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
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!
Introducing Beyond Limits
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
Not a flexible enough provider market Good planning doesn’t happen People are not listened to and understood We don’t share risk (professionals, person, family and provider) We (professionals) think we know best Its an easy option Systems for commissioning support are too rigid and look at short term savings
‘People often end up in expensive out of area placementsbecause local systems have not the flexibility to developsuitable personalised responses. This leads to people beingover-supported and cut off from their own communities.There are currently 10,000 people with mental healthproblems supported in out of area placements and researchsuggests at least 5,000 of these are without significantclinical justification. The use of individual budgets as partof intentional programme to bring people back to their owncommunities with personalised support could save £100million a year.Vidhya Alkeson & Simon Duffy ‘Health Efficiencies - thepossible impact of personalisation in Healthcare ‘ 2011
Good planning (we usually know who is at risk from childhood) Services tailor-made for the person People given Budgets, power and control Providers treated as partners and not held at arms-length Intuitive Commissioning Community connection and contribution seen as a must Working in partnership with families
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
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? (safety 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/Cardiff to visit friends twice Tickets for Peter Andre! Ice skating lessons Been Clubbing loads (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 of admission 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