(pictured: Farzana – see case study – with Mandy Sanghera (left) and (right) Varsha Naik, the social worker who engaged Farzana with services)
Coventry Council is using the resource allocation system to ensure support for users is based on the outcomes they want to achieve, not their needs, finds Gordon Carson
● Project: Coventry Council’s assessment and resource allocation system for personal budgets.
● Number of service users: 100, with a view to roll it out to all 6,000 eligible users.
● Delivered by: Social workers and other professionals, such as occupational therapists.
● Aims and objectives: To ensure support is more focused on the outcomes users want to achieve.
● Outcomes: These are being evaluated by Coventry University.
Coventry Council has made service user outcomes the key measure against which adult services are judged through its new assessment and resource allocation system (RAS) for personal budgets.
The vast majority of councils – 122 of the 152 in England, according to an Audit Commission report in October – have built their RAS from a system developed by In Control, in which people are allocated points according to their needs, leading to an indicative budget.
But in Coventry people are allocated resources, not on the basis of need, but on the outcomes they want to achieve.
Brian Walsh, Coventry’s director of community services, says the council’s approach builds on its experiences as one of 13 authorities to pilot individual budgets in 2006-7. After joining the council 18 months ago from disability charity Scope, Walsh brought in consultants to help develop the outcomes-based assessment and RAS, which was piloted this year with older people before being rolled out to people with learning disabilities too. About 100 people have gone through the RAS so far but the plan is to offer it to all of Coventry’s 6,000 adult service users. There is also a parallel system for carers.
Outcomes are divided into four areas – health and well-being; choice and control; economic and educational participation, and social and community participation – and individuals’ need for support to meet them is grouped into three categories, basic, standard and enhanced, based on their mental, physical and emotional health and the complexity of their day-to-day life.
An indicative amount of funding is assigned to each category to form the basis of care planning, ranging from a maximum of £90 a week in the basic category to £700 a week in enhanced. However, a personal budget can exceed these sums if required to buy suitable services.
Coventry also has to marry its outcomes-based system with the needs-based Fair Access to Care Services eligibility criteria, under which it supports people with substantial or critical needs, by calculating how the outcomes identified for users can be funded through these criteria.
Walsh says the system enables assessments to be completed by a wide range of professionals, including hospital-based care workers and occupational therapists, and not just Coventry’s 130 qualified social workers in adult care.
At initial referral, managers gauge the skills required to complete the assessment and allocate cases accordingly, with social workers generally taking on more complex cases, particularly those with safeguarding issues.
The system is designed to minimise delays in determining the indicative amount for eligible service users. Once workers measure eligibility against the four outcomes, this enables them to come up with the indicative sum, maintaining speed of entry into the support planning process.
In addition, the system, which includes an element of self-assessment, provides “more opportunities for a narrative to go with the assessment”, says Walsh.
“It’s not just a 30-minute session with service users. The current average is four to five hours,” he adds. “It’s a mixture of phone and face-to-face contact because we want to make it more person-centred.”
Eleanor Lisney, a trustee of the Council of Disabled People for Coventry and Warwickshire, says her most recent assessment, a couple of months ago, focused more than previous meetings on the outcomes she wanted to achieve. For her, this means being able to work, so she needs her personal assistants to be available to help when she gets up in the morning.
She says Coventry Council may need to provide further explanation about its new approach as it is rolled out to more service users. “It might be difficult for some disabled people to understand the change in the approach to their assessment so social workers will have to explain it a bit better,” she says.
Coventry has briefed providers on its focus on outcomes, and included this in a recent retender for home care services and a current retender for day services.
Like other authorities, the council faces financial pressures and has to find £2.7m in efficiency savings in adult social care to set its budget for the next financial year, of which the home care re-tender will deliver £1.2m. Its net adult social care budget for 2010-11 is £82m. Although Walsh says social care is a “political priority” in the city, the financial implications of Coventry Council’s new approach are unclear at this stage.
Likewise, it is also too early to tell the impact on outcomes for service users. However, the council has asked Coventry University to carry out a study of the experiences of service users next year, with an interim report due in September 2011.
Farzana* was born with Down’s syndrome and has a moderate to severe learning disability. The 20-year-old, who lives with her grandmother, her uncle and his wife and their five children, did not receive any services for a year after she left school because her grandmother was concerned about her vulnerability.
However, she and her family gradually engaged with services thanks to work by Varsha Naik, a senior social worker in Coventry’s community learning disabilities team, and staff at the Grapevine drop-in centre.
During the assessment process Farzana placed particular emphasis on educational outcomes, so she now attends community college to develop living skills to promote independence.
Naik says Coventry’s outcomes-based approach to assessment and resource allocation enables social workers to look more at what’s important to service users and their families, rather than “trying to fit people into needs-led services”.
“It’s a more structured system for allocating funding and much fairer,” she adds.
The assessment process for Farzana took six months while Naik built a relationship with the family. Once that was established, she did not talk directly about the four categories of outcomes or about budgets, and instead asked what was important to Farzana and her family.
Although the resource allocation system is good for social workers, Naik says it “doesn’t mean a lot to families”, so she avoided jargon.
Farzana’s assessment produced an indicative amount of £195 per week, but she is receiving more than that through her personal budget because the services she uses cost more money. The family declined to take the funding as a direct payment so services are brokered by the Grapevine centre.
Naik also referred the family to Mandy Sanghera, Coventry’s carers’ break co-ordinator. She established through an outcomes-based assessment with Farzana’s grandmother that Farzana’s aunt was a carer for the whole family, while her grandmother also had mobility problems. Although Farzana’s assessment placed her in the “standard” category, the outcome of the carer’s assessment was an “enhanced” score.
Farzana’s attendance at community services has enabled her aunt to take a break from caring duties, which has reduced stress and given her time to look after her own young family. Her aunt says the assessment process has improved the family’s financial security too, by signposting them to more benefits they are entitled to, and has made them aware of other services including Sure Start and a carers’ centre.
* Farzana did not want her surname to be used
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