What can we learn from the Right to Control?

The Right to Control was a new rights-based approach to support and services for disabled people. It brought together a range of government funding streams across social care, housing and employment with a view to improving people’s experiences across these funding streams and, ultimately, improving people’s lives.

I write about it in the past tense because the Right to Control is no more. The pilot ran for two years from December 2009 with a further extension until the end of December 2012. A Ministerial decision in 2014, however, decided not to roll-out the Right to Control any further.

The decision was based in large part on the findings of a formal evaluation (pdf). This

did not find any evidence of the Right to Control having a positive impact on customers, either in terms of their experiences of applying for and organising support or services, or in terms of their day-to-day lives, including employment outcomes.

The evaluation notes, however, this lack of evidence is most likely due to the fact people did “not experience the intended Right to Control customer journey” and that the short space of time for which the pilots existed may not have been sufficient for the full effects of Right to Control to be felt.

What was unique about the Right to Control, compared to pilots regarding Individual Budgets (as were) and Personal Health Budgets (as are) was its attempt to unify – to integrate – funding streams around an individual. It was therefore similar to parts of what the Integrated Personal Commissioning programme is seeking to achieve.

The question is this: What can we learn from the Right to Control? From my reading of the evaluation, other documentation available around the Right to Control, and from conversations with colleagues who were heavily involved in several of the pilot areas, I would suggest eight (by no means comprehensive) things we can learn*.

1. Create demand from the bottom-up by building the understanding and expectations of people who could benefit from the change. There is no point having new rights or the potential for more choice and control if the people these are intended to benefit aren’t aware of them or equipped to expect them. This isn’t just limited to people who use services, either: carers and staff are also important to focus on. For example, employment support in a northern pilot area worked so well under the Right to Control because there were two Disability Employment Advisors who were looking for a way to change a system they saw every day wasn’t working for the people they supported. The Right to Control gave them a vehicle to change things.

2. To build meaningful demand, market development must start as soon as possible. The Right to Control evaluation notes the following specific conditions needed to be in place: (1) People were aware they could request changes; (2) People had information and advice to make confident choices; (3) People had meaningful choices. The first two are extensions of my first point. The third – meaningful choice – is facilitated by two vital, complementary process: (1) coordinated care and support planning, and (2) market development. I’ll deal with coordinated care and support planning in a separate post. On market development, the most important lesson from the Right to Control is that market development didn’t start soon enough. It takes time to start, (re)negotiate or end contracts and agreements with providers of all sizes, to inform and work with them of the types of changes anticipated, to keep people and staff up-to-date on changes to the local ‘market’, and all the other similar activities that make for successful market development. Start early on market development, and be proactive about it.

3. The third lesson is no surprise at all: change on this scale takes time. By “change” I mean both practical and cultural change. Practically, for example, it took around twelve months in most of the Right to Control pilot sites just to get the right people around the table and to start having the right kinds of conversations. Where most good progress was made was for people with mental health problems accessing employment support. The reason for this was because the then Community Mental Health Teams became the most common entry points into the Right to Control because of greater partnership working that had existing from before the Right to Control pilot started. Of course, change taking time is no great lesson, but it is one that bears repetition, especially when the current demands on public services in health and social care are so pronounced, and when numbers are seemingly the only way we can convince people of progress.

4. One of the biggest cultural barriers in the Right to Control is represented by the question: “Whose money is it anyway?” Reasonably often, local managers referred to budgets as “their money”, resulting in difficulties in pooling budgets or integrating them around individuals. It’s actually a very good question, and surfacing these types of questions and discussing them was seen to help progress towards the Right to Control’s aims.

5. User responses to the question of “whose money is it anyway?” are probably best captured by this paraphrase:

We don’t give a toss where the money comes from – we just want a life.

What enabled this voice to be heard was co-production of the Right to Control. Co-production itself was therefore a major driver in changing attitudes, which helped to create confidence, support and a shift in relationships and mindsets between “professionals” and “people”. (It’s worth noting the formal evaluation concluded co-production would last well beyond the life of the Right to Control pilots themselves – a point proven so far, writing from the distance of 18 months since the programme finished.)

The last three lessons from the Right to Control are strategic ones that should be cause for reflection at higher levels in local government, health bodies and central government.

