Personal Budgets

South East and London 2 Pathfinder Champion Event

5th February 2015

Welcome and introductions

• Introductions

• Intro session – interactive, interesting, challenging, reflective, action focussed, fun even!

Accessible to all

Champion contact details

Calendar of events for the region

Delivery Partner information

Useful resources and links

www.se7pathfinderchampion.co.uk

South East and London 2 Regional Wiki

Personal Budgets – Regs and the Code of Practice

andrew.baxter@education.gsi.gov.uk

Personal Budgets

• The Special Educational Needs (Personal Budgets) Regulations 2014:– Made on 24th June 2014– Came into force on 1 September 2014– Available at www.legislation.gov.uk

• Code of Practice:– Approved by Parliament on 29 July– Chapter 3: Joint Commissioning– Chapter 4: Local Offer– Chapter 9: EHC plans– Available at

www.gov.uk/government/publications/send-code-of-practice-0-to-25

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Code of Practice and Personal Budgets:Joint CommissioningChapter 3: Working together across education, health and care for joint outcomes (3.11, 3.38-3.39):

Arrangements must include arrangements for agreeing personal budgets…(3.11)

and should develop and agree a formal approach to making fair and equitable allocation of funding and should set out a local policy for personal budgets …(3.38)

To do this, partners should:• Identify and agree the funding streams and services for inclusion and develop the

necessary infrastructure …• Identify the links to be made locally between the SEN offer and personal health budgets..• Identify and establish the information advice and support…to help families considerer

options for, and to take up and manage, personal budgets• Develop a pathway with… EHC needs assessment and plan development and the

workforce and cultural changes necessary for a person centred approach.• Identify how the new joint commissioning strategies will support greater choice and control

year-on-year…• …ensure children, young people and families are involved in decision making processes at

both an individual and a strategic level (3.39)

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Code of Practice and Personal Budgets: The Local Offer

Chapter 4: The Local Offer (4.58)

The Local Offer …must include information about the option of having a personal budget, including a local policy produced with parents and young people. This should provide:• A description of the services across education, health and social care that currently

lend themselves to the use of personal budgets• The mechanisms of control for funding available…• Clear and simple statements setting out eligibility criteria and the decision making

processes that underpin them• The support available to help families manage a personal budget

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Code of Practice and Personal Budgets: At an individual level

Chapter 9: Education, Health and Care needs assessment and plans (9.62, 9.95 – 9.124)

EHC plan section j –the details of how the budget will support particular outcomes, the provision it will be used for including any flexibility in its usage and the arrangements for any direct payments in education, health and social care. The SEN needs and outcomes that are to be met by any direct payment must be specified (9.62).

The child’s parent or young person has a right to request a personal budget when the local authority has requested an EHC needs assessment and confirmed that it will prepare a plan. They may also request personal budget during a statutory review... (9.98).

The child’s parent or the young person should be given an indication of the level of funding that is likely to be required…local authorities should be clear that any figure discussed at this stage is indicative…the final allocation…must be sufficient to secure agreed provision specified in the plan. (9.102)

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Code of Practice and Personal Budgets: At an individual level

Chapter 9: Education, Health and Care needs assessment and plans (9.62, 9.95 – 9.124)

Details of the proposed personal budget should be included in section j of the draft plan…local authorities must also provide written notice of the conditions of receipt of any direct payment for SEN provision and can do this alongside the draft plan…(9.103)

Where a direct payment is proposed for special educational provision, local authorities must secure the agreement of early years settings, school or college, if any provision is to be delivered on that institution’s premises…should usually do this when consult institution about naming it on the child or young person’s EHC plan (9.104)

Local authorities must consider each request for a personal budgets on its own individual merits (9.106).

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Code of Practice and Personal Budgets: At an individual level

Chapter 9: Education, Health and Care needs assessment and plans – draft revised version 9.106:

Local authorities must consider each request for a Personal Budget on its individual merits and prepare a Personal Budget in each case unless the sum is part of a larger amount and disaggregation of the funds for the Personal Budget:

• would have an adverse impact on services provided or arranged by the local authority for other EHC plan holders, or

• where it should not be an efficient use of the local authority’s resources

In these circumstances, the local authority should inform the child’s parent or the young person of the reasons it is unable to identify a sum of money and work with them to ensure that services are personalised through other means. Demand from parents and young people for funds that cannot, at present, be disaggregated should inform joint commissioning arrangements for greater choice and control

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Joint commissioning to support personalisation, including

personal budgets

Joint commissioning - supporting and extending personalisation

• Joint commissioning• Making It Personal • Levels of commissioning• Joining up around the individual• Discussion

• Commissioned by The DfE. A partnership, led by KIDS between:

• 2-year SEN and Disability grant (April 11- April 13)

• Further 2 years from April 2013 - 2015

The Making it Personal Project

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Commissioners guidance Providers guidance A family guide to Personal Budgets

• National Association of Family Information Services SEND framework • Case studies• E learning

Making it Personal Products

The commissioners guidance - what is it?

