By borrowing from top-performing authorities, Norfolk has turned round its approach to personal budgets, significantly boosting take-up and reducing bureaucracy.
By Mark Hunter
Two years ago the system of self-directed support (SDS) at Norfolk council was in serious trouble. The system was slow, inefficient and bureaucratic. Staff and service users were becoming increasingly frustrated. Moreover, Norfolk was performing particularly poorly compared to similar and neighbouring councils on self-directed support take-up.
“In terms of our performance on SDS in 2011, Norfolk was bottom,” says head of social care Tim O’Mullane. “We were below the national average, the East of England average and our family group average [which looks at similar councils]. On the number of people receiving personal budgets we were well below target, which at that time was 30%.”
Today, the county sits comfortably in mid-table on the national averages. It has also been chosen by the Think Local Act Personal partnership as one of 20 good practice examples of councils who have successfully reduced bureaucracy in the personal budgets process. The turnaround has been achieved through a systematic reform of its assessment and resource allocation processes.
Frankly appraising failings
According to O’Mullane the recovery began with a frank appraisal of the council’s failings, based on Department of Health performance information and feedback from staff that it was taking them a lot longer than it should do to set up personal budgets.
The council then prepared a detailed map of the ‘customer pathway’, from the first time people contact social services through to the time they receive a personal budget and their care is put in place.
“We looked at all the different stages, how long those stages took, where the blocks were and tried to identify the various pinch-points where things needed to improve.”
In Norfolk the ‘pinch points’ included duplication of work between the assessment forms and the personal budget questionnaire, delays during the financial assessment and the slow progress of funding applications through the funding panel.
With the problems duly identified, the next stage was to work out how to solve them. So, O’Mullane went back to the SDS league tables to see which authorities were sitting at the top.
Learning from the best
“We arranged a number of visits to these high-performing authorities to talk about what they were doing and what we could learn from them. They gave us some really good ideas of what we could do to improve our performance.”
One of the ideas gleaned was to appoint ‘SDS Champions’ – a personalisation enthusiast on each team who is available to provide guidance and support to other staff. These champions meet each month to feed back information on what is working well and where there are still problems.
“We also wanted to get feedback from service users,” says O’Mullane. “So we set up an SDS steering group that included service users and family carers. They were asked what we were doing wrong and how we could improve things.”
Having identified financial assessments and funding approval as areas causing unnecessary delays, the council also set up an SDS finance group, chaired by the head of finance. Funding panels were abolished completely.
“We gave authority to team managers to agree funding up to a certain amount, so now they don’t have to wait to get it approved,” says O’Mullane.
Finally, the council set about tackling the mountain of paperwork generated by the SDS system. The CareFirst client record system was given a major overhaul so that both the assessment form and the personal budget questionnaire were integrated and placed online. The resource allocation system (RAS) was also integrated into this system so that CareFirst now automatically generates a personal budget allowance where previously it had to be calculated by the finance team.
Norfolk’s success has led it to be selected as one of 20 case studies in a report published this week by the Think Local Act Personal project in reducing bureaucracy in the personal budgets system.
According to Celia Chivers, an assistant practitioner in the older people and physical disabilities team, the new system is not only more streamlined, it also better reflects the goals and values of personalisation.
“The beauty of personal budgets, right from the start, has been that we have more time with people,” she says. “Asking them questions they would not normally have been asked, looking at their lives and recognising the input of their networks of informal support.”
“But [in the previous system] staff were going out and writing up their assessments in a very specific format. It was very task-oriented, regimented and followed a medical model. There wasn’t much opportunity to work holistically. We were being asked to write this wonderful holistic support plan for people but there was no way to put that into the CareFirst system.
“There was very little free text and you never felt that what you were doing really reflected the person you were dealing with. You were always having to paraphrase in a way that didn’t feel comfortable. We were having to be very creative in trying to shoehorn things in to fit the criteria.”
Chivers feels the new system not only reduces the duplication of work, it also allows staff and clients to be more flexible in the care plans they draw up.
“It gives us more autonomy,” she says. “There’s more free text and we can allow clients to be more broad with their terminology. I don’t know if we spend more time with clients, but the time we do spend feels more valuable because the information we are getting matters more. It feels much more human.”
Lessons learned by Norfolk in reforming personal budgets
- Set a baseline – use performance data and staff feedback to help chart progress;
- Learn from others – seek out the secrets of high performing councils;
- Consult widely – get feedback from staff, service users and carers, before, during and after every change;7
- Map out the ‘customer pathway’ – identify the blockages and pinch-points;
- Be ruthless in cutting paperwork – use client record systems to integrate assessment forms, personal budget questionnaires and the resource allocation system;
- Support your staff – with ‘champions’ and written guidance;
- Trust your staff with greater flexibility and autonomy in assessments and by allowing managers to approve funding without going through a funding panel;
Picture credit: Rex/Image Source