This document summarizes findings from an evaluation of the Right to Control Trailblazers program, which aims to give disabled people more choice and control over support services. The evaluation found that while the program provided benefits, few disabled people actually exercised their right to control. Four key conditions need to be in place for disabled people to successfully exercise choice: a meaningful choice of providers or support, information to make confident choices, help managing support, and knowing they can request changes. The document outlines lessons learned on providing these conditions, including developing the provider market, improving support planning, and involving user-led organizations. Overall, meaningful choice will take sustained commitment over many years as the social care system culture changes.

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Margins
of Error
Personalised Support
services for disabled
people: What can we
learn?

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Version 3 | Internal use only
Learning from the Right to Control Trailblazers:
Helping disabled people exercise choice and
control over their support
Claire Lambert , Ipsos MORI
September 2013

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What is the Right to Control?
• The Right to Control gives disabled adults the legal
right to exercise choice and control over certain
public funding they may receive.
• It covers 6 funding streams:
–Adult Social Care
–Supporting People
–Disabled Facilities Grant
–Access to Work
–Work Choice
–Independent Living Fund

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What is the Right to Control?
Under the Right to Control, disabled people can:
• Receive the support the public body would have provided
before the Right to Control
• Ask the public body to arrange alternative support on
their behalf
• Receive a direct payment and arrange their own
support
• Have a mix of these arrangements

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What is the Right to Control?
• For people eligible for more than one funding stream,
the Right to Control also aims to streamline the
customer journey (avoid duplication in assessment,
support planning and review).
• Tested in seven Trailblazers: Barnet, Essex,
Leicester, Manchester Area Partnership, Newham,
Sheffield and Barnsley, Surrey.
• All new clients have the Right to Control (for the
ILF it is all clients on review).
• Initially for a period of 2 years, starting December
2010, then extended to December 2013

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The evaluation had 3 components
Process study to
look at delivery and
implementation
• 2 waves of qualitative
interviews with
disabled people,
carers, staff, providers
and ULOs (315
interviews)
Impact study to
measure impact of
the RtC on clients’
outcomes
• Survey of RtC clients
and a comparison
group (3,282
interviews) in Autumn
2012
Economic impact
analysis
• Measuring the costs
and benefits of the
RtC
• Break-even analysis
Input from evaluation co-production group and steering group throughout

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Why is the Right to Control important?
‘Although people welcome choice in the
services they use, there is a minority of
people who are excluded from these benefits,
often because they lack the confidence,
information, or the advice they need’
David Boyle, The Barriers to Choice Review

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59%22%
8%
5% 4%
1%
Q7. “It is important to have a choice of (service)”
Having a choice seen as important across services
Source: Ipsos MORI
Strongly agree
Neither/Nor
Strongly
disagree
Service
School Social
care
Hospital GP
surgery
Agree 94% 83% 77% 80%
Disagree 3% 7% 11% 11%
Tend to
agree
Tend to disagree
Base: All those who have changed/used service (1,485), 2012
81%
9%

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46%
51%
3%
Q6. Did you select the school/provider of support or social care services/GPs
surgery/hospital from a number of options or was there no choice at all?
But choice of service is limited in social care…
Source: Ipsos MORI
Yes – selected from
a number of options
No choice
Choice by service
School Social
care
Hospital GP
surgery
Yes 83% 27% 35% 57%
No choice 15% 65% 63% 41%
Don’t
know
2% 9% 2% 2%
Don’t know
Base: All those who have changed/used service (1,485), 2012

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7%
8%
9%
24%
51%
1%
Q7. “It was difficult to make a choice of (service)”
…and more difficult to make
Source: Ipsos MORI
Strongly agree
Neither/Nor
Strongly
disagree
Service
School Social
care
Hospital GP
surgery
Agree 22% 41% 6% 13%
Disagree 71% 44% 82% 78%
Tend to
agree
Tend to disagree
Base: All those who selected their service from a number of options (728), 2012
15%
75%

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Some
examples of
impact
reported by
RtC clients
Better value
for money if
direct
payments
Choice is a
pleasant
surprise, even
if not used
Feeling
empowered
Growing
confidence
Sacking bad
care providers
More flexibility
to change
support
Better support
Better
relationships
with paid
carers
Getting back
into paid
employment
Exercising the RtC is beneficial for disabled people

