Improving outcomes for service users in adult placement - Commissioning and care management

Commissioning adult placement - National agenda

In light of the adult services White Paper and other national policy initiatives, it is clear that increasing emphasis will be placed on giving people more choice and control over they way they are supported, through direct payments, individual funding and self-directed services. Piloting of individual budgets is underway nationally, and early results show that people consistently choose services which are personal and intimate, and which strengthen connections to their own communities, rather than large-scale services (12). 'There seems to be a significant gap in the market between [services aimed at] those who are willing and able to manage in all respects their own support and those who are happy to use large scale services. It is In Control’s expectation that many more people would be interested in using services that were much smaller and more personalised but where some management functions might be paid for’, but these 'micro-services’ are seldom available (13). Adult placement seems well placed to offer such services.

Currently only a few adult placement service users in the project localities are funded through direct payments. Direct payments are not always readily available, but also people may not be aware that they can be used to purchase adult placement services. In Scarborough several short-stay placements have been made with the independent scheme using direct payments. The Essex Home Share Day Care scheme in Braintree accepts a few direct referrals to adult placement carers from self-funding individuals.

Few discussion group participants knew about the national In Control project or the Government’s individual budget pilots, nor were they aware of the prominence of the individualised budget concept in the adult services Green Paper (now superseded by the White Paper). Even those care managers and scheme staff who had heard about individual budgets admitted that due to day-to-day pressures of work they were not yet thinking about what that might mean for their practice. Several scheme staff expressed concerns about being 'just a broker’ or about not understanding how to assess 'unit costs’ (the cost of the service for an individual service user). Others are concerned that individual budgets will change the relationship between the service user and adult placement carer, and between the service user and care manager. A National Association of Adult Placement Services working party is currently looking at these issues.

Gateshead’s first adult placement service user received individual funding via the In Control project (see Person-centred practice), demonstrating how placement can be effectively purchased through an individualised budget. Another participating locality, Essex, is an In Control pilot area, but older people - the client group for the Home Share Day Care scheme - are excluded from the project. Gateshead and Essex have also been selected for the individual budgets pilot. Two other participating localities, Herefordshire and Sheffield, have been chosen for In Control Stage 2.

Practice points

Directors of adult social services should: