Transition to transformation of adult social care

Putting People First:Personalisation Toolkit

Planning for transformation framework: Stage summaries

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This document is part of the Personalisation Toolkoit, which can be seen in full at www.toolkit.personalisation.org.uk

http://www.toolkit.personalisation.org.uk/

Transition to transformation of adult social care

When moving to transformation we have found that councils can:• Clearly articulate the concepts and benefits of the transformation

agenda• Relatively easily put processes in place to manage trialsHowever, we found that some councils:• Struggle to communicate the scale of change required for total

transformation to key stakeholders• Find it difficult to plan activities required for total transformation• Cannot always obtain a clear picture of the informal support that

exists within the community• Are not always clear on what decisions should be taken when, and

by whom• Don’t always have a clear picture of what the ‘future organisation’

looks like

Planning for transformation: introduction

We have developed a Personalisation Toolkit that:• Helps local councils understand what key decisions they

need to take and in what order to move towards transformation

• Specifies the iterative transformation cycle and the products that are needed at each stage

• Suggests minimum and ideal levels of stakeholder buy-in and involvement in co-production at each stage

• Acknowledges that the planning for transformation framework itself is high-level and flexible

Planning for transformation: co-production

• Co-production is a key part of this agenda• Real change can only happen by engaging users and carers

throughout • Personalisation means empowering people to develop solutions

that work for them

Putting People First… “seeks to be the first public service reform programme which is co-produced, co-developed, co-evaluated and recognises that real change will only be achieved through the participation of users and carers at every stage. It recognises that sustainable and meaningful change depends significantly on our capacity to empower people who use services and to win the hearts and minds of all stakeholders’, especially front line staff”

Transformation framework: summary

Phase 1 Full PotentialSwitch On

Investigation

Blueprint(Develop)

ImplementationPlanning

Implementation

InvestigationBlueprint(Enhance)


Implementation

Blueprint(Review)


Implementation

Limited Launch Expanding the new approach to all

Optimising the systems

Monitor & Sustain

Transformation framework: summary

• Co-production and development of an outcome-based vision.•Create project team &governance structure• Understand existing Processes and costs• Test financial Sustainability• Build components (e.g. RAS)• Identify benefits and Success criteria.

Phase 1 Full PotentialSwitch On

• Implementation as default option for all new clients• Rollout training andcommissioning• Review efficiencies• Driving choice in the market

Investigation• All staff on board and delivering• IT support for customers operational• Real choice in the market• System operating to full efficiency • Programme team winds down – business as usual

Limited LaunchExpanding the new

approach to allOptimising the

systems

Trialling or piloting

• Trial phases happen separately from the strategic planning necessary for total transformation

• We recommend that councils undertake trial phases as soon as practical (in Investigation or Blueprint stage in “Phase One”)

• It is essential to understand that the processes and procedures put in place from the trial phases may differ significantly from those in the transformed service

• The practical lessons learned and parts of the process refined through trial phases are essential to being able to implement total transformation

Initiation

• The case for change is strong but resources still need to be committed to investigating transformation before further work can commence

• In this short stage, in order to progress to the next stage, the management team need to sign-off a resource plan outlining what will be required to properly investigate transformation and how these resources will be found

Stage summary: initiation

Activities 1 week

Develop resource plan for next stage

Present to management team

Objectives and description

The objectives of this stage are to:•Demonstrate to stakeholders that transformation should be considered•Decide how transformation should be investigated

Deliverables Decision point & criteria for moving on Estimated resources

Report to management teamResource plan for next stage

Is it clear how transformation will be investigated?

1 analyst/project manager for 1 week

Risk register: initiation

Investigation

• We recommend this stage start and end with a transformation strategy workshop with the management team

• The first workshop should be used to outline the principles, scope and success factors

• This should then give a sufficient basis to consult with key stakeholders, particularly people who use your services, and their families, members; relevant community support groups and senior staff in other council departments, to develop a vision, generate buy-in for self-directed support and the wider transformation agenda, and engage users in co-production

• The second strategy workshop with the management team should approve the developed vision, scope and success factors and allocate resources to developing a Blueprint

• A template slide pack for the initial workshop and report for the second is included as part of this toolkit toolkit.personalisation.org.uk

Stage summary: investigation (Phase 1)

Activities 6 weeks 8 weeks

Project management

Communication

Transformation vision workshop 1 (with management team)

Develop transformation vision, scope & success criteria

Consult with all stakeholders (including on co-production)

Transformation vision workshop 2 (with management team)

Develop resource plan for next stage


The objectives of this stage are to:•Develop a vision for transformation in the council.•Understand the scope of transformation and relationship with other initiatives.•Decide that a Blueprint for transformation should be developed.

