A project in Lincolnshire is bringing together commissioners and providers in a new way to provide better, more person-centred outcomes for service users. Matt Bukowski explains:
With local authority budgets continuing to tighten, the need to make better use of resources to help realise the goals of the personalisation agenda is imperative. To achieve this, North East Lincolnshire Care Trust Plus is undertaking a project to reshape the local market for services to give people with learning disabilities more opportunities to lead their own lives in the community, rather than having to move into residential care – and at less cost than previously.
The trust was established in September 2007. It was set up by North East Lincolnshire Council and the local primary care trust to bring together health and adult social care services within a single organisation. The trust is responsible for commissioning services for adults with learning disabilities. In practice this means: assessing the needs of the population, reviewing services and identifying gaps, prioritising outcomes to be achieved, procuring services and managing relationships with service providers.
Commissioners at the trust are determined to create a culture that encourages innovation and discourages reliance on traditional services and support. They agree with the authors of ‘All Together NOW’ – a paper on developing alternatives to just paid support – state that over-support is a barrier to community participation and can be harmful to the quality of people’s lives.
The trust’s commissioning manager Angie Walker says: “For so many years people have been placed in residential or nursing care with limited choice and opportunity. We are now embracing person centred planning and personalisation by giving everyone the chance to have an individual service that is commissioned around their needs. We are committed to providing local support which means that people can be fully engaged in their own communities. That is why we have set up the market reshaping project.”
In the current financial year the trust’s net spending on services for adults with a learning disability is £13.9 million. This includes annual expenditure of £5.4 million on residential, nursing and continuing healthcare placements for 134 people. The principal objective of the trust’s market reshaping project is to create new opportunities for people to be supported to lead their own lives in their own homes as an alternative to institutional care.
Commissioners are focusing on two groups – those already in care homes and young people in transition who would go there if there was no other option. The project has been given freedom to innovate providing that it fulfills the commissioner’s absolute requirement to produce better outcomes at lower cost.
Making change happen
So how did commissioners in northeast Lincolnshire set about making change happen? It all began with a strong and enduring commitment to core values of inclusion, choice and independence. Everything that follows is about putting these values into action. Belief in the values is what sustains commissioners in the face of challenges from those determined to preserve the status quo. Commissioners should regard these challenges as an expected and ordinary part of the process. Change simply will not happen if commissioners and their organisations are afraid of challenge and allow it to compromise their core values.
Having made a public commitment to their core values, commissioners recognised that they could only put them into action once they had developed a local market of personalised housing and support. However, historical reliance on institutional care meant that the trust had no real experience of what might be possible.
As a result, the project began with the premise that the real expertise in making change happen rests with providers. The project has established a collaborative partnership with five providers to make a reality of the trust’s ambitions for people with learning disabilities.
The selection process required providers to give evidence of their ability to turn person centred thinking into person centred action. Progress and Inclusion were appointed as the project’s housing providers and are now investing their own resources in new options.
Meanwhile, support service providers Care UK, Creative Support and Lifeways have been tasked with providing the right level of support at significantly lower cost than current services. The trust will collect information and evidence through a new outcome-based commissioning process to ensure that all the providers are delivering better outcomes at lower cost.
The trust’s partnership with providers is designed to maximise collective change management capacity and capability. Having formally signed up support providers to a framework agreement to deliver the specification, a more informal collaborative approach to managing the project was taken.
Now, a typical project team meeting sees commissioners and providers working together on strategy and tactics, ensuring that there is a shared vision of what they want to achieve and a single plan to make sure that it happens.
Gill Rhodes, Lifeways’ regional manager says: “Once the trust had chosen its providers, we began to work collaboratively. It is refreshing to be able to work in true partnership as there is now no competition involved between providers. We have been able to bring new ideas and promote them jointly, for example, by organising an open day for families and professionals at Grimsby Town Hall.
“Lifeways has been able to share ideas and resources with other providers, particularly with staff recruitment. We are able to respond flexibly to the needs of service users as we carry out assessments, taking account of compatibility and lifestyle issues. The trust has been clear about its objectives, but at the same time is respectful of providers’ experience and expertise. This has fostered open and honest working relationships.”
The values and objectives of the market reshaping project are firmly embedded in the trust’s learning disability strategy, ‘Changing Lives in Partnership 2011 to 2014’. Commissioners, in partnership with the local learning disability partnership board, have consulted extensively on this plan to ensure that changes are widely understood and owned.
Even though people, families and professionals are proud of their recent achievements, the project team has been given a message that they need to do even more to support people to: live in good quality affordable homes; lead healthy and fulfilling lives; exercise choice and control in their daily lives; and experience good transitions from children’s to adult services.
‘Changing Lives in Partnership’ is all about supporting people to exercise real choice and control in their daily lives. However, consultations have identified some barriers that must be removed if this is to become the norm:
- Adherence to service-based thinking can create a tension between assessment, which is about needs, and person centred planning, which is about dreams and aspirations
- Person centred planning provides lots of good information, but it is not routinely used to influence commissioning decisions
- If values are to be put consistently into action, there still needs to be a big culture and practice change for some people, services and organisations
- People and their families sometimes find professional processes such as reviews confusing and inefficient
- People are not always helped to understand how eligibility criteria work in practice.
The trust and the council have also accepted the message from consultation that joint working between adult and children’s services is still not good enough. Some parents and young people report positive experiences of transition, while others struggle to make sense of different professional roles and processes. The council and trust have now set up a transitions board to provide more focused leadership of a single transitions pathway.
The first tangible outcome of better strategic collaboration is that this year for the first time no transitions pathway has led to residential care. Those young people who cannot live at home – including those with the most complex needs – are all being supported in their own tenancies. Those involved believe that this is proof of their determination to put their values into action.
Cooper O & Warren S (2011) All Together NOW. Birkenhead: Paradigm
About the author
Matt Bukowski is a consultant in strategic leadership, partnership building, change management and service development, and principal consultant of Social Care Strategies Ltd.
This feature first appeared in the October/November 2011 issue of Learning Disability Today. To find out more about the magazine, and for details of how to subscribe, click here