I have worked with small, medium and large organisations including government and non-government agencies in both the disability services and aged care sector.
- #7 Personalisation is a contested term. It means different things to different people and actors. However, within these debates there some agreements. Needham (2011) for example argues that personalisation is “public service delivery mechanisms that aim to modify the service to meet the specific circumstances facing individual users. Such mechanisms could include individual budgets, personalised assessment mechanisms and new forms of conditionality. She contends that personalisation in social care encompasses a broad agenda of approaches that come under the banner of person centred planning and self directed support (pg 31). Two of the central themes of personalisation are choice and control for service users and trying to design service systems that move away from being service centric to focusing on the users of services.
- #8 There are significant changes happening in the policy landscape in age care and disability policy in Australia as part of the agenda of personalisation. The assumptions that underpin these shifts include the changing role of people who use public services shifting from being ‘passive’ clients to ‘active consumers’. It is assumed that people who use disability services or aged care services will become active ‘consumers’. Rather than being passive clients relying on professionals for support and advice people are assumed to be active engaged ‘consumers’ who will make informed choices about their care. Flowing from this assumption is the need for changes in the how agencies are funded from block funded to individually funded. It is assumed that individualised funding will provide more mechanisms for service users to get their needs met. We are seeing this funding system emerging as part of the launch sites of the NDIS as well as the emergence of the concept of ‘consumer directed care’ in packaged care in aged care in Australia. As part of this changing landscape there are significant challenges for small, medium to large organisations in being able to thrive and survive in this changing landscape? As well as considering the structures that are in place to enable the participation and engagement of service users in your service.
- #9 The ‘consumer’ or service user has become a central figure in the implementation of personalisation through the concepts of choice and voice. The positioning of the service user can be placed on a spectrum with different language to describe people who use services and the mechanisms used to promote ‘choice’ and control or hearing the ‘voice’ of older people For those who argue that people who use public services are ‘consumers’ then they favour the creation of markets through the introduction of competition to drive efficiency and effectiveness and services to be more responsive to the needs of consumers. In this economic framework there is also the possibility of co-production where purchasers and producers co-produce outcomes for the interests of service users For those that describe people who use public services as clients. The policy mechanisms are about managing the perceived self interest of the bureaucracy and challenging the paternalism of the welfare state. This can be achieved through competition and the creation of markets but also through voice mechanisms For those who conceptualise service users as citizens the focus moves away from purchasing power to notions of social and political rights and for people to have choice about the voice mechanisms that are introduced. There is also the hybrid citizen –consumer whose relationship with public services can change over time. People can be both active and passive subjects and there needs to be a diversity of policy mechanisms not just those that shift the user of public services to be a ‘consumer’.
- #10 People have described some of the challenges of what personalisation means for their organisations some of which are on the spectrum of the lucky country to fear and somewhere in between. Needham (2011) who has researched the narratives that have influenced policy debates in the personalisation of social care in the UK contends that are five key narratives that have emerged as part of the policy landscape in the UK. These include the following: Personalisation works , transforming people’s lives for the better Personalisation saves money Person – centred approaches reflect the way that people live their lives Personalisation is applicable to everyone People are the experts in their own lives One of the interesting things is that we are seeing these narratives emerging in debates in Australia particularly with the actual implementation of the NDIS which had a much more grass roots campaign. For older people it appears that it has been more driven by professionals and some advocacy groups rather than older people themselves. These narratives can influence how organisations think about personalisation and what it means in your organisation. Some people and organisations will see the possibilities of personalisation but others are fearful.
- #11 We can see these narratives being played out in Australia. Last week I was watching the final of the X factor – it helps me relax and calm my brain. I watched the single of the group Brothers 3 – the Lucky Ones. This was exactly as I was writing this conference paper and thought this could be the theme song of some organisations in how they have embraced the changing landscape through personalisation. For service users this could be a narrative of we are lucky, we can manage our own money. As one service user said to me, a man in his late 50s who had a spinal injury through work – After 17 years I am actually being asked what I want. We are seeing service users both older people and people with disabilities creating organisations and structures so they can lead projects and changes. For some staff they are embracing this changes to work in a different way and to actually be flexible and responsive. As one Aboriginal worker said to me “so you mean that know I am actually encouraged to break the rules, after all these years of breaking the rules and just not telling management”. Some social workers have said to me Hellalujah…. you mean I can actually implement the Social Work Code of Practice…. Thank godness for this. For some Chief Executive Officers and their boards they have surveyed the landscape and are seeing the opportunities. One organisation that I have worked with transformed a traditional group funded model of day programs to individualised programs of support. People are talking about their lives and what they need to have a good life which is supported by how the organisation structures their funding. The Chief Executive Officer and Board members talk about wanting to see people grow and thrive and to say “I like who I am and I like what I do”. This culture has filtered to support workers who talk about people in terms of their passions and their dreams. One thing he did say to me was the reason they were able to transform the organisation was because it is a small to medium organisation which meant that leading change was not as complex if they had been a large organisation. I have also seen stories from front-line workers in large organisations who are frustrated by the inertia in their organisations and that the systems and processes of management. While front-line workers and want to embrace the lucky one’s culture but are not supported by management or the strategic vision and mission of the Chief Executive Officer and the board.
