Slides describing how how individual service funds are changing commissioning from a family perspective

1. How Self direction through
Individual service funds are transforming
commissioning Module 1
“When I wake up each morning...
I want to live a life.. NOT a service”
Aligned to Skills for Care guidance – ‘Supporting & developing the workforce for Individual service funds’ 2020

2. Learning outcomes for today
For you to go away with a better understanding of:
• How health & social care (education) legislation and policy supports self direction
and is driving change in the way we commission care & support
• What an Individual service fund (ISF) is, where it sits on the Self Directed Support
(SDS) continuum , how ISFs works in practice and how it compares to traditional
commissioned services and other forms of self directed options - Direct Payments
• The importance of ‘whole life’ planning and how an ISF supports this
• The possible benefits of an ISF for an individual, the family, a provider, the health
and local authority .. as well as some of the drawbacks
• The roles and responsibilities these same stakeholders have when agreeing to set
up an ISF
• The national picture and some of the different approaches to ISFs across the UK –
2way/3way agreements , how ISFs support change in commissioning social care
Inspiring a commitment within you/organisations, to try new things and embrace change

3. What are the life outcomes
most families aspire to?
• To live a full and valued life in my community
• Appropriate housing and tenancy options
• Skills and confidence to live in my own home
• The ability to get out and about safely
• Have a community with awareness
• Access to the local amenities
• Ability to use public transport or my own form of transport
• Find and Participate in meaningful local activities
• To continue life long learning
• Be a valued member of the community - volunteering/work
• Develop and maintain relationships and build a circle of friends
• Gain independence and respect from parents as adults
• To have ALL the personal skills, resources* and support(where
appropriate) to achieve this

4. Is the local authority utilising
it’s current budgets in the best way
possible to achieve this?
"I'm playing all the
right notes — but
not necessarily
in the right order.”

5. We have separate roles
School is often primarily respite
for families

6. There is little expectation for any skills learned at school to be built
upon, it is a separate siloed adult service traditionally providing respite
xxx
Passive acceptance
of services continues..

7. Learned helplessness
Families have trust in their local authority to
commission service in their best interest,
totally unaware of the ‘dependency’ some
longstanding commissioned services are
unknowingly creating
We find it really hard to speak up when
things are not right, let alone to ask for
something different if, what we get,
we are grateful for
Local authorities need to do more to
promote the Care Act and the freedoms it
can give families, to do things differently

8. Living a service...
• People are often placed in an existing service
Residential home
Supported living scheme,
Day centre or
Domiciliary care provider on a block contract
The placement is seen as the ‘outcome achieved’
• *Support packages in the community, are often
commissioned in isolation
• The process of telling the family the options they
have and what their Personal Budget is, is often
skipped if they do not ask for a Direct payment

9. The majority of people have
their needs assessed and
then often receive siloed
uncoordinated services that
are not aware of each other’s
individual or collective impact
on someone’s life.
Residential care
Supported living
Day service
Adult learning/ Education
Specialist health services
Uncoordinated , siloed services
Driven by shared goals?

10. Months since 1st assessment
Package
cost
Changing
needs
Ineffective
and wasted
spend £
Initial
assessment
12 month
review
Under current contracts, a person and their provider is
unable to use their budget flexibly, they are tied to
delivering contracted hours, no more, no less
At point of
crisis
Commissioned ‘Time & Task’

11. Adult social care is fit to burst
The way we commission can often cause unnecessary long term dependency

12. Here, it is assumed that
everyone will benefit from
the same support.
They are being treated
equally
Here, individuals are given
personalised support to make
it possible for them to have
equal access to the game.
They are being treated
equitably
Is personalisation the whole answer?
Here, all three can see the
game without any support
or accommodation because
the cause of the inequity
has been addressed
The funding was used
differently!

13. All we need to do is
change the conversation!

14. What is the role of social care?
I believe Coproduction and self direction
can help you have that conversation!
This can be achieved through introducing
Individual service funds to your commissioning
options for adult social care

15. Self direction
Being given the opportunity
to take back control of our lives
and ensure the services
commissioned for us had
meaning, were purposeful
and were working towards
a shared vision for our family;
changed our lives
I reduced their dependence on a system
that had a different purpose

16. Let’s take a look at how self directed
support has been working for me ..
If I am to consider handing back our direct payment in favour of an ISF,
this is what I would expect from my son’s ISF holder!

