Results tagged “righttocontrol”

This post is the last in a series of reflections on the Right to Control Trailblazer work in Essex over the last few months. For an overview of the work, an introduction to this post and links to all previous posts in the series, please see the opening post of this series.

Bringing together 3 local public agencies, and different teams from within those agencies, is bound to throw up a number of interesting points at both a principle and practical level. It's the stuff management books are written of. Here are the issues I've encountered so far, in no particular order.

1. Literally bringing together several professionals across different agencies is a logistically difficult thing to do. Email addresses, phone numbers, who to contact if that person isn't in, finding times when everyone can be in the same room at the same time, building a rapport between each of the individuals, working across different typical office hours - is just a practically difficult thing to do. If you throw in any element of time pressure, a lack of understanding of the "why?" or a lack of commitment, the logistics of bringing people together becomes exponentially harder.

2. People operate in different cultures with different expectations and behaviours arising from those cultures. This is obvious, but by far the most interesting implication of it so far has been in the application of language: the single thing that has exercised brains more than anything else (at least collectively) has been on deciding what to call individuals exercising the Right to Control. Are they clients, service users, customers, people or citizens? Addressing this point to the satisfaction of all will be as crucial to the success of the Right to Control as any process redesign, because of the cultural and attitudinal factors it represents.

3. I suspect there is a hierarchy of policy sectors to be found in this work, both in central and local government perception. From a central perspective I suspect that hierarchy goes something like employment > housing > social care. From a local government perspective I suspect that hierarchy is inverted. The implications for this in terms of engagement, particularly with regard to senior managers and who thinks they hold the ultimate decision making power, represents huge risk factors to roll-out, since the tension it creates could fatally undermine the whole project. How does a public service reform agenda that brings together senior leaders from across different sectors address these tensions? I'm pretty sure it's not through talking about efficiencies and savings, because those discussions give rise to the crucial but difficult question of who gains these efficiencies/savings (if not the service user!). And if that's the case, what - really - is left?

4. Bringing people together across different agencies to do similar work creates two related but opposite risks: diluting the professional expertise of an individual, or placing too much trust in the professional expertise of an individual. On the one hand, if you require an individual to work across several funding streams then you're diluting their expertise in the area they originally knew about. But if you equally lift them above the fray and maintain their work only in one area, you're undermining everything you're seeking to achieve. I suspect the solution to this one is to have different levels of expertise commonly available across all service strands. When a service user accesses the Right to Control then they enter at a point where a group of individuals who work across all funding streams can be found. They can then quickly identify, in partnership with the individual, the best approach to take with them, and so call upon the professional expertise available at different 'levels'.

This post is one of a series of reflections on the Right to Control Trailblazer work in Essex over the last few months. For an overview of the work, and an introduction to this post, please see the opening post of this series.

In the present climate, one of the drivers for this work has got to be understanding how joining up the work makes it more effective, both in terms of service user outcomes and in terms of the resources used.

To concentrate on the latter, one area we're currently working on is the cash quantification of a particular service. Once this has been done it is then possible for a service user to have much more control over the services they choose to use, or more to the point the way in which they choose going about meeting their identified outcomes. For example, if Access to Work would fund a taxi for a service user to and from work, it could be possible to give that individual the cash equivalent of those taxi journeys if they can still show they will successfully get to and from work. This ultimately means more choice and control for the service user in meeting the same outcome.

In the first instance, the process challenge this presents is associating service user outcomes with particular pots of money. Once that has successfully been done, the issue then becomes one of attributing service user outcomes to particular pots of money.

Assuming this has been done, and the two processes of assessment and support planning mean that it should be relatively straightforward, the absolutely vital question is this: if a service user has achieved outcomes for less than the pot of money allocated to them, who gets the savings? The main options are (a) the service user, (b) each individual agency, or (c) the collective agencies. For various reasons, I suspect (a) is not a feasible option (though it should be). But cases (b) and (c) are both difficult in principle and doubly-difficult in practice to achieve.

The corollary to this are those occasions in which savings made in one area affect the overall level of resource an individual receives. This could then have a negative knock-on as to what other resources they could receive, since some rely on thresholds being passed before funding is available (e.g. Independent Living Fund is only available to individuals who already receive a certain amount of adult social care funding). I very strongly suspect this won't be allowed to happen, but it's certainly a potential unintended consequence that has to be looked at and worked on very carefully to ensure it isn't allowed to happen.

This post is one of a series of reflections on the Right to Control Trailblazer work in Essex over the last few months. For an overview of the work, and an introduction to this post, please see the opening post of this series.

I've been surprised throughout the Trailblazer process by how little policy is spoken of. My perception is that people delivering services 'on the ground' think of policy happening elsewhere; in some cases, people think that policy doesn't affect them.

This strikes me as worrying, for 4 reasons.

The first is what it means for people's motivations. I think it is vital that people delivering a public service understand the "why?" as much as the "how?". If they have a framework within which they can understand their role, the purpose of the work they do, and the expectations that are required of them, then they are more likely to positively contribute to the delivery of that service. Policy is a vital part of creating that framework, so to think that it's something that happens elsewhere is to undermine one of the foundations for the success of service delivery or reform.

