2. MARCO TEÓRICO
2.4 ENSAYOS DEL CONCRETO ENDURECIDO
Introduction
6.1 The SAB project was a 'demonstration' project - it did not set out to provide definitive answers to questions about putting personalisation into practice. Nonetheless, it provided some indicative lessons about managing the shift from local
authority care management to user-led support planning and brokerage from the perspective of users and those in ULOs and LAs helping to deliver support planning and brokerage with and for them.
6.2 This chapter offers some wider messages emerging from experience in the project at the three sites. It starts with messages from service users who participated in the
qualitative research and concludes with some wider lessons from the project for ULOs, LAs and policymakers elsewhere.
Messages from service users
6.3 At the end of their interviews, service users were asked if they had any messages they wanted to share from their experience during the project. Their answers included the following:
6.4 They were generally very happy with the ULO led support planning system, which led to them having more choice and control in managing their Personal Budgets. They felt it was a more ‘human’ system, and particularly appreciated the ULO role in reducing the bureaucracy involved.
6.5 Despite this positive message, there were also strong views from many service users and carers about the need for support services. It was felt that personal budgets were only useful if there were support services to buy, so a priority must be the development of the provider sector.
6.6 A common message was about the need for better
information, both to ‘advertise’ the PB system to potential service users, and also to explain clearly the different steps in the PB process.
6.7 Some people had experienced a number of different systems of care management and resource allocation in the past, with different terminology attached; they wanted to be sure that people would get this system ‘right’ so they had some stability and clarity for the future.
6.8 Support plans were felt to be most useful when they were flexible. People were worried that their plans would be ‘set in stone’. They wanted to have the right to change the details of their support plan as necessary, on a regular basis at reviews.
6.9 There was a strong message from some service users, and several carers, that support planning should take account of people’s differences. More ‘choice and control’ was the ultimate goal for everyone; but this might be approached differently by people with different impairments and circumstances.
6.10 Family carers regularly performed a core role in supporting their disabled family member. In many cases the PB system would not work without them, so support planning needs to recognise and support their vital role. In particular, getting, and keeping, paid employment outside the family was an important need for carers, but difficult to achieve.
6.11 There was a strong feeling that all disabled people have a right to the benefits of a personal budget. Those who have the highest needs should not be excluded.
6.12 Support from peers in user-led organisations, or networks of disabled people, was felt to be a vital part of the system. Service users said that they felt worried about threatened budget cuts, which might affect the ability of user networks to continue to function and provide them with support.
6.13 Training and support for all those involved in the PB system was felt to be vital. Social services staff , in particular, were
felt to need better training, and service users said they were in a good position to help provide that.
6.14 The second set of interviews was carried out at a time of financial constraint, after the Government’s comprehensive spending review. Not surprisingly, worries were expressed that PBs would be cut, or that people with high levels of need would be ‘re-allocated’ to continuing health care funding. Some service users felt that their own choice and control would be threatened by cuts to services, and that disabled people experienced enough restrictions without this
prospect.
Wider lessons
Commissioning, procurement, market management
and ULOs
6.15 The problems associated with contracting services from user led organisations was singled out by all three sites at the end of the project as being the most significant challenge to
transferring services from LAs to ULOs. Competitive tendering rules working against the development of long term, trusting, partnerships between them.
6.16 ULOs bring additional advantages to work with and for the LA: user-leadership, co-productive working styles and a value driven approach to delivering services. But many ULOs are disadvantaged in the tendering process in
comparison with larger, better resourced organisations and are not well placed to compete against them. For example, one ULO (not in the three sites) spent over £20,000 and more than 120 days of staff time in 2009, on a tender for a Direct Payments Support Service. (The specification was long and complex and included the need to secure a Bond to underwrite the pension entitlements of transferred staff.) Subsequently the LA decided to withdraw the tender
process. No redress or reimbursement of the ULO's costs in preparing their bid was possible, despite the impact on the ULO’s budget. Experiences like this may act as a serious deterrent to ULOs from engaging in subsequent tendering processes.
6.17 For LAs, the problems are different. They are being encouraged, under various national policy agendas, to
explore the potential role of voluntary and community sector agencies, and user-led organisations in particular, in
delivering services. ULOs already have a track record within social care of delivering services related to direct payments and user involvement, consultation, information and advice. There is now increasing interest in ULOs playing a more active role in carrying out other services previously delivered by the LA and other government agencies (as, for example, in the Right to Control42, currently being piloted in seven Trailblazer areas in England).
6.18 LAs operate within a number of regulatory and financial constraints which have a significant effect on how they carry out their procurement and contracting functions. For
example, when services are tendered for, potential 'suppliers' must demonstrate that they are capable of delivering these services. In many cases, ULOs are newly established or do not have a track record of delivering services in the way that will be needed. Yet they must satisfy LAs that they can deliver the services reliably and consistently and have the infrastructure to ensure this. In many LAs around the country there may not be a ULO in place that is capable of delivering effective support planning and brokerage services for one or more groups of service users. In these circumstances the LA needs to take a strategic view on how best they can encourage such organisations.
6.19 Commissioners in LAs are faced with a choice of using existing procurement and tendering processes designed to 'test the market' in an open way or to develop a different approach for ULOs. There can be political and
organisational challenges in developing 'special'
arrangements for some organisations, particularly when there is an absence of clarity on what constitutes a ULO and when a strategic commitment to the role of ULOs has not yet been established locally. There are a number of ways of
42
The Right to Control entitles disabled people to choose how to receive certain kinds of state support for which they are eligible. See ODI, 2010, Good practice guide for delivering the Right to Control, for more details.
trying to address the barriers and difficulties experienced by ULOs and LAs alike here.
Ideas and strategies: contracting services from
ULOs
ULOs
• Develop capacity and skills to engage more effectively with existing procurement and tendering systems
• Explore skill sharing or new organisational models (eg consortia) which optimise the use of existing skills and resources
• Increase engagement with other voluntary and community sector organisations in dealing with procurement issues, eg the Association of Chief Executives of Voluntary
Organisations (ACEVO) and the National Association for Voluntary and Community Action (NAVCA)
LA commissioners
• Examine existing barriers for ULOs when they are competing for tenders and address them wherever possible
• Explore the use of grant making powers for ULO-delivered services where possible, as an alternative to tendering processes
• Make a strategic commitment to the role of ULOs. This might involve helping to build capacity at the ULO, through improvements to infrastructure, like data systems.
• Make use of the National Programme for Third Sector Commissioning.43 This is funded by the Office of the Third Sector and is being delivered with the Ideas and
Improvement Agency (IDeA)44. It aims to improve
commissioners’ understanding of the potential of the third sector in designing, delivering and improving public services.
43 http://www.cabinetoffice.gov.uk/third_sector/public_services/commissioning. aspx 44 http://www.idea.gov.uk/idk/core/page.do?pageId=6583598
LAs and ULOs together
• Jointly evaluate existing tender specifications and contracts and identify opportunities to optimise the contribution of the ULO approach (eg their values and working methods) to achieve an effective balance between procurement/tendering and performance management requirements.
The potential value of ULOs from the LA’s
perspective
6.20 The current constraints on LA spending reinforce the need to ensure that available resources are spent as effectively as possible. Great emphasis is being placed on the potential role of voluntary and community sector. Within this area of interest ULOs bring some specific features that can be attractive to LAs considering how best to externalise certain functions. A number of these advantages are based on the features of ULOs set out in para 1.28.
6.21 When delivered efficiently and making full use of voluntary peer resources, ULOs can deliver good value for money in reaching local people and supporting them to negotiate LA systems. ULOs are often engaged with people’s whole lives and this should help LAs in broader areas of activity (eg Joint Strategic Needs Assessments and Community Budgets) as well as in more focussed areas such as social care, Right to Control and Personal Health Budgets.
6.22 For this to work ULOs need investment in capacity building. This was one of the reasons that Essex County Council seconded a member of LA staff to work for ecdp on the SAB project, thus ensuring the ULO had ready access to
knowledge of LA systems and contacts.
6.23 Time and effort also needs to be invested at a strategic level to explore the potential role of ULOs in the future and what needs to happen in the short term to make this a reality. The Strategic Partnership between Essex County Council and ecdp is a good example of this - not to propose a 'monopoly' arrangement with one organisation but rather recognition of the potential advantages of moving into a new way of
working with a trusted key partner in order to demonstrate effective new ways of working
The variety of ULOs and their approaches
6.24 ULOs come in a variety of forms and work in many different ways. No one model will fit all situations. Annex C sets out the key features of 'user-leadership' in relation to support planning and brokerage, developed in the course of this project.
6.25 The ULOs in the three sites all worked in a different way, each with its own strengths and challenges:
• the ecdp 'empowerment ' model highlights the value of short- term, intensive, interventions which prioritise the choice and control and self-sufficiency of the people using this service • the SCIL model is grounded in the social model of disability
and emphasises the need for the collective voice of disabled people to shape their own views and the general
environment
• the RUILS approach explores the nature of 'user-leadership' in overseeing and delivering a service through non ULOs working on their behalf.
6.26 Other ULOs, in other areas, will bring their own strengths and styles of working to their involvement in support planning and brokerage, as a result of their specific histories, localities and service users. That variety of approach, developed in response to local circumstances, can itself bring added value to what is offered to local users, and LAs need to be wary of thinking that every ULO should operate in a similar way.
Increasing peer activity
6.27 A key element of future LA commissioning of ULO activity will be the part played by non-paid peers in specific areas of service delivery. The picture of peer activity in this project varied between sites. SCIL, for example, has a track record of peer activity as a resource for its members. This has not been a feature of work in the other sites to date, though ecdp’s support planner development programme (para 5.53)
is aimed at providing further capacity for peer support planning (paid or unpaid) for the future.
