Learning Disabilities: Share and Learn Webinar – 28 July 2016
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www.england.nhs.uk
Learning Disabilities:
Share and Learn Webinar
Alex Fox
CEO - Shared Lives Plus
28 July 2016
Personal Health Budgets, Integrated
Personal Commissioning and
Transforming Care
Di Domenico
Personalisation Lead, Learning Disability
Programme – NHS England
Shared Lives: the connection test
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Date Topic Guest speaker Venue
25 Aug 2016
Co production – a long term relationship and
different Conversations
and
Transforming Care and Building the Right
Support – the CQC approach to registering
services for adults with learning disabilities
Samantha Clark, Chief Executive, Inclusion North
Theresa Joyce and Sue Mitchell - Care Quality
Commission
Webinar
29 Sept 2016
To be confirmed To be confirmed Webinar
27 Oct 2016
To be confirmed To be confirmed Webinar
24 Nov 2016
To be confirmed To be confirmed Webinar
26 Jan 2017 To be confirmed To be confirmed Webinar
23 Feb 2017 To be confirmed To be confirmed Webinar
30 Mar 2017 To be confirmed To be confirmed Webinar
Learning Disabilities: Share & Learn webinar programme
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www.england.nhs.uk
Personal Health
Budgets, Integrated
Personal
Commissioning and
Transforming Care
Di Domenico, Personalisation Lead – Learning Disability Programme
July 2016
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www.england.nhs.uk
Claire has a personal budget
You can see her story at
www.cpstrust.co.uk
The My Life My Way initiative in Hampshire will
give many more people the chance to have
choice and control via an integrated health and
social care personal budget
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Claire used to live in residential care. Because of her
personal health budget she now lives in her own home
and can enjoy sailing. Not only that …
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… she met with Simon Stevens, chief executive of NHS
England. They talked for 2 hours about how more
people like Claire could get choice and control.
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Personal Health Budgets: national
policy context
• Continuing healthcare: since Oct 2014 people receiving NHS Continuing
Healthcare (and children receiving continuing care) have had the right to
have a personal health budget.
• Children and Families Act 2014: children who have special educational
needs should have a single assessment, an Educational, Health and Care
Plan and the option of a personal budget.
• The NHS Mandate 2020: sets the expectation that by 2020 50-100,000
people will have a personal health budget or integrated budget. This
could include people with Learning Disabilities, beyond the Transforming
Care Cohort
• The 2016/17 Planning Guidance: CCGs to develop “Sustainability and
Transformation Plan” and sets the expectation that personal health
budgets and integrated budgets should be an integral part of these plans.
• Building the Right Support (Transforming Care): Implementing personal
health budgets and integrated budgets are a key part of realising the
ambitions
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www.england.nhs.uk
What is a Personal Health Budget?
• A Personal Health Budget is an amount of money to
support a person’s identified health and wellbeing needs,
the application of which is planned and agreed between
the individual, their representative, or in the case of
children their families, or carers and the local NHS team
• It is not new money but rather the money that would
normally have been spent by the NHS on a person’s care
being spent more flexibly to meet their identified needs
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www.england.nhs.uk
The Essential Parts of a PHB
The person……
• knows upfront how much money they have available for healthcare and support
• is enabled to choose the health and wellbeing outcomes they want to achieve, in dialogue with one or more healthcare professionals.
• is involved in the design of their care plan.
• is able to request a particular model of budget that best suits the amount of choice and control with which they feel comfortable.
• is able to spend the money in ways and at times that make sense to them, as agreed in their plan.
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www.england.nhs.uk
Part of the solution:
• Radically change the relationship between the health professional and patient to a much more equal one.
• Centre around a care plan and focus on outcomes
• Delivers integration at individual level and higher quality care.
• Works well for people with the highest support needs.
• Enable a wider range of possible solutions than traditionally commissioned services. Not new money
• Promotes self-management and reduces reliance on NHS services.
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www.england.nhs.uk
PHBs enable people to do different
things, this rightly stimulates debate
• Look at the whole picture not just one aspect of care in isolation
• Proactive vs reactive approach to planning/delivering care
• What was the health outcome/need, and did the things agreed in the care plan meet these? What is the traditional NHS solution?
• What is the evidence for both the traditional option and what the PHB is being used for
• Consider overall cost effectiveness, what is the overall impact of the PHB ?
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www.england.nhs.uk
Integrated Personal Commissioning
• At its most basic Integrated Personal Commissioning (IPC) shifts control to service users to plan and shape services that fit with their lives.
• It moves the relationship with services from ‘what’s the matter with you’ to ‘what matters to you’. For the first time it allows service users control over spending on themselves across health, social care, as well as key areas like education for children with complex needs.
• Described as a ‘new commissioning model’, with individuals who have complex needs given the option of ‘commissioning’ their own care through an integrated personal budget.