17. 5x DAY SERVICE
At the time the local authority saw the role of the services (respite)
as the outcomes, so there were no other outcomes in the care plan
This did not mean that we aspired for less
Commissioned services
were not working

18. Person centred planning tools

19. Outcome Where am
I now
What skills do I
need
Where /how can I
get these skills
What
resources
could help
me
‘I can..
By Volunteering
At home
In my community
Local shops
Local clubs/ groups
Supported by:
Provider
Day opportunity
Adult learning
PA
Digital key
rings
Mobile phone
Cash/card
Bus pass
Community
awareness
training
The internet
Games
DVDs
I can do my
shopping
independently
I can not
do my own
shopping
Identify what I need
Memory, make a list
Money / budgeting
Plan the journey
Road safety
Travel training
Social awareness
Communication
Decision making
Breaking down long term outcomes into manageable tasks &
targets to achieve – helped us to choose meaningful activities

20. We ‘micro-commissioned’
brokered with purpose!
All within a context of living a real life!
• Celebrated their strengths and things they learned in school/college.
• Harnessed local activities. Identifying where Assistive Tech could be introduced
• The activities had a role and a purpose* – Time limited*
v
WEST HAY *
DAY SERVICE
ADULT LEARNING COURSE
Numeracy, money skills
LAUNDRY
CAR BOOT
CHAPEL
.
PUB

21. The purpose of the respite break had to change.
We hired a self catering setting with a PA
The funding for this siloed service (now in the DP pot!)
was now working towards the same outcomes
We opted out
of residential respite

22. Get to know the community
• We took the time to talk to
local community groups*
• The boys support their events
• They are valued

23. Use his ‘community currency’
mutual exchange of skills
> Greg helping with Dorothy’s
gardening
Dorothy helping Greg with cooking <
his Sunday lunch meal

24. Mapping the community
Community connections

25. This scheme helped for 3 weeks to
support my son learn the new
journey from the bus stop to his
supported living flat.
This was a community alternative to
a paid PA
He also now wants to learn
to be a dog walker for
(people at work) and
join the scheme
.
Local PAs who could instinctively
spot opportunities

26. Confidence to imaginatively
source Assistive technology

27. Workforce development
Support provider workforce need different
skills to deliver the outcomes we need*
• Manage their own budget
• ‘Do themselves out of their job!’
• Breakdown outcomes into steps to deliver
• Person centred, harness interests*
• Motivation to encourage ‘ownership’
• Making Step by Step resources
• Writing Social stories
• Communication/Verbal prompts
• PBS/Intensive Interaction
• Community mapping/ connecting
• Use of assistive technology

28. 2 hours
3 hours
4 hours
DP
DP
DP
DP holders have naturally
been pooling budgets
DP DP
DP
DP
DP
DP DP

29. This isn’t a service, it’s a great life!

30. Discussion points
How do you think the role of the support provider needs to
change in order to achieve the approach we need for ISFs?
What are the evolving skills set the provider workforce need?
What needs to change in the way providers are commissioned?
Would a more flexible funding approach like ISFs free providers
to be more creative?

31. Barriers to self directed support that
commissioning with Individual Service Funds
could finally put an end to

32. If only LAs would commission at a community level, those with similar
outcomes to achieve, in the same community could pool budgets
Day service
Residential care
SL scheme
Domiciliary care
Direct Payment

34. Although neighbours..
Service led contracts makes it
impossible to connect
.
PERSON WITH A
DIRECT PAYMENT
SUPPORTED LIVING
RESIDENTIAL CARE PROVIDER
DAY CENTRE PROVIDER
DOMICILIARY PROVIDER

35. Although neighbours..
Service led contracts makes it
impossible to connect
.
PERSON WITH A
DIRECT PAYMENT
SUPPORTED LIVING
RESIDENTIAL CARE PROVIDER
DAY CENTRE PROVIDER
DOMICILIARY PROVIDER
INDIVIDUAL SERVICE FUND
Now, it is possible to share activities
and pool budgets with your friends
irrespective of who your provider is

36. Collective community mapping

37. GREG
HELEN
Building
connections
Direct Payment HOLDER
HOSPITAL UNIT
PROVIDER A
PROVIDER B
RESIDENTAIL HOME
Providers coproducing
Direct Payment HOLDER
LIAM
PAULA
PAT
TINA
Day service placement
Day service placement
With more flexible use of funding through ISFs
the opportunity to coproduce support: sharing
activities and pooling budgets increases

