Debbie Walker is “a guardian angel”, according to Julie Mason, whose 86-year-old mother, Elizabeth, has Alzheimer’s.
Two years ago, when Walker, a Sheffield Council care manager, met them, Elizabeth’s care involved daily agency staff plus Julie and her sister as unpaid carers. The family felt Elizabeth lacked choice and control, spent a lot of time with nothing to do and had little social interaction.
Walker helped draw up a support plan, transforming Elizabeth’s care with a personal budget. Since then, she has employed a personal assistant, rediscovered her hobby of baking and begun gardening, painting and sewing.
[Read full coverage of Community Care’s annual personalisation survey, sponsored by Unison and The College of Social Work]
Julie explains: “I’d heard a little bit about it [direct payments]..but I didn’t hear the full thing until Debbie came…She said if we put a support plan together and talk about mum’s life story, then she’d help us write it up and see what help we could get.”
Successful support planning can reinvigorate lives, she adds: “The person has more going on than they did before, they’re doing more activities…if you have someone they can do things with, sewing, painting, jigsaws, it keeps them physically and mentally active.”
Social work-led planning the norm
Elizabeth’s story is a successful example of care manager-led support planning, which remains the norm nationally. Sixty eight per cent of respondents to Community Care’s personalisation survey said support planning was mainly led by care managers or social workers.
However, there is a growing view that service users and families should be empowered to develop support plans themselves – and where they need support, this can often be quicker, more creative and less bureaucratic when provided outside the council, particularly by user-led organisations.
With this in mind, Sheffield launched a drive in April to externalise support planning and only develop plans in-house in exceptional circumstances. If the Masons went through the support planning process in Sheffield today, they would be signposted by the council to an independent support planner.
A key rationale, as the council explains on its website, is to “enable people to be supported to plan in a more timely way than we are currently able to, thus reducing waiting lists”.
Support planning tips
Start with the assumption that people will do their own plan and provide them with simple planning tools and encouragement
Where people want or need help with support planning, this should be proportionate
Support planning tools and resources should be much more accessible for service users, using web-based technologies for example
A mixed economy of support planning services should be developed in the area, including user-led organisations and peer support
Source: Rethinking Support Planning, published October 2011 by Think Local Act Personal
Benefits of independent planners
On the support planning pages of its website, Sheffield sets out other benefits of using independent planners: the ability of users to select the planner who best meets their needs and the fact that they can often work more flexibly with the user.
This reflects the evidence from the Office for Disability Issues’ support planning and brokerage demonstration project, which looked at the experience of support planning by user-led organisations in three areas and found this could be less bureaucratic and more creative.
While the move to signpost users to non-council agencies has been in development for the last two years or so in Sheffield, the implementation is too recent for there to be any official outcomes. However, about a third of planning is currently done by external organisations and the rest in-house, says Jeanette Thompson, Sheffield’s self-directed support manager. The goal is for it all to be done externally.
Sheffield has a list of 30 agencies that can help with plans, a mixture of user-led organisations like Sheffield Centre for Independent Living and other charities, like Age UK. None of the organisations is commissioned by the council, but care managers signpost to them. So why not tender? “The more choice, the better,” Thompson says. “Had we tendered, we would have got one or two organisations, but we wanted more.”
Support planning toolkit
To make the process easier for individuals, Sheffield has a support planning toolkit for use by users and external planners. This, says Thompson, explains what support planning is and helps people decide what kind of planner they need.
As well as the obvious challenge of ensuring that there are enough external agencies to take on the planning, Thompson warns that it might not been easy for care managers to relinquish control. Although care managers are still responsible for checking plans and helping get them agreed, Thompson says care managers have responded to externalisation with “the full range of emotions, some people think it’s great but other think ‘why?’”
Encouraging the cultural change required in Sheffield’s approach has involved training on self-directed support for assessment and care management staff and external planners over the past two years.
Controlling the budget
Thompson acknowledges that some councils might worry that externalizing the process will cost more, but adds Sheffield found that costs of in-house and external support plans are similar. It costs £27.11 an hour for an internal planner and £28-30 an hour for the external counterpart. “The budget situation has meant people think it’s more important to keep control because people think ‘if we control it, we can control the budget’,” adds Thompson. “And people are frightened of the consequences and think it’s high risk.”
As for the future, Thompson says Sheffield hopes to explore support planning for those not eligible for social care, particularly people going through reablement. Another idea is the possibility of using “starter budgets”, under which the council signs off the budget once outcomes for support are agreed, leaving the user free to develop a full support plan with resources in hand.
If councils are truly to let go of support planning, says Thompson, “people have to trust in those who are receiving the care”. Part of that massive conceptual change begins with a change in language, she adds: “We need to change some of the language and help people to be seen as citizens with a choice…People aren’t cases they’re individuals.”