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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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Learning Disabilities Context
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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Learning Disabilities Context
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
Work with Choice Support
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Work with Choice Support
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!
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