Martin Walker is the Policy Advisor for Personalised Commissioning and Self-directed support for TLAP. He leads on Individual Service Funds (ISFs) and over Social Care Curry a few weeks ago I was expressing my frustration that ISFs are still misunderstood and underused but potentially transformative for people and providers. Councils have a duty to offer Personal Budgets in all three of the specified ways under the Care Act, so why is this not happening? I asked Martin to help answer some questions about ISFs for this blog, and next week we are working together with NWADASS and TLAP to see if we can encourage and support people to use them more.
Over to Martin.
Lets start with what are ISFs?
Individual Service Funds, are one of the ways people can take a Personal Budget if they are entitled to support from their Council to meet needs regarding their wellbeing. It’s best to split up the terminology to understand them:
Individual service – the person needing support is in control of tailoring just what is provided, when, and by whom. They are able to flex this support as their life circumstances change, particularly important for people with fluctuating needs. But just as importantly, they enable people to switch the emphasis as some aspects improve and outcomes become achieved. Importantly, this is done in a partnership with a trusted provider, without needing to come back to the Council to change the schedule of support so often currently prescribed in detailed support plans.
Funds – the persons Personal Budget is paid to a trusted provider under the contract between the Council and provider. This fund is then managed by the provider on the persons behalf. The money is used in ways the person and provider agree will meet the needs and help achieve outcomes the person chooses to work on, as described in the HIGH LEVEL outcome focused plan that results from the Councils assessment of need. This might involve the provider purchasing things they don’t provide, effectively acting as a broker of services. It will be in their interests to secure best value for the person in these circumstances.
How do they relate to delivering the Care Act?
They help Councils make sure they are meeting their duty to offer Personal Budgets in all forms described in the Act.
They underpin and offer a practical mechanism to deliver the fundamental shifts outlined in the act to a focus on wellbeing, outcomes, person centred planning, social workers supporting people to achieve their chosen highest level of self advocacy, a changed role for commissioners from purchasers at scale to market facilitators and developers, the driving up of quality standards and a shift to individuals who receive support becoming the determinants of quality.
Most importantly, they offer a solution to the conundrum of the pay off between a high level of control meaning a significant amount of complexity and administrative burden for the person needing support.
What are the benefits?
Control – They offer the person needing support a high degree of control over the support they receive
Simplicity – they offer the person needing support, providers and Councils a real practical way of slimming down and simplifying processes. Layers of unnecessary bureaucracy can be removed.
Efficiency – because of this reduced process and bureaucracy, costs can be reduced but efficiency and productivity can be increased.
Satisfaction – because the person needing support is in control of the support they are much more likely to be better satisfied with it.
Improved outcomes and wellbeing – people are able to use the resources available in ways that make sense to them and on things that have meaning for them in respect of their wellbeing. We know from reports like POET that this delivers better outcomes and improves wellbeing for people needing support.
So if they have so many benefits – how common are they?
Not very. There are only a few examples that fit the description I’ve outlined that’s emerged post Care Act. There are some examples called ISF’s that might be more money management and brokerage support for people with a Direct Payment. Whilst we at TLAP strongly support this, it’s not an ISF. The key characteristic is the contracted relationship between the Council and provider, so it’s NOT an option under Direct Payments.
What needs to happen to make them more available?
Quite a few things, but they’re not complicated. One thing that could happen is that more people needing support who are eligible ask for it to be provided through an ISF. THe Care Act guidance says
“Where an ISF type arrangement is not available locally, the local authority should explore arrangements to develop this offer, and should be receptive to requests from personal budget recipients to create these arrangements with specified providers.”
I think the key thing that needs to happen is that different people in the sector need to build new trust relationships. Commissioners need to build trust in providers. Social Workers too need to build trust with commissioners. Central procurement teams need to build trust in commissioners that EC regulations won’t be breached. Finance teams need to build trust in providers that they won’t spend the money inappropriately and can account for spend adequately.
Providers need to align their systems to individualised purchasing rather than invoicing the council in bulk, and have processes that enable the budget and provision to flex. They need to be able to openly account for spend to the person needing support.
Probably most importantly, local leaders need to check whether they have an ISF offer in place and if not, drive their local team to get one in place. It will make sure they are not on the receiving end of local challenge, but more importantly, for all the Eason above, have all sorts of benefits in cost savings, efficiency, improved outcomes and satisfaction for people needing support.
How is TLAP helping to change this?
We’ve already produced guidance in partnership with the Centre for Welfare Reform that’s published on our website. In addition we’re working up and down the country on a regional basis to raise awareness and through a peer learning approach, unpick ‘sticky issues’ and share good practice and resources like business cases, model contracts and agreements, information leaflets for public and provider engagement.
Why is this important in relation to home care?
Many areas and home care providers are concerned around the sustainability of the current model of home care, which is largely a wholesale arrangement where Councils specify services through contracting and purchasing at scale. ISF’s offer an alternative that could offer the sector a solution. There is limited, but good evidence this can be the case, for example through the work done in Calderdale by commissioners. Better outcomes, more satisfied people needing support, happier providers afforded trust and flexibility resulting in lower operating costs. This then translates to commissioners achieving a shift to outcomes based commissioning successfully, system designers realising simplified, LEAN systems and processes, finance teams assured the Council can meet its duties within the resources available.
They can offer the elusive Win Win for people needing support of taking a high degree of control without having a high administrative burden, a true fundamental shift in the paradigm.
Thank you Martin. Next week I have some questions – and answers, from a commissioner who is working to implement ISFs in London, and will feedback from the conference.