A resourcePracticalDeveloped with providers, commissioners and families Interesting, challenging, aliveOn-going group on the Local Government Association’s

Knowledge Hub – Q + A’s

• For parents and carers, providers and commissioners new to the personalisation agenda

• For those familiar with personalisation but not how they and/or their organisation needs to develop/change to support the agenda

Target audiences

Content• Understanding personalisation – the changes

needed to traditional systems, cultures, behaviours & processes

• History of personalisation including policy drivers

• The commissioning cycle – applied to all perspectives (commissioners, providers, families)

• Exemplars

What is personalisation?

• It’s about a fundamental change in how we think about and organise services and support, and particularly how we think about disabled children, young people and their families

• Not just about Personal Budgets!

Personalisation

• An approach that sees children and young people as individuals with unique skills, talents, aspirations, preferences & support needs.

• Sees the young person and their family as part of, & firmly rooted in, their local community.

• Puts the individual person in the centre with everyone working together as equal partners to support and enable them to achieve their potential in all areas of life

Co-production

“A relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities”

New Economics Foundation

Commissioning

Commissioning is the process for deciding how to use the total resource available for children, young people and their families in order to improve outcomes in the most efficient, effective, equitable and sustainable way

Commissioning Support Programme

Commissioning - jointly

• Children and Families Act• NHS Mandate• Care Act• Health Outcomes Forum• Ministerial commitments• SEND Code of Practice

= Unique opportunity!

Children and Families Act 2014

Key principles:• Planning for whole-life outcomes • Higher aspirations for young people• Co-production and working with the skills and

connections that families bring – focus on building resilience

• Keeping support close to home/local services• Assessment and planning from 0-25• Choice and control including through the use of

Personal Budgets

Section 25

• Duty on LAs to ensure integration between educational, training, health and social care provision where this would promote wellbeing and improve the quality of provision for children and young people with SEND

• Local partners must co-operate

Specific objective on supporting children and young people with SEND, including through the offer of PBs.

CCGs have a statutory duty to act consistently with the Mandate.

NHS England, CCGs and Health and Wellbeing Boards must promote the integration of services

Dan Poulter & Edward Timpson letter April 2014

From September 2014, local commissioners will be required to work together in the interests of children and young people with SEND.

Arrangements must be robust enough to reach a decision in every case, and regularly reviewed.

In the SEND Code of Practice, we will encourage LAs and CCGs to agree shared outcomes, using a joint analysis of intelligence and data about the area

Requires LAs to ensure co-operation between children and adult services to promote the integration of care and support with health services so that young people are not left without care and support as they make the transition between children and adult social care.

Chapter 3 – covers:-

• The scope of joint commissioning arrangements• How local partners should commission services to

meet local needs and support better outcomes• The role children and young people, parents and

representative groups have in informing commissioning arrangements

• Responsibility for decision-making in joint commissioning arrangements

How commissioning helps

• Efficient• Transparent• Neutral• Defendable• Clear• New ways of thinking

• Encourages diversity• Wide application• Engages All• Change Agent• Defined path• Outcome focussed

Commissioning levels• Individual level commissioning

– Lead professionals and/or social workers – Parents and young people

• Operational/community level commissioning– Focus on care groups/care pathways – CCG, district or county council level

• Strategic commissioning – Strategic plans, pace of change, resource allocation, managing

whole system, performance, cyclical

Strategic level - musts

• Partners must agree how they will work together (3.7)

• Partners must engage children and young people with SEN disabilities and children’s parents in commissioning decisions, to give useful insights on how to improve services and outcomes. (3.18)

• LAs, CCGs and NHS England must develop effective ways of harnessing their views (3.18)

“Musts”

• LAs must keep their education, training and social care provision for children and young people with SEND under review (1.19)

• LAs must consult children and young people with SEND and their parents (1.11)

• LAs must involve children and young people with SEND and their parents in the development and review of the Local Offer (1.20)

Scope of joint commissioning musts

• Cover services for 0-25 year old children and young people with SEND (with or without EHC Plan) (3.9)

• Arrangements for agreeing the education, health and social care provision reasonably required by local children and young people with SEND (3.10)

• Arrangements for:-– Securing EHC needs assessments, the education,

health and care provision specified in plans (3.11)– Agreeing Personal budgets (3.11)

Joint commissioning

• Should aim to provide personalised, integrated support that delivers positive outcomes… bringing together support across education, health and social care from early childhood through to adult life, and improves planning for transition points… (3.7)

Effective partnerships (3.13)

• LAs must work to integrate educational provision and training provision with health and social care provision where they think this would promote the wellbeing of children and young people with SEN or disabilities

• Local partners must co-operate with the LA in this.

