Transforming lives and budgets - the Southwark Experience

7/30/2019 Transforming lives and budgets - the Southwark Experience

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Transforming

lives and

budgets - theSouthwark

Experience


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Charity and company limited by guarantee,established in 1984

Work with people with learning disabilities,mental health problems, physical disability,autism, Asperger's syndrome, homeless

Turnover 40 million

Employs 1600 staff (approx.) Support 1000 people

Operate in Wakefield, Mansfield, Oldham,Stockport, Congleton, Nottinghamshire,

Bedfordshire, Milton Keynes, Buckinghamshire,Bracknell, Hampshire, Portsmouth, 9 Londonboroughs


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Southwark 2010-15

Choice Support were pushing at an open door when they suggested an

Individual Service Fund approach for transforming their services in

SouthwarkChris Dorey, Commissioning Manager, Southwark Council 152 people supported

66 registered care, 32 supported living, 54outreach support

Block contract - 6.5 million 83 people


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Summary of key

achievements

The old block contract has been converted to 83 ISFs with

83 personalised support plans created.

Waking-nights have been removed from 11 services (29

people) making Southwark waking-night free.

Increased use of Assistive Technology.

18 care homes are de-registered.

Phased closure of a former PCT campus-like site has begun.

A Shared Lives service has been established. Local authority offered a 1,795,073 reduction in price on

a 6.5 million contract (29.75%)


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Savings

FINANCIAL YEAR PER ANNUM CUMULATIVE

2010-11 324,250 324,250

2011-12 310,750 635,000

2012-13 260,314 895,314

2012-14 250,041 1,145,355

2014-15 649,718 1,795,073


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How savings were achieved (i)

The key savings agreed included reducing:

the direct cost of hourly support rate

local and central overheads to 15% of ISFs

provision of support based on person

centred plans (PCPs).


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How savings were achieved (ii)

deregistering existing homes

reducing the cost of each support hour i.e.

changes in existing staff terms & conditions and

management restructure

reducing direct support hours, including waking

nights and increased use of Assistive Technology

(AT) reducing overheads and closure of the local office


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Research and evaluation

Feeling Settled, NDTi(2011)

ISFs in Action: PersonalisingBlock Contracts, CfWR (2012)

http://www.centreforwelfarereform.org/

Evaluation of Change fromWaking Nights to Sleep in

Night Support, Social &Health Evaluation Unit BucksNew University (2012)


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Replacing waking nights

Research by Social & Health Evaluation Unit BucksNew University identified three key benefits

Outcome 1: Cost reduction

Outcome 2: Safety maintained

Outcome 3: Quality enhanced


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Replacing waking night staff -

Outcome 1: Cost reduction

FINANCIAL YEAR COST OF NIGHTSUPPORT PER ANNUM

CUMULATIVE SAVING

2010-11 384,506

2010-12 159,717 224,789

2012-13 127,604 256,902


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Replacing waking night staff -Outcome 2: Safety maintenance

Three issues were identified as involving potential risks

The first was people having seizures and whether they would be

detected and managed without regular observation.

The second was urinary incontinence and whether people wouldexperience undetected discomfort.

The third was nocturnal activity and whether people might harm

themselves or others.

The research concluded that the change was well managed, risks were

well assessed and that safety was maintained after the removal of

waking night staff


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Replacing waking night staff -

Outcome 3: Quality enhancement (i)

Utility bills are cheaper because lights and electrical

appliances are not working at night.

Cost in regards to each persons ISF (individual service

fund) is less for the individual. People are more settled generally with a better sleep

pattern.

There arent so many handovers which distracts staff

members and is invasive.

There is more consistency of support due to new shift

patterns


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Replacing waking night staff - Outcome

3: Quality enhancement (ii)

Everyone goes to sleep at the same time.

Staff have become more trusting of peoples abilities.

People have more privacy and autonomy

There is no longer confusion around day or night. There isan end and a beginning to the day in regards to staffing so

now people dont seek to engage at night and sleep better

therefore they are more productive and calm during the

day. A number of people have just developed the skills and

confidence to go and do what they want to without

support


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Key success factors

Public commitment by Southwark Council and Choice

Support to work closely together and build relationship

based on real trust.

A dedicated senior and experienced manager. A simple process for the creation of ISFs

Council delegating assessment process to Choice Support.

Research and evaluation: external validation and scrutiny

NDTi, Centre for Welfare Reform, Social & HealthEvaluation Unit Bucks New University.


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www.southwark.gov.uk

Working with Choice Support

Chris Dorey

Disabilities Commissioning Manager


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Some Information about Southwark

Population 287,000

10th smallest borough by area

3rd most densely populated

47% public sector housing

10th most deprived borough in

London

41st most deprived borough in

England

11% unemployment


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Some Further Information..

Diverse population

75% school population

from BME

100+ languages spokenin schools

3 MPs

Labour controlled


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Money

Comprehensive Spending Review 2011-2014:

29% Reduction in councils funding

25% Savings from Adult Social Care

18% Savings from Learning Disabilities

50% Savings from Supporting People


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Learning Disabilities Context

1385 Adults with severe/moderate learningdisabilities known to council

27.75m budget

Good spread of traditional services

Providers are mainly from voluntary sector

Strong on partnership working

Slow start to personalisation


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Shifting the Balance project to move from a caremodel to an ordinary housing and personalisedsupport model:

Deregistration programme

Decommissioning of block contracts

New services

Review of all out of borough placements Better links with Housing & Regeneration

Change in social work practice


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Progress to date:

58% reduction in number of people living in care homes since

2009

YearSpend on LD Residential &

Nursing Home CareNo. of PWLD living in Settled

Accommodation

2009/10 26.630m 190

2010/11 20.907m 320

2011/12 18.017m 364

2012/13 (Projected) 16.857m 385


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Why?

Simple approach to ending complex blockcontract

Savings

Pathway to ordinary housing model

Personal budgets & better outcomes

Separation of housing from support

Work with Choice Support


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How:

Trusted Choice Support with support planning and

resource allocation

Choice Support accepted challenge & risk of major

service/business change

Transitional funding to give time for service change &

to maintain stability

Trust & respect



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Lessons:

Start looking forward, not back

Simple rules, but attention to detail

When stuck, go back to simple rules You need good financial support

Structural change only- check outcomes/qualitye.g. Hearts & minds and NDTi tenancy test

New person centred commissioning approach Keep Going!

Transforming lives and budgets - the Southwark Experience

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