Self Directed Approaches Lessons from a UK provider

Steve Scown CEO Dimensions

The UK context

• Number of Local Authorities (LAs): 152

• LA adult social budgets: £19b (34.2B AUD)

• Number of provider organisations: 12,700

(86% have less than 50 employees)

• Number of people employed in social care: 1.63m

• Number of adults receiving social care support with a personal budget: 605,000

(over 100,000 employ their own care staff)

Dimensions

• Support adults, young people and children with learning disabilities and who experience autism

• Support and accommodate over 3500 people

• We offer support via residential homes, supported living, short breaks, day services and supported employment

• Work in 70 Local Authority areas

• Employ approximately 5000 staff

• Budgeted turnover in 14/15 of £110m

Our Challenges

• Traditional services have offered secure income

• Traditional services are less and less in demand by people who exercise choice

• People want personalised services

• Personalised services have small and fixed margins

• Local authorities have less money to fund increased need

The Provider Conundrum

Managing yesterday’s services today whilst developing new ways of listening and responding to tomorrow’s customer –

and accepting less money for doing it.

The LA commissioned service

Paul lives in a home with 4 other people

Local Authority pays Dimensions £50k per annum

Home has a team of 5 staff – there is 1 staff member there all the time during the day and 1 sleeps in at night

There are 40 hours of shared support per week

Paul wanted to go abroad for a holiday and a group of 8 people decided if that was OK

Paul spends 2 days a week at the local learning disability day centre and the rest at leisure.

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What Paul wants

Paul has an Individual Budget of £34k.

Paul pays Dimensions £22k a year for:

Support in the mornings whilst his Mum is at work

Support 2 days a week whilst he works in a garage keeping the floor clean and the place generally tidy

Support every 4th weekend whilst he goes away for short breaks – either camping or on a city break

One of his support workers is his cousin at his family’s insistence.

Paul is offering a one-off £3k payment if Dimensions can find him a job which he can keep for 6 months.

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“So basically you’re moving from wholesale to bespoke

retail!”

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Our initial market prediction

Now B2B B2C

Future B2B B2C

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Our current experience

£ Local Authority Customer

“It is not the strongest of the species that survive, nor the most intelligent, but the one that is most responsive to

change”

Charles Darwin

Our first journey

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The key questions we posed ourselves

• How will Paul and his Circle of Support know about Dimensions?

• What do we want Paul and his Circle of Support to think of us?

• Can we provide what Paul and his Circle of Support will want to buy?

• How do we cost and then price very different models of support / products?

• How different will Dimensions and our staff have to be?

Your offer - one-off products

Something a family may purchase which may or may not lead on to further business:

Facilitation of a PCP

Support Design

Behaviour Analysis

Review

AT Assessment

Holidays

Service Design

Benefit Review

H&S Environment

Review

Housing Brokerage

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Your offer - defined term products

Something a family may buy for a fixed period of time with a pre-determined outcome:

• Life skills training

• Community integration

• Active support

• Job skills training

• Facilitation of PC Review

Your offer - ongoing products

Something a family would purchase without an end timeframe:

Personal care & support

Sleep-in

Live-in Support

Short Breaks

Training of PAs

Quality Assurance

Waking night

Housing related support

Recruitment of PAs

Management of team of PAs

On-call & out-of-hours

support

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Costing the offer

Overhead activity

Activity Based Costing/Insurance

Premiums

Client Group/Postcode

Specials

Refunds/Discounts/Free offers

Human Resources

Bespoke - Person Specification

- Job Description

- Employment Contract

- Rates of Pay

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You Decide – We Employ

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Human Resources

Our second journey

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Plan

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So what changed for Anne Marie?

• New people in her relationship map

• Voluntary work

• Unpaid support

• New places

• Re-connected with old friends

• Busier and happier

• Better relationship with estranged sister

Reflections on our learning so far

• Ensure all leaders and key organisational players are actively engaged and prepared for the change.

• Establish what good will look like - for your organisation, the people you support and your staff - as soon as possible.

• Be realistic about what you try to achieve - major change takes courage, determination and time.

Reflections on our learning so far

• Be prepared to feel comfortable with discovering some things that are not good enough and must change.

• Be prepared to engage in honest and open dialogue and avoiding the ‘blame game’.

• Develop your organisational response to dealing with a member of staff whom nobody wants to support them.

Reflections on our learning so far

• Develop your own views very early as to how you will manage and account for individual income streams

• Consider the impact upon your organisation when the people you support decide how you spend your funding.

• Staff find change easier when engaged in the process of change and receive support, training and independent challenge.

Reflections on our learning so far

• Everyone, including business support, but particularly every member of operations must be familiar with and ‘fluent’ in person-centred thinking tools.

• Help your staff understand they must have their own personal offer for the people they are supporting. If they haven’t got one, help them to develop one.

• Incorporating feedback from people being supported and their families into individual supervision and appraisal is very beneficial when trying to change staff attitude and behaviour.

Managing through the tough times

• It is easy to under-estimate the impact of broader organisational change upon local services and their attempts to improve how they provide support.

• Find anchor points that are real and use stories and journeys to connect people to change.

• Accept it will never be right and just keep on going.

“If you want something different to happen, you have to do something different”

Sharon Di Santo

• steve.scown@dimensions-uk.org

• @sscown #OzAdventure

• www.dimensions-uk.org