Lucy Martin Jones: City Fellows report. January 2021

Context  

Since March 2020 when the global C-19 pandemic began, WECIL has continued to deliver all our services remotely to meet the needs of the disabled community. Despite some challenges we have been able to continue to work towards the aims of the City Fellows in ‘the ‘development of new systems which are truly person-centred and target supporting disabled people towards independence and control and the One City Plan aim to work towards ‘integrated health and social care’ which ‘seamlessly meet(s) the ever-changing needs of our communities’ 

Progress Report 

1.‘Make it Local’. 

WECIL have received £55k funding from Bristol City Council for 2020/21 for its role in the Make it Local initiative.  Make it Local aims to bring together BCC as the commissioner with key anchor institutions to create market innovations in Adult Social Care, specifically to introduce supply of home care that is both locally and socially owned. WECIL’s role was envisaged to be two-fold; partly to ensure that any new interventions into social care for disabled people are genuinely co-produced with disabled people who are users of the care system, and partly to focus on how the initiative could be used to improve the outcomes for people who use a Direct Payment to manage their care and in particular, those who use a Direct Payment to buy commissioned services. 

Whilst we have been entirely supportive of efforts to shift care delivery away from private sector providers through the development of locally-owned social enterprises, WECIL argued from the outset that this was focussing on the wrong part of the problem and that the focus should be on how the initiative could be used to increase the levels of choice and control disabled people have into how their care needs are met (as is intended by the Care Act) rather than who supplies the ‘units of care’ prescribed by social workers. Improving the supply of the same services without questioning whether these services are what best meet the needs of an individual is merely tinkering within the system rather than acting on the system. 

As such, WECIL has been successful in introducing a new tool for self-directed support planning (Create My Support Plan) which enables an individual to identify their own objectives for achieving independence. We have also begun to develop a pilot of Individual Service Funds (ISFs) with a greater scope for varying the services which a citizen’s personal budget can be used to procure and are working closely with BCC and third sector provider, such as BS3, to develop a market of services for ISFs. We are also working with BCC’s Deputy Director of Adult Social Care and a range of Direct Payment Champions from across his department to apply WECIL’s systems thinking methodology to the study and redesign of the Direct Payments system to better meet the objectives of individual citizen. 

2. Create My Support Plan 

https://www.createmysupportplan.co.uk/  

We have, with the support of a grant from BCC, been able to update our Create My Support Plan tool (CMSP). The tool allows an individual to carry out their own, person centred support planning and share this with whoever they want (i.e., family, social workers, PA’s, GP’s) therefore removing the need to tell their story multiple times, to enable them think about solutions which meet their needs and to feel prepared for a care assessment or review. The tool is even more relevant during a time where agency PA’s may need to be drafted in to support someone if their PA is off sick or isolating.  

3. ‘Self-direct, Connect & Support’ Navigators  

Through the National Lottery Community Fund, WECIL secured funding to support disabled people in response to the C-19 Crisis. We have set up a ‘Navigator’s team to provide a single point of entry into our organisation to ensure that disabled people have somewhere to go for support during the pandemic. Due to the flexible nature of the funding received, our navigators have been able to have in depth, limitless conversations with people. Our systems thinking ethos reminds us to listen to ‘what matters’ to our customers rather than pigeon holing individuals into funded services with set outputs/ outcomes. We have been taking a holistic approach to understanding all the elements of what matters to an individual in their lives. From care needs to social interaction and everything in between. Since October we have worked with approximately 100 individuals. We have helped people to access emergency grants for food and household items, linked people with befrienders, supported people with benefits and care changes as well as more unusual requests- supporting someone to relocate to Bristol, getting a fence fixed for a family with an autistic child which posed a safety risk, helping people to understand their bills, linking disabled people with services in their area where we previously would have signposted and much more. One of the key commonalities we are finding is that just being available to listen is proving a massive help to the people who access the Navigators team.   

The data and learning we are gaining from the Navigators project is helping to inform a complete redesign of our organisational/ service structures. We are gaining a real understanding of what matters to our community on a holistic level and how supporting someone to achieve multiple goals in their life brings greater independence.   

The Navigators team are also leading on the ISF trial work starting in Jan 2021 with an initial cohort of 10 individuals.   

4. ISF (Individual Service Fund) Trial  

Most Disabled people either use Direct Payments to manage their own support or receive council managed Commissioned Services using contract between the council and the support provider. Direct payments have a high level of choice and control, but also a high level of responsibility for the individual. Commissioned Services have low levels of choice and control, but the responsibility remains with the council. 

Independent Service Funds (ISF’s) are a middle option which gives Choice and Control without all the responsibility of managing a Direct Payment. 

Currently ISF’s are an underdeveloped option and it is thought less than 1% of Council spending is via ISF’s.  

WECIL and Bristol City Council are undertaking a ISF Pilot scheme between January 2021 and July 2021, where WECIL will work alongside the Council and the individual to complete Support and Care planning giving the individual the Choice and Control and then act as a Broker to source and pay for services from providers to meet the individual’s outcomes, taking away the responsibility from the individual. 

It is hoped that during the Pilot WECIL Navigators will work with 20 individuals currently funded by Direct payments. The Navigators team will use Create My Support Plan alongside the individual to carry out the initial support planning and to source suitable opportunities to fulfil their support needs.  

Currently Direct Payment are paid for based on a Time and Task model. The ISF pilot will allow the individual with WECIL’s support to take this Time and Task funding and use it more creatively to meet their outcomes. 

It is hoped the ISF pilot will show how ISF can give the individual the same Choice and Control as a Direct payment, but also without the responsibility. It is also hoped by using the funding more creatively and moving away from the Time and Task model it can also be demonstrated that this approach is better at meeting individual’s outcome and more cost effective for the Local authority.  

As part of the pilot, individuals will be able to purchase services directly from VSCE and healthcare providers for example purchasing their attendance at a Peer Support group on a weekly basis. The longer-term aspiration for the ISF trial is that the purchase of services/ activities will help to financially support the sector rather than relying on external funding.  

5. Health and Wellbeing Board  

As part of the fellowship, it was agreed with the support of the City Office that we would engage with the One City boards to help influence the involvement of people at the margins of decision making within the city, primarily with input with the One City Plan refresh. Dr Helen Manchester and I have been working with the Health and Wellbeing board and have attended workshop event to understand how participation currently happens and what is missing. The consensus is that changing the way participation happens to be more inclusive of our communities is a long-term ambition rather than just to impact this most recent iteration of the One City Plan.  

We are in the process of setting up a working group of ‘allies’ from the board to take this work further as well as a stakeholder event in February (VCSE sector, care providers, businesses, other Board reps etc.)  

The overall purpose of the stakeholder event is to see how groups, organisations and individuals would like to interact with HWB and how they can participate in work with BCC and NHS.  

We have had discussions about the very formal way in which information gets to the HWB through reports etc. and how exploring different modes of communication/ feedback could give communities more of a voice in decision making.  

Next steps:  

  • Health and Wellbeing board stakeholder meeting  
  • ISF trial  

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