6.28 Overall, the involvement of non-paid peer support in the delivery of support planning and brokerage has been slow to take off during this project. All the ULOs recognised the importance of this for the future and have been exploring ways of enhancing this aspect of their work.
Conclusions
6.29 This project has shown the potential value of ULO
engagement in delivering services historically seen as LA care management responsibilities. But shifting from one way of delivering these services to the other is not a short term fix and the challenges of making these changes needs to be anticipated, resourced and planned for.
6.30 Other ULOs, in other areas, will bring their own strengths and styles of working to their involvement in support planning and brokerage. Such variety derives at least partly from their specific histories, localities and users.
6.31 The evidence from this project is that where people work with ULOs to produce their support plans, they are more likely to choose a direct payment, than if their support planning is led by the LA. This is significant, given the intention of
Government policy to encourage a greater use of direct payments as the personalisation agenda is implemented.
6.32 The findings from this project indicate that the involvement of ULOs in delivering services and support to disabled people can bring a number of advantages. ULOs are not typical service providers. Many of their positive features derive from their historic role in representing the interests of people who use services in their area. As a result, they have a unique understanding of the lives of this group of local citizens. Harnessing such ULO qualities- in business-like and trusting partnerships - should enhance the capacity of LAs to deliver their duties in a cost-effective, responsive way. On the basis of the evidence of this project, this may, in turn, increase the sense of choice and control experienced by service users.
Annex A - Project methods
Change Management Support
The activities proposed, and undertaken, to deliver change management support at the sites were as follows:
• Support the sites in drawing up Memorandums of
Understanding and detailed plans (to involve both the local authority and the local user-led organisation)
• Establish, or use appropriate existing, mechanisms for
oversight of each site, ensuring that all relevant stakeholders are involved (including disabled people)
• Identify, agree and support required changes to care management systems and procedures
• Identify barriers to user-led support planning and brokerage services and support measures to address capacity gaps within the ULOs
• Develop and implement change plans, including a specific focus on implications for the workforce - both within local authority and user-led organisations
• Respond to specific barriers and difficulties as they arose • Ensure that relevant data was collected to meet the
requirements of the research and analysis programmes
The Qualitative Research
• The research plan was to recruit 40 service users receiving support planning via a ULO and 40 service users in a
comparison group (people whose support planning was managed by the LA).
• All participants would be interviewed twice, with an interval of approximately six months between. It was hoped that the interviews with disabled people in the comparison group would provide an indication of any differences made by ULO involvement.
• The intention was that the 80 interviewees would be spread across all 3 sites, covering disabled people with different impairments as equally as possible, that is:
- 10 people who used learning disability services - 10 people who used mental health services
- 10 people who used services for older people - 10 people who used physical disability or sensory
impairment services
• Since the qualitative research included participants who lacked capacity to consent to research, approval was gained from a national research ethics committee flagged for
proposals relating to mental capacity. Where appropriate, carers and other close individuals were asked to act as
consultees in relation to consent matters. 42 participants also had carers acting as supporters in interviews, evenly spread over the LA and ULO groups.
• In the event, recruitment for both the LA group, and
subsequently the ULO group, was very slow. This was due to factors which included gate-keeping issues, service user research overload and personal difficulties experienced in one site.
• Although the eventual recruitment was on target (39 in the LA group and 41 in the ULO group), the sample was
unevenly spread over the three sites and the four impairment groups (see Tables 3.1 - 3.5). In part, this can be related to the actual people who were offered a ULO based SAB
service. For instance, people whose primary impairment was a learning disability were not offered ULO SAB services in Southampton, and overall there was a preponderance of people with physical and sensory impairments in the SAB project, resulting in proportionally larger numbers in this research sample.
• Strategies for recruiting to the LA group included direct contact with a user-led network in Essex (Direct Payment Users Network), who helped to recruit 13 of their members to the project. This resulted in some skewing of the LA group towards PB users who were relatively experienced and well informed. In Southampton, similarly there was some skewing of the LA group, since it included people with learning
disabilities who were supported by an independent broker. • Data was collected via semi-structured in-depth interviews, with time spent to get to know each person, before working through a topic guide in a way that suited the individual participant. The aim was to provide a context for discussion of issues and reflection, rather than a scheduled list of specific questions.
• The interview was broken up into different parts, one of which was to ask participants to rate their choice and control in different areas of their lives, on a 1-5 scale. This was completed at the first interview in relation to ‘before’ and ‘after’ the support plan, and again at the second interview some six months later.
• The data from the first set of interviews (N=80) were all fully transcribed, and the second set (N= 70) were audio recorded and scanned for relevant themes. All data were analysed using an interpretative methodology grounded in what participants said, so that the themes were both set by the