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But few disabled people exercised their right
Looking back at the four options available to people under
the Right to Control, most chose the first one:
• Receive the support the public body would have
provided before the Right to Control
• Ask the public body to arrange alternative support on
their behalf
• Receive a direct payment and arrange their own support
• Have a mix of these arrangements

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Meaningful choice of
providers or support
Information
to make
confident
choices
Help in managing their
support
Knowing
they could
request
changes
Four conditions need to be met
Conditions needed
before disabled people
could exercise their
Right to Control
successfully

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Helping disabled people exercise choice over
their support
 Disabled people need to be told that they can have
choice over their support, that they can request a
change of provider, or a review.
 Timings matter.
Knowing they
could request
changes
 Provide practical examples of how other disabled people
have exercised choice or used direct payments
 Provide information about providers available locally, what
they offer, ballpark quotes, and feedback from other users
Information to
make
confident
choices

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Helping disabled people exercise choice over
their support
 Third-party support needed to help disabled people deal
with the administrative and legal aspects of direct payments.
 Ensure they can ‘ask the public body to arrange
alternative support on their behalf’.
Managing their
support
 Choice over equipment and adaptations in DFG, Access
to Work
 Choice of providers – in particular for people with complex
needs, and people in rural areas.
 Look at how people may be able to pool budget across
funding streams
Meaningful
choice of
support and/or
providers

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Developing the provider market
• To offer choice to disabled people, Trailblazers had to
move away from block contracts or framework
agreements. This sometimes meant terminating
contracts early or renegotiating them, and widening
the providers’ offer
• Large, well established providers were less willing to
change their offer
• Developing the provider market is a slow process and
very time consuming
• Nonetheless, Trailblazers had made various efforts to
stimulate the market
Online search tools
in Barnet and Bury
to link disabled
people to new
providers
New
commissioning
staff dedicated to
liaising with
providers
Drawing up
alternative provider
lists for delivery
staff to offer to
disabled people

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“The ability to make that happen may
take 10 years though because the
market has to change. The block
contracts that we’re uncoupling from
in social care and Supporting People,
the way DWP commissions and has a
prime provider, that would need
unpicking.”
Strategic staff
“A lot of these small providers,
they’ve got a real passion about
helping these customers. I
phoned someone up and I told
them about the RtC coming out
in a couple of weeks’ time, and
when I went to see them two
weeks later they’d produced
leaflets, support plans and
business plans.”
Commissioning staff

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Things that help
make a good
support plan
Instil a sense of
progress over time
Think creatively,
beyond standard
provision
Consider
mainstream
services as well as
disability services
Involve ULOs/peer
support workers
Speak to other
family members to
get a good
understanding
Understand the
person’s life and
aspirations
Support planning is key to facilitate culture change

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“They were really good with
me, asking questions,
finding out what I wanted to
do, because what I do is
quite specialised. It was
time consuming, but it was
worthwhile.”
Work Choice client
“It’s something I could always look
back and think, yeah, that’s what I’m
doing it for. I need things to jog my
memory, especially when I hit a low
patch … .”
Client for SP, DFG and ASC

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…and so is ULO involvement
• A more neutral place for disabled people to start
discussing employment than Jobcentre Plus
• More creative/tailored support plans that better meet
disabled people’s needs (but they may not get approved)
• Good understanding of the local provider market
• Easy access to informal feedback from disabled people
about local providers
• Can bridge gaps between funding streams that are not
used to working together
• Can help speed up the culture change among staff and
disabled people

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“DEAs, quite regularly some of
them, would come in and ask
us for advice. ‘We’re going to
see someone tomorrow, what
do you suggest is best for
them?’ And that’s good.”
Local co-production team
member
“The questions that we get from
different staff now are more positive
questions. They’re not carrying
assumptions that disabled people
can’t, they’re asking us how
disabled people can, and what
needs to be put into place.”
Local co-production team member

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Summing up
• Four conditions need to be met to help disabled people
exercise choice and control over their support:
– offering them a meaningful choice of provider or support;
– providing information to help them make confident choices;
– offering them help to manage their support; and
– making sure they know they can ask for changes to their support.
• Work toward these is already well underway in the
Trailblazers and elsewhere, but some of these are long-
term goals and will take time, leadership and a sustained
commitment from all those involved.

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More details on the evaluation report
• http://odi.dwp.gov.uk/odi-
projects/right-to-control-
trailblazers/research-and-
statistics.php

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Thank you
claire.lambert@ipsos.com