Deliverables Decision point and criteria for moving on Estimated resources

High-level vision for transformation (developed through co-production).Resource plan for the Phase 1 Blueprint Stage.

Do you have agreement to develop a Blueprint?Agreed vision and viable resource plan for the Phase 1 Blueprint Stage.

1 full-time analyst/project managerPart-time communications officer (2 dpw) & co-production liaison (2 dpw)Administrative suport (1dpw)Part-time SDS sponsor (2 dpw – ideally AD level)

Risk register: investigation (Phase 1)

Key risk Type Mitigating action

Vision is not agreed by all key stakeholders Strategic Co-produce vision with key stakeholders to ensure a common vision is agreed. Invest in the leadership of people who use services and their families to maximise their potential to influence the planning.

Scope of transformation is defined too narrowly meaning that important work is missed out in later stages

Strategic Ensure that full implications of transformation are considered, including preventative internal and external services.

Links with other programmes are not effectively established resulting in duplication of work or opposing projects

Strategic Ensure decision are made at a senior level to join up work programmes from the outset and agree how central transformation is to be in order to ensure that the investigation and any subsequent work is effective.

Failing to secure sufficient resource for the next stage.

Strategic Ensure resource plan for investigation is robust and agreed at a senior level. Identify key skills and individuals to work on the Phase 1 Blueprint Stage.

Fit with existing initiatives

• Many councils have plans, models or visions that reference self-directed support or personalisation. However, very few have a structure and change programme that is designed to deliver total transformation

• Each council needs to take a strategic decision about how transformation will fit with existing initiatives

• Many existing projects will be different but complementary to the introduction of transformation – such as those to introduce early intervention, enablement or crisis support services – work will need to be done through planning to establish the interface with the self-directed support system

• This needs to take into account local circumstances including:• Capacity of the organisation to change• Existing service delivery arrangements (e.g. partnership delivery with PCT)• Level of commitment at senior level to transformation

• We think councils have three basic options when aligning transformation with existing modernisation programmes

How transformation relates to existing corporate change programmes is key

Option Run as a set of stand alone projects

S Run as sub-programme and re-align existing

projects

Re-design programme with transformation as

central focus

Benefits • Easier to manage as individual projects• More flexibility to innovate and take risks.

•Maintains momentum of current projects.•Helps to join up transformation•Acknowledge scale of change.

•Ensures transformation is sustainable in the long-term and benefits are realised.•All parties are signed up to one “vision” for adult social care.

Risks •Confusion about project priorities and dependencies.•Transformation benefits not fully realised.•Organisation not sustainable long-term.

•Possibility of lack of consistency with other projects•Can dilute the “vision”.•Harder to mainstream the cultural change.

•Significant resource investment.•Greatest change management challenges.•Possible loss of momentum during re-design

Conclusion Not appropriate for transformation.

Acceptable if good, operational change

programme in place.

Recommended if good, operational change

programme in place.


When assessing fit with existing initiatives it may be helpful to consider the following:

• Do you have an existing change programme?• Do you have a well established programme and project

management methodology?• Do you have project and programme resources?• Do you have a vision for change?• Is personalisation at the centre?• Does your programme meet the government’s requirements in

‘Transforming social care’:• Personalisation/self-directed support?• Common assessment of individual social care needs?• All individuals eligible for publicly-funded adult social care will have a personal budget?• Transparent allocation of resources?


When assessing fit with existing initiatives it may be helpful to consider the following:• Many councils have plans, models or visions that reference self-

directed support or personalisation. However very few have a structure and change programme that is designed to deliver total transformation.

• Each council needs to take a strategic decision about how personalisation will fit with existing initiatives.

• Many existing projects will be different but complementary to the introduction of transformation – such as those to introduce early intervention, enablement or crisis support services – work will need to be done through planning to establish the interface with the transformation system.

