This document profiles Sam Sly and his work in social services and advocating for personalized support. It discusses his experience working to improve quality of services for people with learning disabilities and mental health needs. It also summarizes some of his views that traditional institutions do not work long-term, people deserve personalized support in their communities near family, and flexible budgets and cultural change are needed.
2. Social Worker for people with learning
disabilities and mental health needs
CSCI (CQC)
Change Team Cornwall (changing housing
and support that had gone badly wrong)
Cornwall PCT continued to improve quality
Bournemouth Campus re-provision
United Response improving quality
Developed ‘Hands Off Its My Home – a path
to Citizenship’
Director for Beyond Limits with Doreen
Kelly
Columnist for Learning Disability Today
3. 3 year project with NHS Plymouth
Personalising Commissioning
Using Individual Service Funds
Using Service Design & Working Policy
20 people currently in Hospital placements
20 people with big reputations
20 people who will get a tailor made service
20 people who will get a life that makes
sense to them
4.
5. Not a flexible enough provider market
Good planning doesn’t happen
People are not listened to and understood
We don’t share risk (professionals, person,
family and provider)
We (professionals) think we know best
Its an easy option
Systems for commissioning support are too
rigid and look at short term savings
6. ‘People often end up in expensive out of area placements
because local systems have not the flexibility to develop
suitable personalised responses. This leads to people being
over-supported and cut off from their own communities.
There are currently 10,000 people with mental health
problems supported in out of area placements and research
suggests at least 5,000 of these are without significant
clinical justification. The use of individual budgets as part
of intentional programme to bring people back to their own
communities with personalised support could save £100
million a year.
Vidhya Alkeson & Simon Duffy ‘Health Efficiencies - the
possible impact of personalisation in Healthcare ‘ 2011
7.
8. Good planning (we usually know who is at
risk from childhood)
Services tailor-made for the person
People given Budgets, power and control
Providers treated as partners and not held at
arms-length
Intuitive Commissioning
Community connection and contribution seen
as a must
Working in partnership with families
9. Individualised, local solutions providing good quality of life
not those too large to provide individualised support, too
far from their homes, and providing good quality of life in
the home and as part of the local community.
Direct payments and individual budgets should always be
considered and be more widely available.
Closer co-ordination between the commissioners paying for
services, the managers providing services and the
professional specialist advising on the support people need
to ensure advice is both practicable and acted on.
Commissioners should allocate a budget to be used to fund
a much wider variety of interventions as an alternative to
placement in a special unit.
Jim Mansell ‘Services for people with learning disabilities and challenging
behaviour or mental health needs’ 2007
10. All have been abused
Have moved between 6-25 Institutions
Youngest 26 Oldest 56
First admission to an Institution aged 14-22
All on MHA Section for between 5-14 years
Most have moved to more and more secure
accommodation as they have fought the system
All families have felt loss of control, marginalised
and physically unable to stay in touch
All people have the same hopes and dreams as all
of us
11. Service Design (Partners for Inclusion/Beyond
Limits)
‘Every service is designed, from scratch, with
only the person in mind, and modified in
the light of experience and as things
change. Individual service design in rooted
in the organisation’s commitment to help
everyone achieve citizenship for
themselves’.
Personalised Support – Julia Fitzpatrick (2010) Published by the Centre for
Welfare Reform
12. A good facilitator
The person
Family and
significant people in
their life
People who know
and care about the
person
People with strong
relationship with
person
13. Planning and pre-
move transition is
funded (one off
payment clawed back
through reductions
from years 2 onward)
Post move transition
is funded
On-going budget
flexible in first year
Greatest reductions
after year two and
three
14. Take time getting to know person and
significant others
In a comfortable environment
Telling their story
Being in control
Direction
Money
Home
Support
Contribution (Giving something back)
15. What does the
person do with
their time now
(routines)?
What should we
keep doing?
What should stop
happening?
What should they
start doing?
What should we
start doing?
16. What hours of paid support do they need?
What will happen in those hours?
What support could help the person become
more independent or develop more natural
support?
What do we need to do to keep them and
others safe?
(safety mapping and enabling is a natural by-
product of service design)
17. Who worked well in
the past and who
didn’t and why?