6. The first is to recognise that funding streams need to be integrated locally because they are separated centrally, i.e. government is asking local areas to merge budgets that they themselves had split up in the first place. As a participant in the evaluation ruefully notes:

What we need to do is look at pooling budgets at a much higher strategic level. It’s very difficult to align funding streams once the money is allocated, if not impossible, so hence the focus on pooling budgets at a much higher level, to have the one-pot approach.

Anything that central agencies can do to integrate funding as soon as possible should be done is the lesson to take from this.

7. The second is to be consistent in the intentions and outcomes of the programme. The Right to Control started as a new legal right to support disabled people to have better lives; it ended (via the evaluation) with a decision that questioned its economic efficiency and impact on primarily social care measurements. What if the evaluation had captured stories from two sites about people with learning disabilities signing housing tenancies for the first time, or fifty people gaining employment because of direct control over funding they never knew was previously spent on them?

8. This links to the final lesson: the Right to Control didn’t connect politically at either a local or national level. The Right to Control squarely support two significant agendas that have existed since 2008 – prevailing attitudes to public services (the idea of empowered consumers) and the zeitgeist of austerity (more for less) – and yet remained unloved, to the point where it was ended and largely forgotten. Reflecting on why it didn’t connect and the roles that different people/organisations could have played in addressing is useful for any current or future change programme.

There are many other areas of learning that can be drawn from what the Right to Control did and didn’t achieve during its time. In the ones above I’ve drawn out the ones that seem most relevant to me for current and future public service reforms, not least of which is Integrated Personal Commissioning and what it seeks to achieve.

*I should note that I was involved in the Essex Right to Control Trailblazer.


Demos’s report on pre-payment cards

I’ve just had a quick read of Demos’s report published today on pre-payment cards.

Recall that pre-payment cards (also called prepaid cards) are like debit cards, where funds are loaded into an account linked to the card and then spent by the card holder until the balance reaches zero. They can be used to make purchases, set up direct debits or standing orders, and sometimes withdraw cash at ATMs.

There has been an increased usage of pre-payment cards by local authorities, especially in the area of administering Direct Payments in social care, and the Demos report makes recommendations about them being considered for wider use, for example in benefits administration and other forms of public payments.

The topic of pre-payment cards is an emotive one, since it symbolises the concept of the state potentially or actually prescribing what Direct Payments or benefits can be spent on. This is fascinating in itself because, as the report highlights, pre-payment cards are essentially a question of the “nitty-gritty of implementation”.

Of course, I have views on pre-payment cards and whether they should be used. This comes from being pretty heavily involved in two areas of work – Direct Payments implementation and making the Right to Control a reality – and especially from the perspective of service users. I’m painfully familiar with the both the advantages and disadvantages that can arise in making payments to people or trying to integrate several types of payment. As I told the judge, I now know more about the appearances of money laundering than I probably should do.

For those interested in the issues, the Guardian has an article by Ally Fogg which covers a lot of the debate.

The wider point to make, though, is that Demos should be congratulated for at least bringing the topic out into the open. Pre-payments cards are a growing phenomenon and there is a need for an open debate on their merits and demerits, rather than their use growing in the absence of a debate.

It would be great if a space could be created in which this debate can take place that brings together users, public bodies, government and those providing pre-payment cards.

Strengthening DPULOs Programme monthly bulletin, no. 10 (end of year edition) #dpulo

This is the tenth monthly update about the Strengthening DPULOs Programme. This is also the last update of 2012, so rather than the usual mix of links and stories (which will begin again in January) I thought it would be useful to reflect on where the DPULOs agenda has got to.

2012: a year for DPULOs?

At the start of the year I suggested 2012 could be the year for DPULOs. There were 3 reasons for this view:

  1. There was a detectable shift towards leveling the playing field for different types of providers in public services
  2. There was proof that DPULOs could be clear about the value they add in representing disabled people’s voices locally
  3. The evidence for the difference DPULOs make was starting to come through, and stakeholders were starting to take note.

What we’ve seen over the last 12 months is further evidence for each of the points above. For example:

  1. DPULOs, social enterprises and mutuals are starting to be treated differently – and for the better – in the way public services are commissioned. Liverpool is one good example and we’ll have more in the New Year
  2. There is now significant evidence of the difference the voice of disabled people in their local communities, represented through DPULOs can make. This isn’t just in saving money (though that’s important), but also in the improvements in people’s quality of life. Just look at the evidence here.
  3. There is also now much more evidence than there’s ever been of the unique value DPULOs add when they deliver local services. They increase choice and control. They’re trusted more. They deliver a return on investment. And they save money. The evidence is here.

