Improving outcomes for service users in adult placement - Commissioning and care management
Commissioning adult placement - Systems and structures
The continuing relentless pace of change, initiated locally as well as in response to the Government’s agenda, forms the background for adult placement activity within local authorities and health trusts (see Context). Discussion group participants noted positive and negative elements, but overall staff appear overwhelmed by new systems and structures, reorganisation, regulatory requirements and administrative ('paperwork’) demands.
Eight of the nine participating schemes are managed through the local authority (nationally, 90 per cent of adult placement schemes are local authority schemes), and all of these cited positive features of being local authority-affiliated, including:
- access to colleagues through sharing offices
- easier information sharing
- access to local authority training including person-centred planning training
- cost savings
- job security where adult placement scheme staff are seconded from the local authority.
Several schemes anticipate becoming independent of the local authority in the near future, and are apprehensive of this pending change. The sole independent scheme participating in the project is equally positive about the benefits of independence, including:
- easier to be firm with/make demands on local authority/health colleagues, e.g. insisting on full assessments and care plans before agreeing to a placement
- easier to be creative and flexible in designing and providing services;
- able to accept a placement funded through direct payments, and in future through individual budgets.
Several localities expressed concern that good relationships between schemes and local councils/NHS trusts, fostered over many years, would be undercut by rearranging primary care trust boundaries.
Staff in several trusts thought new electronic information systems made information-sharing between health and social services easier. Many care managers and scheme staff, however, thought new computer-based single assessment systems were 'tick boxy’, 'long and medical’ (see Assessment); several schemes said new Single Assessment Process (SAP) forms required by local authorities are 'not highly regarded’ and do not give the full picture of the assessed person. Lewisham Mental Health Trust has a good 'patient journey’ electronic IT system to which the adult placement scheme (as part of the trust) has access.
Evidence emerged from the discussion groups that not all practitioners embrace changes imposed from above or understand new ways of working. Conversely, care managers in all localities wishing to work in a person-centred way, to be creative and flexible, and to support service users to take risks associated with independence, stressed the importance of supportive line managers.
Senior managers should:
- make sure that the design and implementation of electronic information systems (e.g. CLIX, SWIFT, SID), in place or being developed in all participating localities, take account of adult placement, and do not result in less person-centred practice.