Examination of Witnesses (Questions 236
- 239)
MONDAY 29 JUNE 2009
MR ROD
CRAIG, MR
STEPHEN CHEETHAM,
MS REBECCA
POTTER AND
MS LISA
MOON
Chair: Same advice as to the last lot,
given that there are four of you, do not feel obliged to repeat
things if you actually agree.
Q236 Andrew George: The personalisation
agenda, it seems to have mixed reactions amongst some of those
who have provided evidence to us, and certainly, as far as North
East Somerset is concerned, I know you have put a particular focus
on that, certainly in the evidence that you have sent us. I mean,
the problem, it seems that some of those who have provided evidence
argue, is that it is almost impossible to deliver, in that it
creates many obstacles on the way. How have you found the pilot
project itself in Bath?
Ms Potter: In Bath and North East
Somerset, our commissioning body agreed an amount to be put into
the individual budget pot, and in developing the tools that we
used, we developed a Supporting People resource allocation section,
which basically enabled a social worker to go through and identify
whether an individual had housing related support needs, but we
really left it to the person that did the assessment together
with the service user to then administer that funding. We basically
handed them some funding as agreed by our commissioning body.
All the people that were able to take advantage of individual
SP funded individual budgets at that time were people who were
eligible for a FACs (fair access to care) service, so people with
critical or substantial needs. What we have not managed to do
in Bath and North East Somerset so far is find an effective way
to roll out individual budgets for people who do not meet those
two top criteria at the moment, and we are continuing to look
at ways to do that, but we certainly do not have the answers for
people who are vulnerable but who may not be receiving a service
already from social services, et cetera. We have concerns, just
like everybody else does, around such things as accommodation
based projects which require a certain critical mass, in order
to exist; if half the people opt out of receiving that service,
particularly if the service provider is also the landlord, then
it clearly puts that service under quite a lot of risk, and we
have not managed to find ways around that in Bath and North East
Somerset at this stage.
Q237 Andrew George: You have described
quite different problems to the personalisation agenda that I
was imagining. What I was expecting was for you to say that the
service users were finding that either the services were not changing
as a result of the attempt to try and ensure that it was more
tailor-made to their individual needs, or that you were finding
that in spite of the extra effort, that you were still delivering
pretty much the same kind of blueprint services.
Ms Potter: Most Supporting People
funding in Bath and North East Somerset is still wrapped up in
gross contracts, not individual budgets. Where people have been
given a Supporting People funded individual budget, they have
tended to purchase services from providers who do not necessarily
sit in the Supporting People sector, so they buy in their housing-related
support from personal assistants quite often, or others who are
non-specialist in the arena of housing-related support. What we
have not done in Bath and North East Somerset, which is what I
do not think has happened anywhere, is effectively develop the
marketplace for people to actually be able to purchase their housing-related
support. Another major problem I think that we have to overcome
before we can truly roll out individual budgets is around—a
social worker will do an assessment for somebody who is eligible
for a service under fair access to care, but there is not necessarily
an independent person to do the assessment for a vulnerable individual
who's needs are below FACs. At the moment, it is the support provider
that does that assessment, so in terms of developing an infrastructure
to be able to effectively deliver Supporting People, individual
budgets is also tricky. But we would argue in Bath and North East
Somerset that actually, Supporting People services are individualised
services already. They are not individual budgets, but they are
personalised services which put the individual at the heart of
the service. People have individual support plans which are outcomes-focused,
which are reviewed, usually every few months, at least annually,
and they are in that sense certainly on that continuum of personalisation.
Mr Cheetham: In Cambridgeshire,
we have not had an opportunity to test out individual budgets
with service users of Supporting People services, but we strongly
feel that you can achieve the principles of personalisation without
necessarily going down the individual budgets route, but if we
feel that that is appropriate, and service users are indicating
that to us, then our feeling is that we want to adopt a resource
allocation that would include the elements of housing-related
support, so the individual would get an individual budget in the
end, but we feel very strongly, echoing something that was just
said earlier by Rebecca, that actually you can achieve some of
the principles of personalisation through existing services, because
that was one of the fundamentals of the Supporting People programme
in the first place.
Mr Craig: In fact, probably many
of them. Can I just add one other thing? Ultimately, removing
the ringfence from Supporting People budgets gives you the opportunity
to pool resources elsewhere, so for example, one of the continuums
of care that you will see often in Supporting People with mental
health recovery, related to drug and alcohol and so on, if we
were in a better position to pool the resources at the crossover
between social care and Supporting People funding, then we would
have a dedicated budget from which an individual budget might
flow much more easily, so those for us are one of the reasons
why ringfencing ending gives you more opportunity in this area.
Q238 Andrew George: There are two
issues, I just wanted to get a clear impression from what you
are saying so far, whether you think that the additional resources
necessary in order to be able to deliver the personalisation service
is excessively resource intensive in terms of the time of the
people involved; and secondly, whether it appears to raise expectations
which then cannot be met. I just wonder whether you could comment
briefly on those two aspects.
Mr Craig: This is predicated on
an assumption that it would cost more resources in order to deliver
personalised services, and I would say Supporting People has a
proud record of those aspects of personalisation which are about
enabling the individual to identify their needs, and to aspire
to the sorts of services that would deliver those needs, so that
is the main component of personalisation. The choice to have a
budget in your hands to purchase those services is the step further
down the line. Personalisation is more about self-assessment,
self-directed support, and then using the vehicle to spend the
money. I do not think that should necessarily be more resource
intensive. I think the issue about providers shifting uneasily
about the possibility of people using those resources to purchase
services elsewhere, well, they will not, if a service is of good
enough quality and delivers on the aspiration; they will if it
does not. I am afraid I think that is what the market should be
doing, being driven by individual choice.
Q239 Chair: Would you agree with
that?
Ms Moon: Yes, I do agree, I have
nothing further to add to that.
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