This document summarizes the experiences and lessons learned by Dimensions, a UK social care provider, in transitioning from a traditional agency model to more personalized, self-directed services. Key points include: - Dimensions supports over 3,500 individuals with learning disabilities and autism across the UK. They are shifting from large, facility-based services to individualized support based on personal budgets. - This transition requires rethinking Dimensions' offerings, costs, staffing and role. It also necessitates cultural and operational changes to empower individuals and their circles of support in decision making. - The experience highlighted challenges around staff engagement, accountability for individual budgets, and managing diverse service models, but demonstrated benefits for

1. Self Directed Approaches
Lessons from a UK provider
Steve Scown
CEO Dimensions

2. The UK context
• Number of Local Authorities (LAs): 152
• LA adult social budgets: £19b (34.2B AUD)
• Number of provider organisations: 12,700
(86% have less than 50 employees)
• Number of people employed in social care: 1.63m
• Number of adults receiving social care support with a
personal budget: 605,000
(over 100,000 employ their own care staff)

3. Dimensions
• Support adults, young people and children with learning
disabilities and who experience autism
• Support and accommodate over 3500 people
• We offer support via residential homes, supported living,
short breaks, day services and supported employment
• Work in 70 Local Authority areas
• Employ approximately 5000 staff
• Budgeted turnover in 14/15 of £110m

4. Our Challenges
• Traditional services have offered secure income
• Traditional services are less and less in demand by people
who exercise choice
• People want personalised services
• Personalised services have small and fixed margins
• Local authorities have less money to fund increased need

5. The Provider Conundrum
Managing yesterday’s services today whilst developing new
ways of listening and responding to tomorrow’s customer –
and accepting less money for doing it.

6. The LA commissioned service
Paul lives in a home with 4 other people
Local Authority pays Dimensions £50k per annum
Home has a team of 5 staff – there is 1 staff member there
all the time during the day and 1 sleeps in at night
There are 40 hours of shared support per week
Paul wanted to go abroad for a holiday and a group of 8
people decided if that was OK
Paul spends 2 days a week at the local learning disability
day centre and the rest at leisure.
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7. What Paul wants
Paul has an Individual Budget of £34k.
Paul pays Dimensions £22k a year for:
 Support in the mornings whilst his Mum is at work
 Support 2 days a week whilst he works in a garage
keeping the floor clean and the place generally tidy
 Support every 4th weekend whilst he goes away for short
breaks – either camping or on a city break
One of his support workers is his cousin at his family’s
insistence.
Paul is offering a one-off £3k payment if Dimensions can
find him a job which he can keep for 6 months.
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8. “So basically you’re moving from wholesale to bespoke
retail!”
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9. Our initial market prediction
Now B2B B2C
Future B2B B2C

10. 10
Our current experience
£
Local Authority Customer

11. “It is not the strongest of the species that survive, nor the
most intelligent, but the one that is most responsive to
change”
Charles Darwin

12. Our first journey
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13. The key questions we posed ourselves
• How will Paul and his Circle of Support know about
Dimensions?
• What do we want Paul and his Circle of Support to think
of us?
• Can we provide what Paul and his Circle of Support will
want to buy?
• How do we cost and then price very different models of
support / products?
• How different will Dimensions and our staff have to be?

14. Your offer - one-off products
Something a family may purchase which may or may not
lead on to further business:
 Facilitation of a PCP
 Support Design
 Behaviour Analysis
Review
 AT Assessment
 Holidays
 Service Design
 Benefit Review
 H&S Environment
Review
 Housing Brokerage
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15. Your offer - defined term products
Something a family may buy for a fixed period of time with a
pre-determined outcome:
• Life skills training
• Community integration
• Active support
• Job skills training
• Facilitation of PC Review

16. Your offer - ongoing products
Something a family would purchase without an end
timeframe:
 Personal care & support
 Sleep-in
 Live-in Support
 Short Breaks
 Training of PAs
 Quality Assurance
 Waking night
 Housing related support
 Recruitment of PAs
 Management of team of PAs
 On-call & out-of-hours
support
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17. Costing the offer
Overhead activity
Activity Based Costing/Insurance
Premiums
Client Group/Postcode
Specials
Refunds/Discounts/Free offers

18. Human Resources
Bespoke - Person Specification
- Job Description
- Employment Contract
- Rates of Pay
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19. You Decide – We Employ
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Human Resources

20. Our second journey

21. 21

22. 22

23. Plan
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24. So what changed for Anne Marie?
• New people in her relationship map
• Voluntary work
• Unpaid support
• New places
• Re-connected with old friends
• Busier and happier
• Better relationship with estranged sister

25. Reflections on our learning so far
• Ensure all leaders and key organisational players are
actively engaged and prepared for the change.
• Establish what good will look like - for your organisation,
the people you support and your staff - as soon as possible.
• Be realistic about what you try to achieve - major change
takes courage, determination and time.

26. Reflections on our learning so far
• Be prepared to feel comfortable with discovering some
things that are not good enough and must change.
• Be prepared to engage in honest and open dialogue and
avoiding the ‘blame game’.
• Develop your organisational response to dealing with a
member of staff whom nobody wants to support them.

27. Reflections on our learning so far
• Develop your own views very early as to how you will
manage and account for individual income streams
• Consider the impact upon your organisation when the
people you support decide how you spend your funding.
• Staff find change easier when engaged in the process of
change and receive support, training and independent
challenge.

28. Reflections on our learning so far
• Everyone, including business support, but particularly every
member of operations must be familiar with and ‘fluent’ in
person-centred thinking tools.
• Help your staff understand they must have their own
personal offer for the people they are supporting. If they
haven’t got one, help them to develop one.
• Incorporating feedback from people being supported and
their families into individual supervision and appraisal is
very beneficial when trying to change staff attitude and
behaviour.

29. Managing through the tough times
• It is easy to under-estimate the impact of broader
organisational change upon local services and their
attempts to improve how they provide support.
• Find anchor points that are real and use stories and
journeys to connect people to change.
• Accept it will never be right and just keep on going.

30. “If you want something different to happen, you have to do
something different”
Sharon Di Santo

31. • steve.scown@dimensions-uk.org
• @sscown #OzAdventure
• www.dimensions-uk.org