A presentation with TLAP's Martin Walker talking about ISFs and then I introduced Wellbeing Teams and why CQC describe them as a new model of care

1. Commissioning -
The need for a different
approach

2. Where we should be going
Commissioning for better outcomes – and an integrated version coming soon
• Person and community centred approaches and a shift in focus from deficits to
strengths
• Three P’s
• People
• Places
• Populations
• Co-production – rebalancing power towards communities and citizens
• Choice and control
• Shift from wholesale to retail market – macro to micro wherever possible
• From anticipating market failure to facilitating thriving high quality market
• From services to personalised support solutions
• Reducing demand on statutory services and helping self funders

3. Rhetoric versus Reality
• Experience of process
• Experience of support
• Better lives, better outcomes?

4. One promising, under used option that could
transform commissioning

5. Individual Service Funds
Q. What are they? A. One of the ways a person
can take a Personal Budget under the Care Act
2014
11.30 There are 3 main ways in which a personal budget can be
deployed:
• as a managed account held by the local authority with
support provided in line with the persons wishes
• as a managed account held by a third party (often called an
individual service fund or ISF) with support provided in line
with the persons wishes
• as a direct payment

6. • Provided under contract
Contract in place between provider and statutory
organisation
• Flexible Support
Provider works with individual on an on-going basis to decide
how best to provide care and support
• Provider managed fund
Provider sets up individual accounting lines for each person
they support and agrees and records spend with and for
them
Individual Service Funds

7. Implications
• Contracting
– Need appropriate form
• Assessment and care planning
– Shift to high level outcomes as output of assessment
• Procurement
– Provider may ‘broker’ care and support they don’t
provide
• Provider
– Accounting systems
– Recruitment

8. • Control
• Simplicity
• Efficiency
• Satisfaction
• Improved outcomes and wellbeing
Benefits

9. Co-production is the key
• Sharing power in an equal relationship
• Having good conversations
• People, not process
• Support not services – better lives
• Its not easy!
• But its not rocket science and its do-able

10. Implications for the commissioning
function and culture
Different skills needed
• Facilitation of balanced conversations across commissioners, providers, people
• Community development – with a default of removing barriers to enable the
community to take up power and do stuff
• Risk management – being aware of associated risks and mitigating them rather than
using purchasing power to control them
Different behaviours needed
• Build trust across the system
• Become system leaders – others in the system will need persuading and assuring
• Bravery– supporting innovation, using the best evidence there is, but then taking a
calculated punt
Different actions needed
• Stop purchasing in the main at scale, start creating different ways for people to
purchase and be in control, either themselves or through support
• Stop focusing on minutiae start focusing on outcomes

11. v
Self-managed teams in homecare
inspired by Buurtzorg
A new approach to support at home
@HelenHSAUK

13. How can we…
…deliver choice,
control, and improve
health and
wellbeing? …create effective,
self-organised
teams?
…focus on
outcomes,
not on hours?
…make this work for
ISFs and for
self-funders?

14. NEW MODEL OF CARE
1) Purpose: do whatever it takes to support people to live
well at home and be part of their community
2) Support Sequence – reablement ethos
3) Community Circles partnership
4) Self-organising, neighbourhood teams

15. 1) What is different? How support is organised
Self-organised teams Value Based
Recruitment
Whole person to
work
Neighbourhood-
based

16. 2) What is different? How support is delivered
Co-production Whole person focus Build capacity and
connections
• Person’s priorities
& outcomes
• Co-design service
• Choose their team
• What matters to
you
• Asset-based
• 5 Ways to
Wellbeing
• Support sequence
• Community Circles

17. The Support Sequence

18. “Circles have developed and
harnessed community
resources, which promote
social inclusion and improve
wellbeing for all relevant
members […]Circle members
universally said that [circles]
produced major social,
psychological and practical
outcomes for the individual and
their family.”
Perkins M. Wistow G. Knapp M. & Bauer A (2014) Circles of Support
and Personalisation: exploring the economic case. PSSRU Discussion
Paper no 2882. London: LSE/PSSRU

19. Community Circles @HelenHSAUK

21. Wellbeing Teams @HelenHSAUK

22. Wellbeing Teams
Personalised
support
Co –produced
with the person
• Where
• When
• Who
Focused
on…
• Self-care
• Assistive
technology
• Prevention
Community Circles Outcomes not hours
Loneliness Boredom
Building social
capital
Helplessness
Lack of choice
and control
Poor health
Risk of visiting A&E
Risk of long-term care
Change in loneliness shown to improve health
WellbeingTeamsdeliver…Thishelpstocombat…

23. How can this happen at scale?
Open source
Membership site
Support package
New provider - me

24. Twitter @HelenHSAUK
E: helen@helensandersonassociates.co.uk
Follow our journey at
Helensanderson.net