38. 2 hours
3 hours
4 hours
ISF
ISF
ISF
ISF holders can pool budgets
with other ISF / DP holders
DP DP
£
DP
DP
DP ISF

39. Are an empowering way to
manage your personal
budget with your chosen
provider
“Let’s have a look”
Individual service
funds (ISFs)

40. Not everyone wants the
responsibility of a Direct payment..
But no less seek the opportunity (right) to self direct their care & support:
• Tell their story, say what matters to them and the barriers they are experiencing
• COPRODUCE their assessment with their SW
• COPRODUCE the LA care plan and mutually AGREE the outcomes
• UNDERSTAND how the budget is calculated
• Be INVOLVED in how the provider is chosen
• CODESIGN their daily activities & support with their chosen service provider
To ensure they Live a life not a service
They should be given choice & control over:
• The services/budget they are eligible for – understand the role of that budget
• WHERE they receive the support
• WHAT their activity are
• WHEN they want to do that activity
• HOW they are supported
• WHO supports them
and so need access to information & advice, resources and support to make this happen

41. A person is entitled to know what their
‘personal budget’ is for the services they
are receiving, even if it is shared support
or a block contract* (day services,
respite residential short breaks,
domiciliary care services.. Their Health
service or Education )
We all remember Valuing People and
Transforming care programme.
The Care Act 2014 gives people choice
and control over the health & social care
they receive
Those receiving Education* and Health*
also have the right to ask for a personal
budget
Transparency & Accountability is key if
you want people who use services to
take ownership and responsibility of
their lives, get more involved in their care
& support and be inspired to reach their
best potential, which over time could
reduce their reliance on funded support
“When I was told how much my son’s services cost, I knew
I could get better outcomes by spending the money differently”
Legislation and national policy

42. The Self Directed Support
(SDS) continuum

43. What does an ISF offer?
An ISF offers transparency and accountability within
a commissioned service that we didn’t have before.
Our support package budget is no longer ‘given to a
provider’ after a tendering process, but we have choice
over which provider holds our budget
We are ‘at the table’ as partners for the whole journey
from set up to delivery
We know what the budget is and together with the
provider, we are involved in how it is spent
It is clear what budget is committed* to shared core
hours and what budget can be used flexibly
We can ask the provider to broker support from other
services or buy something that will achieve any of our
outcomes
We can bank unused funding to plan ahead

44. Costed support planning
“Having a better conversation”
We cannot avoid using time & task to calculate an indicative
budget to identify the cost to deliver the outcomes identified in
the care plan...
But the beauty of taking a personal budget as a DP or ISF
is the ‘slate is wiped clean’ and it’s OVER TO YOU to be creative with it!

45. A support planning process

47. Who can hold an ISF?
Once set up with the right infrastructure and workforce
training :
• Support providers
• Micro-providers
• User led organisations, Voluntary sector
• 3rd party brokerage organisations (no delivery of care)
• Education settings
** Much more involved than a pay role function
Quality checking / Peer reviewing scheme are key to success and self regulation

48. The role of an ISF holder organisation
Expectation for coproduction enablement & creativity
• Be transparent about the budget they’re holding
• Coproduce support plan with the person & their family
• Harness and build on strengths and skills already gained
• Utilise natural assets, family, friends, local volunteers
• Build community connections/valued citizenship
• Introduce assistive technology options
• Deliver /broker enabling (tapering) support
• Pool budgets with other ISF/DP holders
• Confidence to broker services outside themselves

49. With choice & control
comes responsibility
• Unlike a Direct Payment, where the
person is accountable for how the
budget is spent, the liability sits with
the provider.
• However, in both circumstances when
an Individual has choice & control it is
vital they know this comes with
responsibility
• Having an informal agreement with the
individual to ‘Strive to reach their best
potential with the funding and
support available to them’ is a useful
incentive and motivator.
• Work to improve your life
• Reduce reliance on funded support
• Share the decisions, Coproduce
• Co-operate , work in partnership
• Agree outcomes to work towards
• Understand it is public money given
to you for a purpose, not a DWP
benefit*
• Commit to pay your self contribution
• Be Respectful of the provider’s role

50. Accountability

51. What next?
Let’s take a look at what needs to be
in place to be able to offer ISFs

52. Contracts and agreements
© Self-Directed Futures
• Assessment (A) and support
plan, details who the person
would like to hold their ISF
• Contract agreed (1) between
the funder and the ISF
holding organisation
• Agreement (2) between the
person and their ISF holding
organisation, setting out how
they will work together to use
their budget
This is commonly know as a
‘2 way’ agreement model
(1) (A)
(2)