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As part of their Local Offer, Local Authorities must include information about the option of having a PB including a local policy for PBs, produced with parents and young people (4.58)This should provide:- a description of the services across education, heath and social care that currently lend themselves to the use of PBs- the mechanisms of control for funding available to parents and young people- clear & simple statements setting out eligibility criteria & the decision making processes that underpin them- the support available to help families manage a PB

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Personal Budgets - COP

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Scope of Personal Budgets – COP

The scope of PBs should increase over time as local joint commissioning arrangements provide greater opportunity for choice and control over local provision (9.110)

Resilience, identity & contributionThe need for a person centred approach to the integration of support to people and communities – summer 2014

The challenge

• “To retain a focus on the person, child and family whilst having to redesign services and approaches to commissioning maintain both commitment and focus on being person centred and the need to integrate to improve the lives of people who need support”

Integration must be integration around the person

• Real integration means an equal partnership between the child, the family and their communities – set alongside any offers of support through public funding

• Person centred integration is about supporting community members towards independence, interaction and interdependence and doing so in simple, easily understood ways that make sense to people

Integrated PBs

• Their experiences?

• Examples from elsewhere

MIP

The commissioning cycle

SEND COP

• Partners should use their joint understanding to determine the shared outcomes they seek to achieve (3.33)

• They should draw on national & local priorities• This should be a transparent process – the local

community should be aware both of what the shared outcomes are and the plan to achieve them. This requirement could be discharged through the requirement to consult publically on the Local Offer. (3.33)

Understand• JSNAs & joint data sets• Shared outcomes - POET

To EnjoyTo Participate

To Achieve

COP (3.3)

• Partners should use their joint understanding to determine the shared outcomes they seek to achieve

• They should draw on national & local priorities• This should be a transparent process – the local

community should be aware both of what the shared outcomes are and the plan to achieve them. This requirement could be discharged through the required to consult publically on the Local Offer.

• Local offer - aligned to the new joint commissioning duty

• Improved information, transparency & accountability

• Understanding the real cost of services & the outcomes they achieve

Understand

Individual level

• Clearly defined outcomes which are meaningful to the individual or family will unite resources and the way they interact

Plan

• to transform support & outcomes for disabled children and young people • developed by parent/carers & professionals from a range of services, informed by young

people & regularly reviewed• overall vision to ensure that within 10 years:-

– Disabled children equal their non-disabled peers in the extent to which they achieve agreed outcomes and reach their potential, and that this is monitored and evidenced

– All disabled c&yp are able to access the same range of opportunities, community activities and mainstream support as their non-disabled brothers, sisters and friends, with additional support being available as necessary, & receive specialist services only where this is the most effective way of meeting identified needs

– All staff in mainstream provision confident and able to work with all disabled children/young people apart from those with the most complex of needs

– C, yp & families in the driving seat in the development of support and removal of barriers– Statutory services (& services commissioned by statutory commissioners) build on the

strengths & abilities of children and families rather than focusing on what they cannot do & where they are failing to cope

– Yp move smoothly into adulthood with changes in support being planned & known in advance

Gloucestershire County Council’s 10 year commissioning strategy – (2007-2017)

Commissioning for inclusion

• Newcastle exemplar

• Early use of Market Position statements

Do - changing systems & processes

• From block contracts to individual commissioning - power in the hands of families & front line workers

• A different partnership with providers• Learning from adult services & each other• Individual Service Funds

Block Contracts• The premise – the degree to which

personalisation & PBs can transform the system is limited by how far providers develop personalised offers & the support that children & families want to buy

• Need, therefore, to review:-length of contractswhether to continue, re-procure in a different way,

cease altogether

Block contracts – possible options

• Reduce the size to cover core costs only – then spot• Provide an initial safety net – then taper the value of

contracts• Use framework rather than block contracts – QA• Cease block contracts & reinvest in community

resources• Support providers, including schools, to personalise

their services

Individual Service Funds

Providers can develop ISFs by:• Responding to individual commissions from

people or their families acting on their behalf, responding to individual commissions from commissioners

• Transforming block contract monies that they receive and committing to using that money in a personalised way, ideally in partnership with the service user and commissioner

Opportunities

• Understanding what types of personalised services people are wanting

• Shared training• Changeover in financial systems to handle

costing and billing of services on a per person basis

• QA processes – Trafford• Supporting the pooling of budgets

Review • Are we achieving outcomes? How do we know?• Linking the investment of resources to the

achievement of outcomes• Is the right support for people out there?• Are people and communities becoming more

resilient & self-sufficient?

