A recent evaluation of the In Control pilots show they have improved the quality of life for people with learning difficulties at no extra cost to councils. Natalie Valios and Maria Ahmed report
“Every time I go somewhere I think about people who can’t get out. I’m here in my own home, happy, got good staff and that’s what it’s all about – being happy,” says Clive Sneddon.
Sneddon, who has learning difficulties, is one of the service users to have taken advantage of the In Control pilot being run by South Gloucestershire Council. He had been living in a residential home for eight years but hadn’t been happy there.
“I wanted to be independent. You had to be in bed by 10pm during the week and by 11pm at the weekend. Since I left the home my confidence has improved and I have more freedom.
“I can go out in the evenings now. I joined a gym and have a personal trainer because I’m training for the Bristol half marathon.”
His brother Paul bought a house for Sneddon and is now his landlord. He lives with his friend Andrea, who was also at the
residential home, and buys in support from Three Trees Day Care, an independent provider for people with learning difficulties.
A support worker comes to the house for an hour in the morning – to ensure medication is taken and help get them ready and make sure the house is locked when they leave – and two hours in the evening to help prepare an evening meal. At the
weekends, they have four hours’ support in the morning and none in the evenings. On Tuesdays they have a living skills day
for eight hours at the house with support worker Natalie Pemble.
“Clive and Andrea are in a good position because they can do a lot more than other people because of the funding,” says Pemble.
Jo Williams (pictured left), chief executive of Mencap, says: “It’s hard to put a price on stories where people say how their lives have been
“One person told me that before In Control, meetings were held without him. He felt like he was on a lead – every time he stepped towards independence he was pulled back. Now there is nobody pulling him back and he feels like a human being. People genuinely are able to say ‘my life has changed for the better’.”
The recent report into the evaluation of In Control’s first phase found that users’ satisfaction with services doubled at no extra cost to local authorities. Councils are spending a huge amount of money on learning difficulties and the number of people requiring support is growing, says Williams.
“The existing system is not working. There is real evidence of services being cut and councils strapped for resources. What
In Control demonstrates is creativity and imagination. It’s more than a social care system. It raises people’s quality of life in communities,” she says. “The full cost implications have yet to be ironed out but the evidence so far is very promising.”
The report shows that people can get a better quality of life and services for the same amount of money that councils are
spending on traditional services.
Rob Greig, national director of learning difficulties, says: “This is about using money differently and more effectively.”
But, he warns: “For some people, services have been cheaper but we can’t jump too far or too fast in predicting savings.”
Carl Poll (pictured right), report author and learning difficulties consultant, agrees. “It’s not about efficiencies but sustainability of this part of public services. Current services are not sustainable – they’re at a dead end in terms of resources and support.”
He says that traditional commissioning is driven by crisis intervention with a narrow band of services for fewer people. “We need to reach everyone and get a balance in people’s support plans. In Control is about an equitable distribution of resources.”
Inevitably, putting resources closer to people results in better value for money than commissioning services some distance away from them.
Simon Duffy, report author and one of the founders of In Control, explains: “In the current system, services are re-purchased and pre-commissioned and the system tries to slot people in. There are a lot of expensive services based on institutional models of provision. In Control turns the ‘professional knows best’ model on its head.”
He says that while In Control is not a panacea for all financial worries, it could provide a different economic framework for
It could also mean a very different role for care managers and this has worried some. However, the report says that rather
than In Control putting care managers out of work, it gives them the opportunity to use their core social work skills because
they are freed from filling forms. They have the time to work with more complex cases and visit people in out-of-area placements.
Ken Stapleton, team manager on the self-directed support team (professional development) at Oldham Council, believes that although there will be a “big cultural change” there will still be a clear and important role for care managers in dealing with the initial contact, supporting some users through the assessment process or providing an advisory role.
“The process moves from having service users as supplicants at the local authority’s table to a citizenship model that gives them the buying power.
“Arguably it’s possibly the only time that people have sat down in a rational way to look at the delivery of social care in an inclusive model, rather than there being a disaster or tragedy, and people saying ‘let’s fix it’,” Stapleton adds.
Oldham is one of the 80 local authorities that have now signed up to In Control, setting up self-directed support systems across all client groups. Gavin Croft is one who has taken it up. Croft was diagnosed with multiple sclerosis four years ago at the age of 34. The condition has affected his mobility, the dexterity in his hands and vision. He also has a stomach peg after having difficulty eating and swallowing.
“You just get on with it. My wife and I do everything that we did before, just slightly differently,” says Croft.
He still works, although he took medical retirement from his job managing day services for adults with learning difficulties.
Now he does consultancy work on individualised budgets.
Croft has spent some In Control money on having technology fitted in the house – a door entry system and fall detectors – so he can remain independent for longer.
He also uses In Control to free up time so that he and his wife have more time together, by paying someone to do the housework and ironing.
“It relieves a lot of the pressure. In Control gives you more flexibility and choice than direct payments especially with the chance to incorporate different funding streams. It makes life more ordinary – it’s about having a life not a service.”
What is the In Control projectIn Control is a partnership begun by the Valuing People Support Team, Mencap, local authorities and independent organisations. It allows greater control over budgets and gives more freedom than direct payments or personalised budgets.
The six local authority pilot sites that began work in 2003 were Essex, Gateshead, Redcar and Cleveland, South Gloucestershire, West Sussex and Wigan. All pilots focused on people with learning difficulties.
There are seven steps that form the self-directed support system: set personalised budget; plan support; agree the plan; manage personalised budget; organise support; live life; review and learn.
Out of 31 people taking part in the pilots, before using In Control most people were unhappy with the level of control they had over their lives, but after using In Control almost everyone was happy.
More people had creater control over their money – 26 per cent more had bank accounts.
The average number of days spent at day centres reduced by 28 per cent.
48 per cent were satisfied with their support prior to In Control, this rose to 100 per cent.
Satisfaction with community life rose from 61 per cent of people to 100 per cent.
In Control report
Contact the authors
This article appeared in the 2 November issue on pages 26 & 27 under the headline "It makes life more ordinary"