- #12 For others including some service users, carers and providers it is fear. It is fear about moving from a block funded model to individualised funding. What does this mean for my son, daughter, father and mother. For staff, it may mean what does this mean for my work? Will I have a job? As one support worker said to me in a workshop – if I encourage older people to be independent then I wont have a job? If people do more for themselves then I may not have as much work as I like. For case managers or support facilitators many like to be the professional and ‘tell people how to live their lives”. As one allied health professional said to me “the allied health people come together and do the planning before we meet the person”. When I asked do people actually implement their plan if they are not involved in the decision making, she looked at me and said “my plans always work”. For Chief Executive Officers who are leading this transition it can be a stressful time. There are risks in terms of funding, how will we exist in the future. This can be impacted by a board who are either disengaged or see the new world as the Lucky Ones with no sense of how to manage and identify the risks. The Chief Executive Officer comes out of board meetings either dispairing or going home and waking up in the middle of night and thinking about the challenges ahead. One of the things that people say why they cannot change is because of funding, time and it is all too hard so we will just let government drive the agenda. However, as leaders of organisations it is important to start different conversations in your organisations. The conversations may shift people’s thinking of what is possible.
- #13 So we can see from our brief discussion that there are many areas of opportunities for agencies working with people and carers. This includes Governance, Service Improvement, leadership, Learning, Development and Research
- #15 Some have described the changes occurring as like trying to turn the Titanic around. The titanic was indestructible, however, no-one planned for it to hit an ice berg. Part of preparing for the external policy drivers is thinking about planning for the future and what are the contingencies if your organisation that you lead is hit by an ice-berg. Some leaders have started to change and rebuild the titanic and implement changes in a staged process. For small to medium organisations this may be easier because it does not require such efforts to dismantle the ship and turn it around. Personalisation represents a significant change process for all stakeholders
- #16 One of the challenges of personalisation is to appreciate and understand the historical forces or structures that have created the different service systems in this country. If you look at history we have come a long way, however, we are in the process of dismantling a whole service infrastructure and moving from a block funded to individualised funding system with different stages occurring for older people, people with disabilities and their carers. This picture shows some of the drivers of personalisation for older people in Australia. It contends that for older people they were largely invisible and the system was created in the interests of professionals, providers and with older people institutionalised. However, with the economic costs of ageing combined with the changing expectations and the emergence of the concept of active ageing we are seeing changing models. However, moving from the Old to New system takes time is a complex process of dismantling and transitioning not only funding but the practices, values of people in your organisations. It also requires people to lead organisations through significant changes
- #17 Currently in the different support streams for carers we have a mix of block and individualised funding . For example with the NDIS
- #20 Given the risks of mechanisms promoting choice then perhaps it is about focusing on voice. What does voice mean? Simmons argues that voice is about ‘giving users a more effective say in the direction of services, by means of representative bodies, complaints mechanisms and surveys of individual preferences. According to Hirschman it can also be about exit whereby people choose to exit a service because they are dissatisfied. This, however, is tricky in aged care because there is often nowhere else for people to exit. Voice can also have a political focus through expressing wishes and preferences through voting or participation in political parties or representative bodies. Simmons argues that voice can go beyond the confines of choice because it allows people to express their preferences or feelings about a particular issue. This can also be undertaken as part of the membership of a group which can increase the impact on political processes and outcomes. Rather than being a consumer who expresses their individual preferences in the market, people can express their preferences through relationships with other people, providers and groups. It concept of voice and the mechanisms to promote voice are therefore often aligned with the concept of citizenship.
- #21 There are strategic questions for boards and leaders of organisations. Can we survive in this changing space? What will our organisation look like? How will we operate in a changing market of care?
- #25 Perhaps the answers for front-line managers, middle management and chief executive officers is striving for person centred management. . The elements of this are Visionary Leadership, by being clear about the direction of the organisation, motivating people and aligning the direction with actual implementation. All these areas are important, however, one area I think that agencies could improve is for management to get behind the front-line staff. They are your most important asset the markets what your service does.
- #27 As part of these changes there are examples of communities and service users coming together to create structures to support them through this transformation process. For older people there is a self help movement through the Village to Village network which encourages people living in local communities to create their own organisations. Originating in Boston, older people are coming together to create their own structures, the organisations are member based and designed to connect older people to age well in their community. These models have been expanded for all members of the community. For example the Waverton Hub one of the first examples in Australia . It could be accessing a range of activities in the local community.
- #34 Thanks and