53. In arrears v advance payments

54. ISF admin costs –
what is over & above?
• Person centred planning sessions?
• Coproducing & regularly reviewing the support plan?
• Planning & reviewing how the budget is being spent?
• Evaluating the support, recording progress?
• Reviewing and updating the outcomes to work on?
• Coordination of weekly activities?
• Organising staff work schedules?
• Processing invoices?
• Community mapping & connecting?
• Sourcing Assistive technology?
• Finding other supported people to pool budgets?
Strangely I’m getting the feeling people with a commissioned
service will feel they have a right to all of the above too!!

55. ISF create staff teams
Driven by the coproduced support plan, teams holding the budget:
• Build Trust and a common purpose
• Working together – with a common purpose
• Agree Consistent approach – PBS/ health plans/ decision making
• Mentor agency , new staff
• OPProfiles/Indv skills and characteristics are matched to activities
• Design work schedule to support activities/rotas shifts
• Identify their own strengths and training needs
• See their role in the person’s life – not ‘a shift to turn up to’
• Do themselves out of the job.. With pride!
• Collectively identify AT, new opportunities, community assets
• Identify outcomes, break down into POSITIVE/POSSIBLE steps
Source solutions to achieve them
Evaluate progress and enjoy the satisfaction SEE lives change!
• Do with, NOT TO a person - Ownership stays with the person

56. Tools and resources to support ISFs

57. Southwest tool kit

58. Easy read/ accessible
important to have these in place
• Funding options to choose from
• ISF guide
• ISF contract
• ISF agreements
• Care act eligibility
• Moving from commissioned to ISF
• ISF decision pathway
• Reviewing & Auditing process
• My responsibilities
• Provide library of good stories to inspire families to get
involved and SDS their care and take DP or ISF

59. SW Self assessment tools

60. ISF ‘ I statements’
• My Personal budget
• 
I know my personal budget allocation before I start
planning
• 
I am involved in planning how to spend my budget
• 
I get regular updates on how my budget is being
spent
• 
I choose how things are organised and am told how
this affects my budget
• 
The costs of managing my ISF are clear, transparent
and written into my ISF agreement
Flexible Support

I can tailor my support so that that is right for me

I am given information on the cost of my supports and the services
available to me - these are clear and easy for me to understand

My support arrangement is planned and designed by spending
time with me and the people who know me best and finding out
what makes sense for me

I am involved as much as I want to be in deciding what to do with
my Individual Service Fund and how it is managed

My individual service funds holding organisation is flexible and
responds to changes in my life and needs

61. • Focus On a good Life
• 
I am involved in planning and thinking about what a good life means for
• me and so are my family and circle of friends
• 
My skills, gifts and aspirations, existing relationships and community
• networks area also written into my support plan
• 
I can plan to use my ISF for a wide range of solutions, not just paying for
• support hours
• 
I can spend money on things that help me to achieve the things in my
• life that I have had agreed as eligible outcomes
• 
My ISF holding organisation helps me to work out how to spend my ISF
• on other things not just on their services – it is creatively used
• 
I feel listened to and in control
• 
My plan covers how to support me to keep safe, healthy and well
• 
I feel I am getting a good life not just a service
Maximum Control

I am at the centre of planning my support

I am able to influence how my plan develops right from the start and can
be involved in all the things I want to be (like choosing my staff)

My plan states how I make decisions or who will help me do this and this
is updated over time

I get offered ongoing help, support and information to help take control
and make more decisions over time

There are no unnecessary restrictions on how my Individual Service Fund
can be used as long as it is legal and helps me to achieve my identified
outcomes

All of the money spent through my budget relates to the outcomes I
need to achieve and I can easily see how it is being used on my support
ISF ‘ I statements’

62. Importance of planning ahead
• Training
• Recruitment
• Emergency cover
• Equipment/AT
• Specialist services (non
statutory)
• Person centred planning. Life
planning
• Transitioning
• Fluctuations in presentation
• Seasonal activities/ weather
• Volunteer sustainability
• Contingency planning
• Crisis planning
• End of life planning
• Holiday support
• Hospital / inpatient admission
Things to keep in mind when the budget is being banked:

63. Claw back v Hand back
Both DP and ISF allow a build up of funds
(2months) to act as a buffer
Families need a budget that is responsive
to immediate need and planned events.
Unlike families with DP, providers have
reserves to buffer overspend as they have a
duty under the contract.
In the past LAs have been too quick to see a
build up in the account and clawed it back.
‘Who owns the saving?’ debate??!

