School for Social Care Research

Personalisation in practice

Nadia Brookes, Lisa Callaghan and Ann Netten

NIHR SSCR Personalisation Workshop,

12 June 2013

Personal Social Services Research Unit (PSSRU)University of Kent

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Personalisation in practice

• Context

• Scoping study

• Shared Lives

• Looking forward

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Context

• Personalisation policy

• Targets for personal budgets

• Wider emphasis on personalisation of support

• Emphasis on outcomes

• Lack of evidence for services about

• ‘What works’

• Cost-effectiveness

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Scoping study

• Oct 2009-July 2011

• Overall aim:

– To identify type of research evidence needed to support social care practice

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Scoping study objectives

To identify:• Outcomes difficult to address in care & support plans• Services and support wanted but not available• Services councils should be commissioning• Services being decommissioned/ reduced demand• Examples of promising personalised interventions• Interventions meriting evaluation and further research

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Scoping study methods

• Initial scoping • Literature review• Consultation• Analysis of data from IB pilots evaluation (IBSEN)• In-depth case studies (Aug 2010-Mar 2011)• 3 councils• 40 interviews (55 people), 4 focus groups (5-7 people)• Survey of sample of 20 councils (Apr-May

2011)

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Key research issues

• Timing of in-depth fieldwork and survey• Spending Review, ADASS reporting requirements• Participants felt it was ‘early days’ • Recruitment of participants • via Personalisation Lead – ‘gatekeeping’?

• Difficulty in gaining perspective of some service users

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Personalised planning and commissioning

• Practitioner difficulties with use of outcomes

• Social participation and occupation hardest outcomes to achieve – but also where innovative services were making progress

• Financial resources critical issue; need for personalised services that deliver good outcomes at low cost

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Recommendations for research

• Engagement of hard-to-reach groups

• Alternatives to personal budgets

• Effectiveness of different models of support planning and brokerage

• Options for the management of personal budgets

• New models for day activities and support

• Effective use of the workforce

• The role of Personal Assistants

• Evaluation of innovative personalised interventions

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Personalised services and innovations

• Innovation Fund

• Mental health service user PB pilot

• Family home-based day-care scheme

• Support with Confidence scheme

• Individual Service Funds for nursing home residents

• User-run sports and social group for people recovering from mental health problems

• Shared Lives

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What is Shared Lives?• Individuals involved in SL carers homes & lives

• Careful matching of individuals in need of support and SL carers • Long term or residential arrangements – Person lives long-term in the home of the SL carer• Rehabilitative or intermediate arrangements– Person stays in home of the SL carer as a ‘stepping stone’ to more

independent living• Respite arrangements/ short breaks – Person stays in home of the SL carer to give an unpaid carer a break• Day time arrangements– Person regularly visits home of the SL carer during day• Outreach or ‘kinship support’ – SL carer acts as ‘extended family’ to someone living in their own home

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Outcomes, processes and costs of Shared Lives• January 2012 - March 2014

• Overall aim:

To generate evidence about the potential of Shared Lives for older people

– who need low-level 24-hour support and/or

– are socially isolated or

– a carer has need for respite and support

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Shared Lives (SL) study objectives

• To identify– Demand for SL among older people & carers– Outcomes of SL compared with alternative services– Costs and cost-effectiveness– Barriers and facilitators – Elements of good practice

• Challenging to evaluate – Small number of older people thinly spread– Long processes– Barriers to expansion

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Shared Lives (SL) study methods

• Multi-method approach• In-depth work with 3 councils planning to expand

– Local user, carer and practitioner groups – Interviews with managers/commissioners/SWs– Interviews with new users of SL, family carers & SL carers

(over 12 months)• Surveys of SL schemes and users• Delphi technique for demand estimation• Cost analysis of 5 schemes

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Stage 1 • Survey of SL schemes• Development work with 3 councils

– Local groups and fieldworkers recruited– Interviews on

• Current status of SL and plans• Barriers and facilitators

– Consultation on design• Following the SL ‘journey’ • Estimating demand

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In-depth study areas

• Council A (County council )– Established scheme primarily for people with LD– Previous attempts to extend to OP not sustained

• Council B (Metropolitan Borough)– Established very active scheme– Focus on outreach/kinship support – No long term placements

• Council C (County council)– New project focused on people with dementia

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Survey of SL schemes

• 43 schemes responded– 35 in-house– 7 independent– 1 becoming ‘LA trading company’

• 19 out of 34 had plans to increase provision for older people• 4 out of 11 who had recently tried to increase had been successful• Problems were due to lack of

– Funding/awareness/commitment from management– Suitable accommodation

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Use of SL by older people

Type of arrangement No. of schemes Older people

Long-term residential 26 24%

Day time arrangements 15 31%

Respite/short breaks 15 14%

Outreach/kinship support 3 30%

Total number   780

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Next steps

• Survey of SL users 65+ and carers – On-going, 17 schemes participating– Planned comparison with data from surveys and research

• Continued attempts to follow new referrals – Still low numbers

• Staff interviews in each case study areas• Costing

– 5 schemes – Including event record for matching process

• Key and potentially costly feature

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NIHR School for Social Care Research This presentation reports on independent research funded by the NIHR School for Social Care Research. The views expressed in this presentation are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health/NIHR.

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