What kind of person –
quiet, busy and lively?
What knowledge, skills
and experience?
What contracts are
needed?
Leadership skills
needed?
What hobbies interests
should they have?
Man or woman?
Age?
18. Being seen as a fellow citizen by others
Controlled by the person
Provided by who you choose
Enables you to do what you want and does
not control what you do
Invisible
Simon Duffy (2006)
19. It enhances the person’s dignity and respect
in the community
It helps the person be present in the
community
It helps the person participate in community
life
It helps the person develop and learn new
skills
It gives the person choice and control
20. Many great plans are made and fall down
because they are not followed up by a
detailed ‘how to’ bit.
It is fundamentally important that once a
service is designed a ‘how to’ plan is written.
Partners for Inclusion and Beyond Limits call
this a Working Policy.
Involves the person (if they wish), present
and past professionals and family
21. Aged 28
25 different placements furthest was 349
miles away from home
Went through Criminal Justice System
Sectioned for 6 years
Physical Intervention from aged 17
Family seen as a problem
She was seen as a big problem
Always wanted to come home to be part of
family
22. Part of the family (highs and lows!)
Has own home
Interviews for her team
Health problems stable
Been to Bristol/Cardiff to visit friends twice
Tickets for Peter Andre!
Ice skating lessons
Been Clubbing loads (first times in 11 years!)
Says she never wants to go back to Hospital
23. Hospital doesn’t work
long or medium term
Being away from family
and community is
destructive
Planning for a normal
life has to start from
day one of admission
Matching teams makes
the difference
Individual flexible
budgets
Cultural change is
required
People want lives
24. Hospitals
Hostels and
Campuses
Residential Care
Homes
Don’t let
‘supported living’
be the next
institutions
People want to live
in their own homes
just like you and
me
25. Sam Sly
Beyond Limits
sam@beyondlimits-uk.org
sam.sly@enoughisenough.org.uk
07900 424144
www.beyondlimits-uk.org
Editor's Notes
Decided after years of trying to persuade others to do ‘it right’ for people time to bite the bullet and have a go Doreen had run a person-centred organisation but wanted to work out how to transfer the ‘model’ to other organisations.
A registered domiciliary Care Organisation Service Design then mini tender for long term support Working Policy with Beyond Limits or coaching other Organisations to implement the detail and reshape the way they provide support
The Service Models Jim Mansell recommends underpin the project
Family members, neighbours, taxi driver, advocates, friends, professionals, support workers People who knew them before systems kicked in Got to see the strengths, gifts and skills – the potential and the way forward Meet in a place comfortable for the person – more likely to contribute For every person so far we have been told they won’t contribute, they won’t be able to stay the full day, - for every person they have because it is a positive day about them and about a positive future.
Examples Person 1. 2:1 24/7 support reduced to 1:1 73 hours. She now she spends some time on her own early evening and first thing in the morning. Her service costs have reduced from £211,000 per annum to £85,000 per annum. Person 2. reduced from 1:! 24/7 reduced to 40 hours per week with an on-call service for emergencies. In just over 2 years his service reduced from £109,000 to £71,000
What people had in their lives, how they were in different situations, what experiences they had good and bad, what support worked and didn’t. Authority – how will they remain in control of life, what support is required with communication, is representation required Direction – persons desires, hopes and dreams, how can we support them to reach their goals Money – what money is available Home – what kind of house, where does it make sense to live, sharing or alone, equipment AT adaptations. Support – what kind of support, how often and when is it needed, what kind of person Contribution – how will the person live, what relationships need to be maintained or strengthened, what interests, job do they want, how can they contribute to their community Concentrating on the positives – starting from the positive not the negative behaviours.
What has worked in the past Lost hopes and dreams Things people used to be good at and liked to do Support that didn’t work in the past Routines are often made to fit the staff, building and others in Hospital (cigarettes breaks, meals, getting up and going to bed) What they do in Hospital is often ‘service-land led’ or things that they would do everyday that is labelled ‘activities’ and lots of groups.
This then becomes your job ads and job specifications.
Really detailed planning including especially what to do when someone is having a hard time. Looking at what has worked in the past and working with current provider to drill down into recent situations. This usually gives us big clues to what is going wrong!