• Nine sites are testing out these new models, 5 of which are focussing on people with a learning disability – more demonstrator sites planned
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What needs to be different at an
individual level? • One person at a time: supporting people to live in their own
home or family home – at same cost or less than conventional services
• Outcome-based: focus on what matters to the person and their family, build on people’s assets and interests
• Whole-life, whole family approach: housing, education, employment, leisure and interests, not just health and care needs
• Joined-up - transition from children to adult services, and between social care and health
• Tailor-made solutions: Direct payments, individual service funds/third party budgets, equipment, support from hand-picked, well-trained people
• Risk enablement: thinking differently and being creative
• Developing peer support and VCS: peer networks, support planning, advice and advocacy
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www.england.nhs.uk
What needs to be different at a
strategic level? • Strong leadership – a clear vision that is communicated and
shared
• Individual champions – and wider support for a more person centred approach
• Accessible information – in different formats and easily available
• Peer networks - “tell it like it is”
• Build confidence in the system – adequate plans for scale and pace in personalised approaches
• Joint NHS/social care processes and infrastructure
• Training and workforce development in a range of person centred approaches
• Market development using intelligence from experts by experience
• “What isn’t forbidden is possible”
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www.england.nhs.uk
Learning so far: what can help
• Ensuring a strong voice for people with learning disabilities and families throughout
• Using people’s stories and promoting good practice
• Targeting family carer and self-advocacy groups to raise awareness
• Peer support and independent brokerage
• Holistic and personalised support planning
• Start young!
• Commitment to joint working
• It shouldn’t matter where the money comes from!
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www.england.nhs.uk
Learning so far: pitfalls
• Can be hard to make the right links locally
• Senior people need to be on board
• Caution and risk aversion
• “Ping pong” between children’s services, adult
services and NHS/social care
• “What’s new/we are already person-centred”
• It takes a lot of work and time to make change
happen even for a few people
• Focus only on individual at expense of strategic
change
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www.england.nhs.uk Personal health budgets – Accelerated development programme 17
If you’re going to do it, do it right
• Evaluation – showed that PHBs work best for those with the most complex needs BUT the benefits depend on how they were introduced.
• Best results – people know budget up front; advice and support available; choice and flexibility over how to spend budget , choice on how it is managed, knowing the ‘offer’.
• Scale-up - challenge of maintaining the integrity of the values.
• To work well, personal health budgets need: - good support from all parts of the system - co-production with people with direct experience
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www.england.nhs.uk
What Support is available?
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www.england.nhs.uk
What is already available
• Stories and films
• Guide to PHBs for people with learning disabilities
• Personal health budgets toolkit and FAQs
• Learning network and discussion forum
• Regional networks
www.personalhealthbudgets.england.nhs.uk
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www.england.nhs.uk
Resources and information
• NHS Choices
• Personal health budgets: Including people with learning disabilities
• More resources about people with learning disabilities:
• stories and films
• delegation and risk
• Advice on employing personal assistants
• Third party budget and ISFs
• Joint commissioning across age groups and agencies
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www.england.nhs.uk
• IPC targeted support: On-site support to areas taking part in the Integrated Personal Commissioning programme
• This will focus initially on the 9 existing IPC sites; there will be an option to expand more widely during 2016-17 which may also include TCPs.
• The objective will be to develop a set of places that are taking the lead in implementing personal health budgets and integrated personal budgets, and building this into the local approach for Transforming Care.
• Information from IPC sites will be shared via the Sustainable Improvement Programme
What will be available 16/17 - IPC
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www.england.nhs.uk
Questions
22
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Shared Lives: the connection test
Alex Fox, CEO
Shared Lives Plus
www.SharedLivesPlus.org.uk
http://alexfoxblog.wordpress.com
http://vimeo.com/108993357
Karl and Clare with Shared Lives carers Blossom and
Mike, at their wedding, before moving to live
independently
Kent Shared
Lives
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James
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From a report by Your Voice Counts 2015.
Shared Lives is when you live
with a family or one carer in
their home and they help and
support you with what you
need.
A chance to have a
life with their
family.
When I moved into shared lives my carers
saved my life, I was depressed and being
bullied before I went to live with them.
Now I feel so much better.
I love everything about
my life: now I feel like I
belong to a family.
Where I live now is the best place
I have ever lived. I have my
freedom but I know people care
about me and I feel safe.
What Shared Lives means
to me
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• Achieves great outcomes like
(lots of!) new friends.
• Government inspectors say
Shared Lives is consistently
better and safer.
• £26,000 a year lower cost per
person.
Safer, better, lower cost
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www.england.nhs.uk
Shared Lives Plus is the UK network for Shared Lives and
Homeshare. Our members are Shared Lives carers, Shared
Lives schemes and Homeshare programmes.
Shared Lives Plus was established in 1992 and has over 5,500
members UK-wide, including 5,000 of the UK’s Shared Lives
carers and almost every Shared Lives scheme and
Homeshare programme.
Our sister organisation develops the micro- and community
enterprise sector and supports Shared Lives development:
www.CommunityCatalysts.co.uk
Who are we?