• This needs to take into account local circumstances including:• Capacity of the organisation to change• Existing service delivery arrangements (e.g. partnership delivery with PCT)• Level of commitment at senior level to transformation.

• We think councils have three basic options when aligning transformation with existing modernisation programmes.

Programme/project management

For guidance on programme and project management please refer to:

• Prince 2www.prince2.org.uk/home/home.asp

• Managing successful programmeswww.programmes.org/home/home.asp

• Useful documents on Product Sharewww.productshare.org.uk/pp/publications/projects.asp?ID=5966

Blueprint

• The Blueprint stage is focused on determining the shape of the future organisation

• We recommend that you start with how the organisation will look in the future, after the changes have been embedded

• This is not about planning the detail of implementation or identifying all of the issues that will be faced in the first year

• This stage will need to be repeated at the beginning of the “Switch On” and “Full Potential” phases to provide the opportunity to reshape the Blueprint based on evaluation feedback from the previous phase

Blueprint

There are two distinct phases to this stage:

1. Strategic decisionsConsidering the big questions about how the organisation will look.

2. Operational designWorking out how these strategic decisions will look in practice. We recommend that this is initially at a fairly high level , and that it incorporate a degree of co-production.(i.e. not Business Process Re-engineering)

Stage summary: BlueprintActivities 6 weeks 12 weeks

Prog management & communication

Commissioning

Customer journey

Back office

Support & planning brokerage

Manage the money

Resource allocation

Finance case

Resource plan for next stage

Developing the Blueprint


The objectives of this stage are to:•Develop a future operating model for the new organisation based on transformation•Develop a sustainable financial model for adult social care costs, including the first cut of a Resource Allocation System•Understand at a high-level the back office organisation functions required to support the new model •Map out the interface with enablement, prevention, crisis support and early intervention services•Communicate and engage in co-production over the proposed changes with the key stakeholders both internal and external to your authority

Deliverables Decision point & criteria for moving on

Estimated resources

Target operating modelFinancial modelResource plan for next stage(Implementation Planning)

Has your Blueprint and Resource Plan for the next stage been signed off?

Full-time programme managerMinimum of 5 workstream leadsPart-time resources for finance and adminPart-time SDS sponsor (2 dpw)Resources to support involvement of users, carers and userled organisations

Strategic decisions

Operational design

Risk register: blueprint

Key risk Type Mitigating action

Implications for commissioning are not understood at a high-level and so poor decisions are made

Financial Consider having short-term commissioning plan in place – including avoiding entering long-term, binding commissioning arrangements until implications of transformation have become clearer

The new service blueprint fails to match how customers need/want to interact with adult social care and the proposed customer access channels

Strategic Engage with users, carers and user-led organisations through co-production. Make use of previous surveys/customer intelligence. Carefully work through implications for customers of any changes proposed

The new service blueprint fails to remove existing barriers to access for some groups of people, or constructs new ones

Ensure involvement of people with experience of relevant barriers. Undertake Equality Impact Assessments where appropriate

Employees and/or unions are unhappy and uncooperative about proposed changes to adult social care

HR Ensure social workers, other adult social care staff and unions are fully engaged in the development of the new model for adult social care

New adult social care model does not meet the legal requirements binding local authorities

Legal Involvement of legal and audit teams in development of blueprint. Keep up-to-date with Department of Health guidance

Failure to develop robust understanding of how to manage adult social care budget under self-directed support model

Financial Test, challenge and refine the financial model. Understand local limitations on levers for financial control. Ensure RAS and financial model interdependencies are understood.

New service blueprint is unlikely to be implemented due to unrealistic assumptions or lack of senior member/officer support

Strategic Regularly test out assumptions and expose them to challenge outside of the project team. Involve senior members and officers through the blueprint development.

Failure to secure significant resource for the next stage Strategic Ensure resource plan for investigation is robust. Identify key skills and individuals to work on next stage

Target operating model

• After developing a high level vision for transformation, local authorities need to develop a target operating model for their Blueprint in each phase

• This is a detailed view of what the organisation will look like in the future

• Very few councils have a target operation model that recognises the scale of change that total transformation entails

• Most advanced councils have a vision underpinned by some financial data and a high level customer pathway with some aspects of the target operating model developed

• It is assumed that, in line with Putting People First, this blueprint will be co-produced with people who use services and their families, including user-led organisations

Key elements of the Target Operating Model

For a detailed breakdown of the customer journey elements of the Target Operating Model, see Self-directed Support Process document.

