Darwin Care support people with learning disabilities and autism in Dorset and use ISFs.
Authors: Alex Goff and Chris Watson
The ISF (Individual Service Fund) model empowers individuals by placing them at the forefront of day-to-day decision-making regarding their own care and support needs using their personal budget. It focuses on enabling people to forge their unique care and support pathways and make decisions about how their outcomes are met.
This approach not only provides opportunities for better and more creative support delivery by providers but also optimises the utilisation of local resources and community-based support. Since the publication of the Care Act guidance in 2014, the ISF approach has undergone a progressive nationwide rollout and continues to be adopted by an increasing number of Local Authorities over time.
Darwin Care, an organisation supporting people with Learning Disabilities and Autistic individuals in Dorset, has been an early adopter of ISFs since 2016. Currently, all the people under the care of Darwin Care are either on ISFs or utilise Direct Payments, allowing them to self-direct their support arrangements. From Darwin Care’s perspective, ISFs offer ongoing benefits for individuals relying on social care and health funding, as well as for the organisation itself as it manages ISFs on behalf of the people they support. This paper discusses the key observations and learning points from Darwin Care's experience.
The ISF model establishes a three-way partnership between citizens, service providers, and Local Authorities, aligning with the Care Act and NHS Personalised Commissioning guidance. It aims to foster autonomy, trust, and the principles of personalisation. Organisations holding ISFs often operate as an extension of social services, making minor day-to-day adjustments to support, planning, and brokering solutions for the individuals they serve. Full transparency regarding budget decisions is critical, and service providers must demonstrate capabilities in person-centred planning, risk assessment, and asset-based working. Overcoming mistrust between commissioning organisations and service providers is crucial for ISF success. This is achieved through developing genuine partnerships, allowing providers the flexibility and autonomy to showcase their qualities while aligning decisions with assessed outcomes and Care Act eligibility. Local success stories should be gathered to promote the positive impacts of ISFs to more people and service provider organisations.
Traditional social care services have focused on time and tasks, mainly commissioning based on the hours of care needed by individuals. This approach has shaped service providers to see themselves primarily as deliverers of these support hours through employed staff. ISFs challenge this view, encouraging care providers to reimagine their services as creative deliverers of outcomes, not just providers of a set number of support hours. This cultural shift requires organisations to equip support staff and management with a better understanding of self-directed support and how to work creatively using the personal budget. Additionally, ISFs may give smaller or newer support providers an advantage when entering new markets alongside more established service provider organisations, as people and families shape the local market using their personal budgets.
ISFs enable near real-time adaptation to changing outcomes, prompting providers to think creatively in addressing barriers and meeting needs. Recognising individuals' strengths, abilities, and the community assets they want access to locally becomes paramount in developing personalised and outcomes-based support plans. Plans should be consistently reviewed and adjusted creatively, aligning with the person’s wishes. Local Authorities should ideally allow service providers flexibility in budget use and in identifying and meeting outcomes as directed, without overly restrictive processes or policies. A strong emphasis should be placed on Local Authorities recruiting creative and values-driven organisations and granting them trusted provider status. To address concerns about inappropriate budget use, local authorities can utilise third-party holding systems for remote auditing by people, families, social workers, and commissioners.
ISF paperwork, processes, and systems should ideally be co-produced and designed to reduce process friction. ISFs may also benefit local community-based social work teams, streamlining workflows and reducing unnecessary contacts by allowing service providers to make day-to-day decisions alongside the people they support. Pre-agreed thresholds for risk and budget expenditure can ensure inclusion and consultation when necessary. Certain conditions and restrictions can also be applied to the use of ISFs where appropriate, such as conditions set by the Ministry of Justice.
Technology, as an innovation, is sometimes underutilised as a component of people's support arrangements. ISFs provide a pathway to facilitate innovation here too, using bespoke technology-enabled care solutions, taking advantage of the widest and most up-to-date range of options available for purchase through a person's ISF budget.
K has fairly limited verbal communication and uses a tablet and a mobile phone to help with his communication. K ideally wants to be more independent in future, enjoys using technology and has a good understanding of it. His team initially were supporting him in person with reminders and prompts for his daily routines and reminders.
K’s team found an item of personalised technology called MEMOplanner (which is basically a large digital planning board) which assists people with prompts and reminders and helps create a visual daily schedule. K and his team used his ISF to purchase a MEMO planner device (costing £1400 including a 3 year licence) and programmed it to cover all of his routines and prompts each day and week. His planner also linked to his phone via an app so is always with him even when he is out and about.
As a result of this K was able to reduce his support each day by around 45 minutes which equated to around £117 per week or £6084 per year! This surplus ISF fund was returned to the council to be available again for other people who draw upon social care services in Dorset.
When used effectively, ISFs significantly enhance citizens' connectivity within local communities. Collaborative use of ISF budgets with citizens and various types of service providers, including sole trader micro providers, can create new links with local businesses, the voluntary sector, and community groups. This not only channels social care funding into local economies but also breaks down societal barriers, ensuring people are present, included, and able to contribute to their local areas. Emphasis should be on assisting smaller, community-led organisations in embedding ISFs within their services. This approach may be quicker and easier to implement than attempting to shift culture and practice within larger organisations, which may take more time.
Supporting real co-production and allowing people's natural creativity to flourish via ISFs often leads to outcomes that surpass those achievable through more rigid, task-based commissioning approaches. Success in this respect requires the right combination of ethos, culture, trust, creativity, flexibility, positive risk-taking, and person-centred thinking.
Creating an environment that encourages shared experiences facilitates the growth of both individuals and staff teams. This transformative approach has been particularly impactful, leading to staff members feeling valued and gaining a greater degree of personal fulfilment from their roles. Staff surveys have shown that this contributes to heightened job satisfaction, increased staff retention, and a reduction in recruitment costs. Ultimately, this results in the delivery of consistent and high-quality support. ISFs have supported Darwin’s commitment as an organisation to deliver real change in the way that their support staff are empowered to carry out their roles.
In some local authority areas, challenges still persist with a reluctance to embrace ISFs, often due to concerns about the use of public funds and loss of control and oversight. While understandable to some extent, this reluctance can hinder creativity and perpetuate the model of delivering time and task-based support.
The ISF model continues to emerge as a transformative force in social care and health services, redefining citizen empowerment and fostering collaborative relationships among citizens, communities, service providers, NHS, and local authorities. This exploration of ISFs through Darwin Care showcases their impacts on trust, attitudes, creativity, community links, processes, and relationships. This paper advocates for ISF service providers as key agents of change in communities, particularly when combined with a strategic shift towards locally based and connected organisations, promising a future where the principles of personalised and community-led care are further embedded throughout the country.
The publisher is Citizen Network Research. Supporting People with Individual Service Funds © Alex Goff and Chris Watson 2024.
Inclusion, Self-Directed Support, social care, England, Article