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www.england.nhs.uk
Transforming care
Shared Lives has demonstrated it can be part of the solution:
• A distinct support choice available in nearly every area
• Adaptable for people with complex needs
• A twin focus: great care and a great life.
A different ethos:
• ‘Independent’ doesn’t have to mean living alone.
• A good life is about friends, family, purpose, love.
• Asset-based: people contribute to a household & community
Personalisation: lessons from social care, RSA: http://goo.gl/QSlDg
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www.england.nhs.uk
• The Shared Lives carer’s house feels
like a family home.
• Participants share home and family
life, either living together or through
the adult visiting their Shared Lives
carer regularly.
• Organised by 150 registered local
schemes who recruit, train, support
and monitor Shared Lives carers.
“You see people grow - they blossom.”
Sharing home and family life.
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www.england.nhs.uk
The Shared Lives carer role
Personal & unpaid
• Sharing home
• Sharing family life
• Family & friends help
• Visible & valued
• Build informal networks
• Holidays together
• Professional personal care
• Max 3 individuals
• Self-employed: no ‘staff’
• Trained & paid (not p. hr)
• Can use ‘support carers’
• 4 weeks paid breaks p.a.
Professional, paid.
Shared Lives
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www.england.nhs.uk
Shared Lives relationships
Shared Lives carer
Shared Lives
agency
Care manager
Advocate
Local council or NHS
Shared Lives Plus
Government
inspectors
Families
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Shared Lives carer
assessment and approval
Shared Lives Haringey • Rigorous 3-6 month
assessment and approval
process.
• Looks for skills, values,
attitudes and knowledge.
• Considers housing and
rest of household.
Initial meeting Application & interview
ID & DBS, references
Training pre & post approval
Approval process
Approval panel
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Shared Lives carer
My family
Shared Lives matching
Shared Lives carer family
Me • Matching takes time, but
pays huge dividends.
• Short breaks can be part of
matching.
“It’s like extending
your own family.”
Paper matching Involve family
Meeting Activities Overnight, Weekend
Trial period
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Shared Lives consistently outperforms all other regulated care.
Inspection results 2015
The number of scheme staff stayed static this year (8% increase last year).
Increase workloads and turnover pose a risk to continued high safety and
quality.
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Shared Lives: outcomes
‘Firsts’ for 500 individuals using Shared Lives:
• 35% learned a household task
• First ever holiday: 30% (UK) 16% (abroad)
• First boyfriend/girlfriend: 12%
• 26% joined a club not
exclusively for disabled people.
• Almost all made friends.
• 34% of service users had
made five or more new friends.
Our outcome measuring tool has
been piloted for launch soon.
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Shared Lives carer
John Shared Lives
scheme
How the funding flows
£
£
£
£
Local Council or
NHS
£ Housing benefit
£
Disability benefits
£
1 coordinator
to 25
supported
individuals
(live-in).
Payment for
care includes
4 weeks’ paid
breaks p.a.
1
2?
3? Staff team & office
Recruiting,
training,
supporting
Shared
Lives carers.
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www.england.nhs.uk
Shared Lives growth in
England
In England in 2014-15 11,570 people were being supported
in arrangements, an increase of 2450 (27%) in two years.
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Regional variation
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• Lancashire Shared Lives supports 11% of people with learning
disabilities who receive support. If all areas did this, 7300 more
people would use Shared Lives, saving £227m.
• Vivo Care Choices in Cheshire West support 3% of older
people who access support. If all areas did this, 23,860 more
people would use Shared Lives, totalling 25,600.
• Herefordshire Shared Lives supports 2.6% of people using
mental health services. If all areas caught up, 6000 more people
would use Shared Lives, saving £42.7m
• If all areas caught up with the best performing, 37,000 more
people would use Shared Lives (48,600 in total) saving £145m.
The areas out in front
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www.england.nhs.uk
Connect
people &
families
Our national role
Shared Lives Plus
Support Shared Lives carers
Raise
awareness
& influence
Innovation
research
& grants
Awareness
Support
local
schemes
Families Advice
skills &
learning
Protect
the values
& ethos
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www.england.nhs.uk
Mental
health
support
We support innovation
Shared Lives
Parent & child
Transitions
& young
adults
Domestic
violence
Awareness
Older
people &
dementia
Families Offenders
substance
misuse
Out of
hospital
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www.england.nhs.uk
A number of approaches are arranged around
informal networks & fostering social action:
• Shared Lives
• Homeshare
• Local Area Coordination
• Circles of Support
• Micro-enterprise development
• KeyRing networks
Could we challenge all interventions to connect people?
The connection test
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www.england.nhs.uk
Alex Fox, CEO,
Shared Lives Plus,
www.SharedLivesPlus.org.uk
07738641897
http://alexfoxblog.wordpress.com
Twitter: @alexsharedlives
• The new social care, Royal Society of Arts, 2013: http://goo.gl/6NPnP;
• Can we have a People Powered NHS? RSA, 2014: http://bit.ly/1psacBe;
• Our 3 minute film: http://vimeo.com/108993357
Contact details
West Wales Adult
Placement