Facilitating, or brokering, services for clients who hold individual budgets is a fledgling area. But the role of broker is now taking shape, finds Andrew Mickel
Individual budgets allow users to independently choose what services they want. But working out what services are needed, finding the right providers and getting things going can be very complicated.
That’s where brokers can help – but no-one is yet sure exactly who or what they are. Should they work with users to draw up care plans, or just find good deals in the marketplace? Is there a role for them in making sure new arrangements are working? And what training and accreditation requirements will ensure a competent workforce without making the process too difficult for those doing the work casually?
With all these questions yet to be answered, brokerage currently means different things to different people. Some councils have in-house brokers who work exclusively at piecing together the best care package. Other local authorities now fund independent organisations to broker with users. And for complete independence of decision-making, users on individual budgets can fund a broker themselves.
Bernadette Brady, personal broker, Devon Council
Devon Council has used brokers for years, taking care package requirements from care managers to the marketplace. At the end of last year the county piloted and then developed personal brokering to deal with more complex individual cases, where Bernadette Brady works.
“Personal brokerage is slightly different to standard,” says Brady. “Care managers fill in outcome statements which are sent to the providers.”
Once the providers have sent back bids, the brokers appraise them on the basis of a 60-40 split of quality assurance and budget best fit. A shortlist is drawn up and returned to the care manager to pick the best option with the user.
Devon’s system means its nine personal brokers dedicate their time to researching different options to get the best package for between eight to 20 service users a week, although that does mean there’s no interaction with users.
Despite this, Brady believes personal brokers definitely need a background in social care. “We spend quite a while researching options, because there are lots of specialist treatments and providers out there.”
The team has worked with people with physical and learning disabilities since the end of last year, and with people with mental illness since Easter.
Personal brokers work best with complex needs, because “if someone needs a perching stool and domiciliary visits, it doesn’t need to go through the more personalised route”, Brady says. A lot of work is instead done with young people going through the transitional stage from education to supported living.
And the most important effect in a rural county like Devon, she says, is simply that users are informed about all their options. “Users and care managers can now get to see all of the provision across the county because personal brokers can explore everything on offer, so that they see things outside their own, small area,” she says.
“And the feedback [from users] is that what they’re getting is more appropriate.”
Jeremy Long-Price, broker for self-directed support scheme InControl, Southampton Centre for Independent Living
While Devon has a brokerage team in-house, Southampton Council has contracts with independent organisations for four brokers to do the work. Jeremy Long-Price specialises in work for disabled people at the city’s Centre for Independent Living. He says that being a direct payments support worker for five years has given him the skills to help, and he works much more closely with users than the Devon model.
“Social services determine their eligibility for services, work out their resource allocation and actual budget – once that budget has been made, I can sit down with a service user and draw up a plan that will meet their eligible needs.
“That’s then submitted to a care manager. If it’s agreed and signed off then the money is released to the individual.”
While Long-Price may also provide some ongoing support with details such as holiday pay, the duty of care remains with social services. But in these early stages of brokerage in Southampton – the council has not yet fully rolled it out, and Long-Price says his workload is light – he has more time to make sure users are comfortable with their new arrangements.
“People do feel more comfortable talking to us [than to local authorities], especially when it’s a sensitive issue. Some will call social services but sometimes people who are less articulate and don’t understand how things work will fall over at that first hurdle of the initial assessment. Other times, people think they can handle it, but if you dig a little deeper then you discover that isn’t the case.”
With providers still adjusting to personalisation, a lot of time is also spent on setting up new arrangements – Long-Price notes that “currently, there is a vacuum in the care provision market” – but even while these processes are slow, he says they are paying off.
“In terms of being cost-effective it’s the same, but in terms of quality of life, it’s better. That’s the real measure.”
Tony Phillips, independent broker and chair of the National Brokerage Network
Given that independent brokerage is an emerging area, it is perhaps surprising that Tony Phillips has been working in the field in Essex since 1996. But whereas once his work was paid for by private trusts and rich users, the last few years has seen a shift to users on individual budgets or direct payments.
He is also chair of the National Brokerage Network (NBN) which has drawn up guidance for the profession. “There’s a model of seven layers which start from just giving some advice and guidance, to busting someone out of their secure unit with a care package. We do a kind of builder’s estimate, giving an idea of how much it’ll cost at the national broker’s rate of £20 an hour, to achieve what they want.”
Standard NBN prices range from under £60 for simple planning to up to £5,000 for 250 hours of complex facilitation.
The surprising results of his work have included helping a user to fund building their own house by putting in the hours to sort out a special mortgage. It certainly contrasts with Phillips’ old job as a social worker, something he left when it became “largely management and systems-orientated”.
The new work is so effective at letting people get on with practising social work that the network now has a student unit with 10 final-year students. But although the student unit is an obvious nod towards the future expansion prospects of brokerage Phillips says it is vital that any training or accreditation schemes that are set up do not let brokers become a closed system that stops individuals from doing it themselves.
Regardless of who is doing the brokering, it is crucial that it isn’t something that stifles users’ independence, but the thing that facilitates it.
“You’ll find this repeated across the independent living advocacy movement: what they ask for, you respond to. No one else will respond to it. And that’s what brokerage is.”
Published in the 11 September edition of Community Care under the heading ‘Going for Broke’