Not engaging in policy discussions means potentially missing out on service transformation. Engaging with what a policy is seeking to achieve is engaging with changing at every level the way a service is approached, delivered, and ultimately what the service is there to achieve. To take one example: you can think of adult social care as meeting the day to day needs of disabled and older people. Or you can think of adult social care as the means by which people, irrespective of age or impairment, can live independent and fulfilling lives. Without an eye on the policy, the potential for transformation is compromised.

The third reason is that not engaging with policy means focusing too much on process. It is easier for people to talk about things they know and to make small improvements to the stuff they do already. By not discussing and debating the policy approach (the "why?") it becomes easy to concentrate on the comfort of the "how?".

The final reason for worrying about a lack of policy discussion is that it exacerbates the central 'versus' local tension. This seems to me to be most pertinent in the opposite way to that we'd normally expect: at the level of central government. If local public agencies don't engage in the policy discussion then there could be a tendency at the centre to disengage from the implementation of that policy. This is unhelpful in several ways, not least of which is a potential lack of feedback about whether or not the policy is right, or ways in which the centre can act to facilitate successful implementation.

This post is one of a series of reflections on the Right to Control Trailblazer work in Essex over the last few months. For an overview of the work, and an introduction to this post, please see the opening post of this series.

The Right to Control Trailblazer learnt from one of the significant problems with the Individual Budget pilots and is looking to ensure there is a solid regulatory basis for the Trailblazers to start from. Indeed, dedicated Regulations for the Trailblazers will be in place before the Trailblazers begin delivery to the public later this year.

One significant challenge is aligning services in which some agencies have statutory obligations (such as adult social care) and others only discretionary choices (such as the Disabled Facilities Grant) - something the Regulations won't change. The concern here is that the statutory obligation trumps everything else - not just discretionary choices, but also a potentially innovative way of doing things.

It would be my argument that a Trailblazer is, by definition, the place for such innovations to be tested. To this end, any Regulations don't just have to be restrictive in the sense they limit what can be done. For me, they can also be enabling in order to give local agencies the chance to test if something works better than it does at present.

This post is one of a series of reflections on the Right to Control Trailblazer work in Essex over the last few months. For an overview of the work, and an introduction to this post, please see the opening post of this series.

Essex is a big local authority area. There are approximately 17,500 new social care assessments each year and there are currently over 33,000 current social care users. All staff in agencies touched by the Right to Control totals around 850 FTEs. The question is thus: how can we role out the Trailblazer on the scale required?

One option is to create a multidisciplinary team that brings together social workers, occupational therapists, Disability Employment Advisers, housing officers etc. and ensure that everyone who accesses the Right to Control comes through this team.

But this approach has its problems: as the Individual Budget pilots of 2005-7 showed, creating small-scale pilots works fine but can often present an unrealistic picture of how to deliver the service and what the underlying challenges are. So the Right to Control could work at a small scale, but as soon as you look to extend it beyond that subset it becomes much harder to deliver.

The alternative is to offer the Right to Control to everyone from day one. But to do this all 850 FTEs across all agencies involved in its delivery will need to have been trained across the 6 funding streams available. The likelihood is that the majority of these FTEs will already be going through significant change in their own agency anyway, so creating this additional (perceived) burden is a significant risk. It's also probable that each member of staff won't need all of the knowledge straight away, so double training is a possibility.

For me, the answer lies in knowing the numbers. Yes, it's true there are 17,500 new social care assessments each year. But there are only 500-600 existing ILF users in Essex (and we know that number isn't going to grow). Similarly, the numbers of people accessing the other funding streams are relatively low. Thus, at the risk of creating a very complex Venn diagram, ensuring an early understanding of the overlaps of different funding streams, and thus those areas where the Right to Control will really come into its own as it brings together funding streams - the main area of complexity - is absolutely vital.

Doing this will ensure a proportionality to the approach is built in from the very start.

In my professional life I have spent a considerable proportion of time over the last few months working on the Right to Control Trailblazer in Essex, focusing on service design and reform.

My initial thoughts on the Right to Control Trailblazer, posted after the launch event, can be found here. This post updates those thoughts after 5 months of significant work and progress.

First, an overview. We're seeking to achieve 3 aims with the Trailblazer.

The first is to ensure that the services and resources a disabled person accesses, and the systems and processes they have to navigate to secure those resources, are organised around the individual. This rather than the more typically found arrangements in which individuals have to fit around service providers, sometimes changing their behaviour to do so.

The second is to ensure that the services an individual accesses are personalised to their requirements, rather than a one-size-fits-all approach.

The third and final aim is, as far as possible, to put choice and control in the hands of the individual instead of the service/professional (the idea of "professionals on tap, not on top"). This includes cash-quantifying a service and working towards giving an individual this cash equivalent amount in lieu of the service to achieve the same results/outcomes. (Such cash payments take the form of Direct Payments in a narrow version of the work, and Personal Budgets in a more ambitious version.)

