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Oxfordshire Still Optimistic About Self-Directed Support

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articles: IMGP2690.JPGJon and Keith both turned out at the launch event for the Oxfordshire Wheel, an organisation we've been involved with since we started down our own path to personalisation in 2010. Keith dutifully staffed the stall (devoid of leaflets and the banner proudly displayed by the photo as a result of a delivery error by our printers). Jon facilitated two consecutive workshops around brokerage.

 

The workshops kicked off looking at the need for brokerage in the context of self-directed support. As the Social Care Institute for Excellence puts it “It is recognised that support brokerage is an almost inevitable outcome of direct payment schemes in social care.” The key question was, what would it look like?

 

The Department of Health says “Support brokerage has a number of functions which imply an array of activities or tasks. It is best seen and understood by this set of functions, rather than seeing brokerage encapsulated within a role of a support broker.” In the workshop, we looked at these functions by discussing them in pairs and deciding who was best placed to deliver what. We looked at service users, carers, professionals, voluntary sector agencies and brokers. Although there was quite a lot of diversity, there was quite a lot of agreement. For example both groups agreed that service users and carers should not be expected to do everything themselves, and both groups felt that professionals should probably be in charge of rationing the money. A lot of the disagreement was focussed on the role of the broker!

 

We used a six stage model of self-directed support as a way of structuring a conversation on the opportunities for brokers to make a positive difference, and the challenges they face in doing so. Both workshops had plenty of contributions from people with a wide variety of experience – some as service users, some as carers, some as professionals, and many speaking from more than one perspective. At the end of the workshop we reviewed what had been said, and voted on the most important issues to take forwards.

 

The main opportunities highlighted by both groups, interestingly, reflected the original aspirations of Self-Directed Support: working in a more person-centred way, and being more creative and imaginative instead of fitting people in to what was already there. One mechanism highlighted by both groups was where budget-holders pooled resources to create 'micro services' for themselves. People's experience was that this worked particularly well where they had stable needs over long periods of time, and did not move in and out of eligibility for social care. The message seems to be that brokers still have a great deal to contribute to help fulfil the original vision of SDS as being person-centred, and helping people meet their needs by living independently instead of being forced to rely on institutional services.

 

A common theme in the workshops was that the opportunities often had challenges that run alongside them. One of the big challenges for micro-services is organising broker support in a timely way. At the moment brokerage usually follows an individual, so getting a broker to work with a whole group of people is difficult. Similarly brokerage is usually time-limited – until the support plan is in place – but a 'micro service is likely to need adapting on an ongoing basis. One possible solution would be to put the budget for brokerage into personal budgets, so that people could get help from a broker whenever it was most useful for them.

 

However, putting the broker fee into the personal budget is not risk free. Neither workshop group was convinced that people would continue to prioritise the use of a broker if their personal budgets were reduced or restricted. In this situation, people may not have enough information to make an informed choice and end up with a limited range of inferior supports as a result. Worse, the expertise developed by the new brokerage services over the last 3 or 4 years could be lost.

 

Conflicts of interest were perceived to be another challenge. Although neither of the contract-holders for Oxfordshire were discussed, the recent allegations of fraud aimed at a large national provider have given a timely reminder that sharp practice does exist. Other challenges identified included being unable to find a broker with the right specialist skills, and unequal access to brokers (for example for people living in outlying areas of the county, or facing communication or language barriers).

 

Happily, some of the potential solutions people suggested are within our grasp; training people who have used services to work as brokers ('peer brokers') may help to improve the availability with specialist knowledge of different types of support, and better networking (particularly between brokers and user-led organisations) offers the possibility of identifying and overcoming many of the barriers. Overall, the mood of both groups was positive, and it seems that despite the many challenges, many the result of budget cuts, people were optimistic that SDS can yet be made to live up to the hype!

Comments

1 #1 jhyslop
on March 02 2012 18:04:19
Conflict of interests have been raised and discussed at national level with AgeUK and others a few years back and we recognised at the very beginning of our involvement in support planning services that we needed to ensure we had appropriate procedures and practices to manage this properly.

Key conflict management includes ensuring our brokerage department is very separate to other service departments and has a director who is not linked with overseeing other care providing services. Learning from having had many years of experience with successfully managing conflicts of interests when providing our information and advice service, we follow the similar practice of not promoting individual services including our own and providing people with at least 3 options to consider.

Additionally, the brokerage service also monitors the level of people who chose to use an AgeUK service and makes regular quality assurance checks that checks that people's chosen options for care support have been made following the opportunity for full consideration of all available options, rather than any steering or favouritism from support brokers.

Added at request of Christine Witcher, Brokerage Service Manager, Age UK

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