64. Months since 1st assessment
Package
cost
Changing
needs
Initial
assessment
12 month
review
With ISF, s a person can reduce their own budget without
a formal reassessment and where appropriate hand back
unused funds
SAVINGS!
Flexible budgets can be banked
or handed back

65. Potential barriers
The care and support planning , usually
written by the care manager (SW), is still
causing some barriers to both ISF and DP
holders.
If the outcomes are not written well, or are
themselves too prescriptive and limited so
as not to allow for innovative solutions, the
provider will have to keep coming back for
permission
DPs and ISFs can be sabotaged because of intense monitoring by LAs.
There is a lack of trust that it will be spend well and taken advantage of

66. Benefits Drawbacks/barriers
Discussion point
• Click to add text

67. Aditional slides

68. Individual services funds
are the perfect vehicle to support
a local authority looking to:
Review high cost packages,
Seeing what’s possible for the same funding
De register residential care settings
Disaggregate block contracts

69. De-registration
Supporting families to understand the financial support costs of moving from
Residential care to living in their own homes with a tenancy (supported living ), can
be really hard.
Using the 247grid to map the support and the often restricted flexibility of their
individual residential packages, shows the current cost involved
Taking that same cost in a grid, and mapping what could be achieved with the same
funding (without the hotel fees being taken out ), families see the budget goes
further and is more flexible
They become more confident and inspired to choose differently

70. Mapping how the current placement
funding would be spent and the level of
support he would get:
Shared daytime hours with 8 residents
Shared night time support
1 hour 1:1 key worker time
Hotel costs* – utilities, food, mortgage , insurance
Moving from residential care

71. Look at the difference!
Moving to a different setting is scary.
But when we know what is currently being spent on a service that
isn’t right, or isn’t working; allow someone to re-imagine a different
way that would support better outcomes and often a better life!
Taking that budget, and looking at
a different way of spending it!

72. Disaggregation
Block contracts
Day services have traditionally been contracted in a block contract
People after being assessed as ‘needing a day centre’ are allocated a
place (if there is capacity within the contract)
Vey often the day centre placement sadly becomes the ‘outcome’
and the person feels they have no choice and control over the
activities or their funding as it is tied up in this block contract
The Care act states a person is entitled to know the individual cost of
their support so they can decide if it is being spent well

73. Receiving a traditional day service
Here is an example..
Thomas (35), is living at home with his mother. He has received 5 days of traditional
day services for 17yrs. The ‘placement’ costing £260 was part of a block contract,
was 20 miles from home, with no outcomes and he had no control over the
activities . He would become reliant on this service for life.

74. Thomas took the cost of the commissioned service as an ISF £260
He now has 17.5hrs of 1:1 from different providers and an adult learning course.
Telecare has been installed in the family home, so he can practice being in the
house independently for structured sessions and lunchtimes. for the same cost!

75. The aim was to connect Thomas to volunteers who would support him in his
community activities within 6 months, reducing his reliance on funded support
The LA acknowledge Thomas’s long term condition and the ISF budget £260 remains
available if the free support breaks down. The ISF safety net encourages +risk taking

76. Mr Tom Jones
6, High Street
Newtown
DA 1 4GT
“This is the week
Tom had. These
are the activities
and the type of
support he got”
“These are the
hours we delivered
and the costs
involved”
“Are you happy with the way the budget was spent?
Would you like anything done differently?”

77. Implementing a ‘self reviewing cycle
By successfully turning a
RED area a different colour
1:1 to independent ,
results in saving £5500.
Social workers
request regular grids.
They are able to be
kept up to date with
progress.
Where there appears
to be little progress, a
more formal review
can take place

78. Devon county Council

79. Other individual ISF examples
can be found here:
• https://www.youtube.com/watch?v=HTZYNPN
VIbw
• http://in-controlscotland.org/sds-
cinema/calum-and-moiras-story-on-using-an-
individual-service-fund/
• https://vimeo.com/352026373/2fcce355ac

80. Skills for care guidance

81. Further reading..

82. Essex pilot - ISF route map

83. Summary of the day
Rachel.mason@selfdirectedfutures.co.uk
Chris.watson@selfdirectedfutures.co.uk

84. Work in other areas

85. Wiltshire CCG

86. Bristol city council

87. Essex county council