As a result, there’s been a major shift in thinking: the question I used to be asked all the time was “What is a DPULO?” Now, the question I am asked is “Now I know the difference they can make, how can I get the most out of one in my local area?”

Government has taken note, too: where DPULOs used to be thought of mainly in terms of social care, now they are reflected in several areas of policy:

  • In the ODI’s Fulfilling Potential documents and Right to Control Trailblazers
  • In the Home Office’s Hate Crime Action Plan
  • In the DWP’s drive to increase take up of Access to Work
  • In the DfE’s new approach to SEN and disability
  • In DCLG’s Community Budgets work
  • In the Cabinet Office’s Open Public Services White Paper
  • (A full list is here)

Not only this, but the Strengthening DPULOs Programme has provided over £1m of funding through the Facilitation Fund to enhance the sustainability of DPULOs (see here) .

And we’re thinking ahead to the future, too: whilst keeping on with the good stuff we’ve been doing, we’ll be getting new work going  in areas such as:

  • Examples of DPULOs working well with commissioners
  • DPULOs and Making It Real in social care
  • DPULOs and local Healthwatch
  • DPULOs and young disabled people
  • DPULOs, social media and accessible engagement
  • DPULOs and fundraising
  • Mapping the DPULO sector
  • Further evidence on the return on investment DPULOs deliver.

What about 2013?

Despite all of the positives of 2012, it has of course been an incredibly challenging year. DPULOs have not been immune from this, partly because of the significant challenges that disabled people themselves have faced and will continue to face.

And we know that circumstances facing DPULOs are likely to be just as hard, if not harder, into the future as local government and others also face a tough time.

But I am optimistic. As Baroness Campbell said:

Disabled people are the best problem solvers.

In a year that will see lots of problems for lots of different people and organisations, what better people and organisations to have working with you than disabled people and Disabled People’s User-Led Organisations?

Over the festive period, I shall reflect on the incredible work that all of you have done through your DPULOs in your local communities, and think forward to what you will continue to achieve in 2013 and beyond.

I hope you have a restful and relaxing holiday.

Rich Watts

(On behalf of all at the Strengthening DPULOs Programme team)

Find out more about the Programme

To find out more about the Strengthening DPULOs Programme, you can visit our website. We also regularly update our Facebook the page with lots of information you will hopefully find useful, plus news from other DPULOs: http://www.facebook.com/dpulos. If you are on Twitter, you can share information and find out more about DPULOs using the hashtag #dpulo. Please also remember to use the #dpulo hashtag if ever you’re tweeting about your work

You can find all 9 of the previous monthly updates here.

Contact us

For information, biographies, contact details and details of the areas covered by each of the DPULO Ambassadors covers, please visit the Ambassadors page.

If you have any questions about the Facilitation Fund or any part Strengthening DPULOs Programme, please contact odi.businessperformance@dwp.gsi.gov.uk

Please feel free to forward this information on to any DPULOs, networks or stakeholders you think might find it interesting.

Disabled People’s User-Led Organisations: a full overview

Information regarding Disabled People’s User-Led Organisations – the what, who, how, where etc. – tends to be found in very many places indeed.

With my centralising tendencies, I thought it would be useful to publish a post that links together some of the key information available here about DPULOs. In turn, these posts link on to a wide array of resources available.

This is by no means comprehensive, so please do let me know (in the comments, via @rich_w on Twitter or via Facebook) if there’s anything I need to add in.

What is a DPULO?

What DPULOs exist?

What do DPULOs do?

What value do DPULOs add?

See also the evidence section below

What does the government think of DPULOs?

What evidence is there concerning DPULOs?

Welcoming a DACO

What’s a DACO? It’s a Deregulation and Contracting Order and it looks like this (pdf).

This particular Order relates to two key policy pilots going on at the moment: one from the Department of Health on Social Work Practices and another from the Office for Disability Issues (sponsored by Department for Work and Pensions) on the Right to Control.