Lunch

Afternoon session

• Examples of work going on around the country – POET, Integrated RAS systems, London work on joint commissioning and possible Action Learning Sets

• Small group activity and discussion

• Action planning

“Musts”

• At a strategic level, partners must engage children and young people with SEN disabilities and children’s parents in commissioning decisions, to give useful insights on how to improve services and outcomes. (3.18)

• LAs, CCGs and NHS England must develop effective ways of harnessing their views (3.18)

What’s working and what’s not?

• Children’s POET

Children and Young People’s POET – the brief

A tool able to capture:-– The experience of obtaining an EHCP (and in

some cases a personal budget) from the perspective of the child/young person, family and practitioner

– Outcomes of having an EHCP (and in some cases a personal budget)

POET

• In total over 8000 people across health, adult social care and children’s services have shared their experiences to date using POET.

• Latest adults services report includes data from over 4000 people – over 2,500 personal budget holders and over 1,300 carers

• Personal Health Budgets report – 129 personal health budget holders and 101 carers

POET questionnaires

• Low cost• Quick and easy to complete on line or on

paper• Able to repeat• Ask people meaningful questions about what’s

working (and what isn’t working)• Feedback and action planning• Voluntary

How does POET evidence help?

• A way of measuring and understanding performance as it is understood by local people – practice-based evidence

• Focused on outcomes as well as ‘experience of process’

• Enables pooling of information to produce big enough datasets to address questions that could not be investigated using local data only

National evidence - adults

• Views fully included when needs are being assessed

• Views fully included when the amount of budget was set

• Views fully included when support plan was written

• Support to plan• Ensuring the personal budget process is easy

Children and Young People’s questionnaire - testing & timescales

• First iteration - 6 Local areas• Second iteration & the children and

young people’s tool – 20 local areas – benchmarking reports

• Available to use nationally from Spring 2015

The first six sites

• Cambridgeshire County Council• Essex County Council• Lincolnshire County Council• Middlesborough• East Sussex • West Sussex

Testing September-December 2014

• London: Greenwich, Islington, Lambeth, Newham• South East: Brighton & Hove (West & East Sussex)• South West: Gloucestershire & Torbay• Yorkshire & Humber: Doncaster, York & North

Yorkshire• North East: (Middlesborough)• East Midlands: Leicester City & Nottinghamshire CC• West Midlands: Worcestershire• East: Hertfordshire (Cambridgeshire & Essex)• North West: Wigan

Summary of findings

• Both parents/carers & practitioners were broadly positive about the process of ECH Plans or PBs

• At least 80% of parents/carers said that things had worked well all or most of the time

Parent Carer experience of process

Experience of process (Practitioners)

Parent/carer outcomes for their children

Parent/carer outcomes for themselves

Does the EHC Plan/PB meet the needs of your child

How PBs were used

Free text responses (parents)

Areas identified by both families and practitioners

• Working in Partnership• Keeping the process simple

How are local areas using POET?

• Holding local engagement and planning sessions

• Incorporating POET within regular processes for checking user experience

• Benchmarking and action planning

Next steps

• Analysis of the 500+ returns• Second national report• Individual benchmarking reports • Final editing of the tools• Refined tools available Spring 2015• Coherence

Other developments

• Northern Going Further Faster Sites – integrated RAS

• London – work on joint commissioning including possible action learning sets

• Work for NHSE on extending PHBs to children and young people with long-term health conditions

Group Work

Discussion – 30 mins• Market development• Block contracts – releasing funds• Extending PBs including integrated PBs• Using EHC Plans to inform JSNAs

Action planning – local and sub-regional/regional

Useful websites

• http://www.in-control.org.uk• www.in-control.org.uk/ehcpoetreport

http://www.kids.org.uk• https://knowledgehub.local.gov.uk/group/

makingitpersonalcommissioners• http://www.councilfordisabledchildren.org.uk• http://www.sendpathfinder.co.uk/foodforthought• http://www.sqw.co.uk• http://www.thinklocalactpersonal.org.uk• www.se7pathfinder.co.uk

clairelazarus@btinternet.com

07880 787190

Wrap up and next steps

Close