A commissioners view on ISFs

choices

If ISFs are so great, why are n’t there more of them? I asked  Ann Lloyd, interim strategic commissioner,  to share how she is creating the opportunity for ISFs in London, and her views from a commissioning perspective.

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What are the benefits of ISFs?

For me, it’s the core features of ISFs: that planning is person centred; that they’re flexible and outcome focused; they’re coproduced and there’s accountability. They design in planning around people’s strengths and community assets – family, friends, networks. They focus on real quality of life stuff: what’s important to you; what do you want to do; who do you want to support you?

If implemented properly, they’ll naturally evidence Care Act and Transforming Care compliance – choice and control in meeting needs, options for deploying personal budgets, market development that looks beyond traditional services and builds positive expectations of providers – of creativity, trust, accountability.

ISFs make personal funding and costs clear and require value for money. What’s free in the community, are there support networks, can people do more themselves, will technology help? Paid support can then be really targeted with holistic coordination. They’re good for support staff too. Their knowledge is valued and matching to customer’s choices, means workers do more of the things they like and are good at.

What are the challenges for commissioners in making them happen?

They’re still under-utilised and there are probably many reasons for that. Most providers aren’t given the flexibility to really deliver for outcomes. Contracts for ISFs should be straightforward but can be a stumbling block with much commissioning still via block contracts. We need convincing before adopting something new. If we can’t answer the what ifs? we stick with what we know despite the imperfections – paying for voids, squeezing people in to vacancies, lack of transparency.

ISFs aren’t complicated, but social care functions are fragmented. It takes different roles across the system to enable them happen at scale.

How did you address this?

We developed local learning by running a pilot based on a provider proposal. The pilot covered all ISF related functions – workforce development, Planning Live sessions, costed support plans, aligning RAS generated personal budgets. External expertise was really helpful in shaping the work.

With key people involved – social workers, commissioners, procurement and finance staff – we began to understand concerns and find solutions. Learning grew through market, staff and customer engagement events. Interestingly, people with learning disabilities and families had very few concerns as ISFs answered many of their issues with traditional services or direct payments.

Having local evidence helped secure strategic sign up. We are now moving to commissioning accommodation & support for people with learning disabilities and embedding ISF approaches.

What advice would you give to others?

Don’t assume people know what you are talking about! Ensure people grasp the core principles – it’s not just a managed account. There’s some good guidance available as a starting point.

Understand people’s drivers. Is it savings, community benefits, quality? Get it on team agendas and align with existing plans – workforce and customer journey plans will no doubt focus on independence, outcomes, choice. For ISFs to work, social workers have to understand impacts on their role so need to be fully part of planning and testing.

Predict where the blocks might be. Directors may be signed up but implementation may fall down due to issues with procurement, payments or recording systems. Are provider systems able to account individually?

It helps to invest in local examples, for example having a local provider explain how their ISFs work in practice and people presenting their own plans really helped make it real.

It doesn’t have to be perfect. Learn by doing and create some local evidence.

 

Why is this important in relation to home care?

Home care can be really tough. It’s cut back to the bone but is still inefficient. Quality is compromised with high staff turnover, short visits, market instability. Staff feel rushed and work in isolation. Local authorities are intervening in complaints, quality concerns and market failure.

Home Truths (King’s Fund 2016) highlighted the human cost with people feeling out of control and families estranged. What’s meant to help brings its own stresses and many with DPs also struggle.

ISFs bring vital ingredients of flexibility, creativity and coordination. They are efficient building on the strengths of all involved. Providers take a key role and good plans help keep people’s families engaged. ISFs can help plan beyond immediate personal care needs (most using home care have multiple needs), be more organised, more flexible, listen to support staff who can pick up on issues. This improves care but could also help people avoid hospital or get home sooner, help reduce staff turnover and offer a supportive way for families and friends to be “part of the team”.

The ideas aren’t new but ISFs build on the best of lots of approaches. Getting it right upfront is the way to be efficient and meet outcomes in the long run.

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