First contact - advice and signposting

Meet immediate needs and enable

AssessCalculateinitial personal budget

Support planAuthorise&validate

Universal services and early intervention

Go liveMonitor & review

Suggested workstreams for developing the Blueprint

Process

OrgDesign

Finance

ICT

Governance

ChangeMngmt

Example: Specific organisation design work stream for entire customer journey

Example: Work stream focused on particular element of customer journey

Example: Specific IT works team which also picks up process in some elements of the customer journey

First contact - advice and signposting

Meet immediate needs and reable

Assess

Calculateinitial personal budget

Support plan

Authorise&validate

Universal services andearlyintervention

Go liveMonitor & review

Implementation planning

• Having established how your service will look in a few years time, this is now the stage to start planning how you will implement and produce a detailed plan for the first year

• You will need to pay particular attention to:• Reengineering processes to fit the new ways of working• Training staff• Developing information systems• Working with current and potential suppliers in the voluntary and private sectors • Refining the resource allocation system

Business process reengineering

For guidance on BPR please refer to:

• Business Improvement Package resourcesbip.rcoe.gov.uk/rce/core/page.do?pageld=40236

• Sprint – public sector developed methodologywww.sprint.gov.uk

• Care Services Efficiency Deliverywww.csed.csip.org.uk

Activities 3 months 6 monthsProg management & communicationDevelop detailed implementation plan

Business Process Reengineering

Training and development

Technology

Commissioning programme

Resource allocation

HR changes consultation

Detailed budgeting for first year

Resource plan for next stage

Stage summary: implementation planning


The objectives of this stage are to:•Determine the detail of the future organisation•Determine how quickly the transition to self directed support will take place•Prepare the organisation for transition to the new mode of operating


Programme team structureDetailed implementation planResource plan for next stage

Do you have sign-off and funding to implement Transformation?Implementation plans & resources signed-off by Cabinet and officers with buy-in from key stakeholders

Full time programme manager4 FTE workstream leads2 BRP analysts (full time)Part time resource for HR, IT, communications, co-production, finance & admin

Risk register: implementation planning

Phasing implementation

Implementation will occur in each of the three phases of the iterative cycle.

• There is no universally correct way to phase implementation• Potential criteria include:

• Reengineering new clients/transitions/reviews• Locations• Client group • Type of current provision (services/cost)• Wide vs. deep (initial implementation with lots of people at a basic level or few people with higher quality)

• You need to pick what is most appropriate for your locality

Managing financial sustainability

• When planning for implementation, it is important to devise a strategy that will be financially sustainable

• Councils will need to consider where early savings will come from (to offset anticipated increase in demand):• High cost placements?• Process improvements to reduce inefficiency?• New users/transitions?

• Transition arrangements may be needed for some individuals:• Person’s budget increases/stays same – none• Person’s budget decreases & in long-term residential care – transition arrangements may be needed • Person’s budget decreases but not in residential care – to be agreed on an individual basis

Stage summary: implementation

Activities 1 year 2 years 3 years

Prog management

Communication

Phased roll-out of personal budgets

Commissioning programme

Training and development


The objectives of this stage are to:•Fully implement self-directed support in adult social care•Deliver a sustainable service that meets needs by the end of the stage

The phasing of this stage will vary significantly from council to council depending on the decisions they have takenThe activities above are illustrative only


Performance metrics Has implementation been successful

Full time programme manager2 FTE workstream leadsPart time resource for IT, communications, co-production & admin

Risk register: implementation

Monitor & sustain

• The process and many of the tools you used will need to be continually improved

• It is important to agree early on:• What to monitor• When to review• Who will take responsibility

• This represents a major change – you shouldn’t expect to get everything right first time

Stage summary: monitor and sustain

Risk register: implementation

Additional guides, examples and templates to support councils with their transformation

programmes can be found at www.toolkit.personalisation.org.uk

This framework and accompanying templates were developed by iMPOWER on behalf of the Department of Health. Thank you to the Individual Budget Pilot Sites, in particular to Lincolnshire, Barnsley, Oldham and other

authorities, for support with the development and testing of this framework.

Transition to transformation of adult social care

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