For the Right to Control we're working on a subset of services and resources that disabled people access. These go across 3 policy sectors and 6 funding streams as follows: social care (Adult Social Care funding, Independent Living Fund), employment (Access to Work, Work Choice) and housing (Disabled Facilities Grant, Supporting People). These sectors and funding streams touch 6 main types of public agency at local and central government levels: local authorities with social service responsibilities, Job Centres Plus and District / Borough Councils, with input from the Department of Health, the Department for Work and Pensions, and the Office for Disability Issues in a coordinating, facilitative role. The role of my organisation (ecdp) is to provide service user perspectives and ensure the whole process is delivered through the principle and effect of coproduction.

As will all public service design and reform, but particularly that which goes across several different policy sectors, the process so far has been fascinating. As we've been going along I've been keeping notes across various themes of the challenges and issues we've faced. These are shared in a series of posts containing various observations and questions (not all of which have answers). They're shared in the hope they may be useful for people undertaking other projects, of which I suspect there are more as the public purse realities hit home, or for us to benefit from the knowledge and experience of others. The areas covered are below (I shall include the links after each post is published):

• Scale, and knowing your numbers
• Legislation and Regulations
• Policy 'versus' process
• Money, outcomes and money again
• Public agencies working together and the implications for staff

One area of obvious overlap with the Right to Control work is with Total Place. Unfortunately, I don't know enough of the practical lessons and implications from Total Place so far to usefully draw parallels with the Right to Control Trailblazer work. However, if anyone with that knowledge wants to get together and draw those parallels, I'd love to - please get in touch.

The usual caveat applies to this series of posts: these are personal reflections that should in no way be taken to reflect any official view.

The Total Place initiative was a significant development in local government policy over the last term of the Labour government. Details about what Total Place is and what it's seeking to achieve are here.

I have a professional interest in Total Place because I see the Right to Control - a significant transformation project that aims to bring together several funding streams which provide choice and control for disabled people - as a kind of Total Place for disabled people. (I'm involved in the Right to Control Trailblazer in Essex, more details of which are here, and on which I'll be blogging in more detail soon.)

So it's interesting to read John Tizard's view on whether Total Place will survive under the Tories.

His view is that, though the Total Place agenda aligns with many of the coalition government's policies and intentions, there are some other changes arising from the localist agenda which may undermine Total Place. These include the evolving role of PCTs, academies and free schools, and the possibility of elected police commissioners. Thus, Total Place will need to reinvent itself and ensure these increasingly autonomous partners work together locally, based within a framework that enables/makes this happen between the centre and localities.

In many ways, Tizard's views echo Stef's post on localism yesterday. His conclusion was that:

[W]hat is appropriately local will vary from circumstance to circumstance. In most cases very strong incentives will be needed to foster the collaboration between localities and at the moment there are neither the ideas nor the funds to support this.

My interpretation (hardly unique or insightful though it is) of both Tizard and Stef's views is that the very nature of localism means it will be driven forward by effective leaders in some areas and not in others. The challenge for the centre is thus ensuring that localism benefits everyone in a given locality to some minimum level whilst enabling others to go further if they want to.

Whether this moves us into a post-bureaucratic age, or one of fairness for all - two further drivers of the coalition government - are moot points.

I enjoyed attending the launch of the Right to Control Trailblazer yesterday. I attended as a representative of a user-led organisation in Essex - one of eight successful Trailblazer areas.

The Right to Control represents an innovative project that seeks to bring together a whole range of funding streams so that disabled people have more choice and control over how they use the funding they're eligible for. It's actually really easy to get into the details of the Right to Control and what it will mean in practice, but much harder to capture the overall shift it represents. The way I characterise it is that, instead of disabled people changing their behaviour and accommodating the way services and funding is provided, the whole thing is shifted around: let's start (as we so obviously should) with enabling an individual as much possible and configure the services to make sure that happens.

As an approach it clearly has value in and of itself; but it's one that I think will deliver lessons for a whole range of public services, particularly within the tough budget settlement the public sector will find itself with in 2011/12 onwards.

Alongside many positives, there are many challenges to implementing the Right to Control. For example, getting agencies across the public sector working together - including social care, housing, Job Centres Plus, the Independent Living Fund and user-led organisations - will be tough. There are the system and process changes required to underpin the Right to Control, not least of which is a single or common assessment, as well as the huge complexities of putting all money in one pot whilst still being able to identity outcomes by each agency involved. Ensuring all information, advice and peer support is available is more straightforward, though the delivery of this will require both cultural change within public agencies and appropriate capacity within the voluntary sector. And then, as with everything, there's the question of political will and senior leadership buy-in.

If these challenges can be overcome - which is precisely what the Right to Control Trailblazers are created to find out (and I think they will work) - then the Right to Control could be a significant success we'll see replicated across the public sector.

(More information on the Right to Control is available from the Office for Disability Issues and here. Tweets from yesterday's event are available here.)