For Social Work Practices, the Order is relatively straightforward: it provides for the ability for SWPs to “discharge the statutory duties of the local authority” for their social care clients. (I wrote positively about SWPs back in November.)

The Order is interesting, though, because it also allows third parties to undertake social care reviews as part of the Right to Control process (which I’ve written about here).

This is potentially very exciting: within a controlled (i.e. pilot) environment, it provides for disabled people’s user-led organisations to be involved in the review of social care packages. It could also extend to other areas the Right to Control covers.

Where DPULOs have been as integrally involved in the social care process it has led to better outcomes for disabled and older people (as per this research on Support, Advocacy and Brokerage by the Office for Disability Issues.)

On the back of the Open Public Services White Paper yesterday, this is one example of how a tweak of a regulation here or there can have a positive and leveling impact on the commissioning landscape. I welcome it.

(Note / disclosure: My organisation ecdp is involved in the Right to Control and has contributed to work with colleagues in local and central government to realise this Order.)

What community budgets can learn from the Right to Control and the Individual Budgets pilot

Nick Clegg today announced that Community Budgets are to be rolled out more extensively than they currently are. As Public Finance puts it:

Under Community Budgets, various different sources of funding are merged into a single ‘local bank account’. The current pilots are pooling money for tackling social problems around families with complex needs… [and Councils can] put forward plans for their own Community Budgets [so that] plans would be developed locally for the pooling of both central and local government budgets.

This is a good idea and follows similar ideas around pooling budgets that have been around for a while. It also creates a space in which services can be more personalised around individuals rather than individuals having to fit around services.

I’ve had the fortune to be involved in two programmes with the same intention to do this before, specifically (though not limited to) adult social care. The first was the Individual Budgets pilot (an evaluation of which is available here), which sought to pool budgets from adult social care, Access to Work, Independent Living Fund, Supporting People, Disabled Facilities Grant, and local integrated Community Equipment Services.

The second is the current Right to Control trailblazers, which seeks to pool budgets from adult social care, Access to Work, Independent Living Fund, Supporting People, Disabled Facilities Grant and Workchoice.

That the Right to Control trailblazers cover virtually the same funding streams as the IB pilots should give you an idea of what I’m going to say next: pooling budgets is not as easy as it looks.

I’ve written about 5 key areas the Right to Control trailblazers grappled with early on: detailed analysis starts here and covers issues like legislation and regulations, policy ‘versus’ process and public agencies working together.

So whilst I fully support Community Budgets – especially as they provide the potential for more personalised services for people, and particularly because I recognise them as reflecting the way public services will (need to) be delivered in the future – let’s not be under any illusions about how hard they’ll be to deliver.

Clegg et al. might not like it, but they’ll need brilliant public sector managers and leaders to make it happen. They’ll also need money, too.

ILF announcement couldn’t be timed any worse

(Note: This is a personal post)

As an aside to today’s announcement that the ILF is to be closed from 2015 onwards, it’s worth pointing out the timing couldn’t be any worse, because today is the day that the Right to Control is launched in Trailblazers across the country.

(It’s also the day on which the government has announced that those organisations which will most likely become responsible for ILF users post-2015 – local Councils – have had an average of 4.4% taken from their budgets.)

The Right to Control is a new legal right that gives disabled people more choice and control over the services they receive.

Amongst many other services, one of these is, erm, the Independent Living Fund.

Despite the fact the ILF change won’t happen until 2015 and that the Right to Control maintains eligibility criteria for all funding streams (meaning that only current ILF users could benefit), making the announcement that the ILF is to close today risks hugely undermining what is actually a very good project.

I’ve been closely involved in the development of the Trailblazer (news of today’s launch available on my employer’s website here). Throughout this development, the uncertainty floating around about the ILF has added complexity into what is already a complicated (but deliverable) project. With this announcement, the government will replace uncertainty with anxiety and worry. And whilst that exists, it’s highly likely the people affected won’t feel enabled or empowered to take up the choice and control the Right to Control offers.

As I implied in my earlier post, what the government says on disability is very different to what it does.

(For more information on the Right to Control, please see my series of posts here.)

Right to Control Trailblazer: Public agencies working together and the implications for staff

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’.

Right to Control Trailblazer: Money, outcomes and money again

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.

Right to Control Trailblazer: Policy ‘versus’ process

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.