EALING

Adult Services Personalisation Programme
Putting People First:

A Shared Commissioning Outline for Independence, Health & Wellbeing
(2009 – 2011)
In partnership with
Independence, health and wellbeing
Contents
1. Introduction 3 Appendix 1
2. A shared approach 4 Transitional and integrated commissioning

intentions (2009 – 2011)
3. Why we need to change 5
• Resources
4. National commissioning and performance drivers 6 • Cross-cutting themes and priorities
• Older people
5. Local independence, health and wellbeing objectives 9 • Physical disabilities and long-term
conditions
6. Ealing’s high-level direction of travel: 10 • Mental health
• Learning disabilities
6.1 A universal offer 11
• Substance misuse
6.2 Prevention and early intervention 12
• Carers
6.3 Choice and control 13
• Market development
6.4 Social capital and community capacity building 14
• Workforce development
7. The future commissioning landscape in Ealing: 15
Appendix 2
7.1 A new commissioning framework 16
7.2 The shift to outcome-based commissioning and contracting 18
• Glossary of terms
7.3 New commissioning principles 20
7.4 Identifying future patterns of need and demand 21
7.5 Stakeholder engagement 22
8. Commissioning for independence, health and wellbeing beyond 2011 23
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1 Introduction
The introduction of personalisation means thinking about care and support services in an entirely different way. It means starting with the person as an individual
with strengths, preferences and aspirations. It means placing them at the centre of identifying their own needs, making choices and exercising control over how,
when and where they are supported to live their lives. Consequently it requires a significant transformation of adult social care so that all systems, processes,
staff and services are geared-up to putting people first 1.
Within this context commissioning for personalisation can be defined as:
Working together with citizens & service providers to support individuals to translate their aspirations into timely
& quality services, which meet their needs; enable choice & control; are cost effective; & support the whole
community 2
The purpose of this shared commissioning outline is to set-out the high-level direction of travel and key transitional commissioning intentions for Ealing; in
readiness for the commencement of the Council’s personalisation programme in April 2010 and subsequent full programme implementation from April 2011. As
such this document builds on the Council’s existing and highly successful integrated commissioning arrangements with NHS Ealing; and forms an integral part
of the Adult Services Personalisation ‘Blueprint’ Strategy 3.
In essence the outline document identifies the central reasons for why we need to change our approach over the coming years and institutes a new
commissioning framework and a series of personalised commissioning principles that will underpin what we will do. It further describes how we will reconfigure
our existing structures and systems; and realign our resources in relation to Ealing’s core personalisation objectives over the next 18-months and beyond.
For Ealing personalisation goes further than simply offering individual budgets to people eligible for Council funding. Incumbent throughout any new process will
be a clear commitment to put local people at the heart of decision-making; tackle inequality; and promote the independence, health and wellbeing of the
borough’s residents as a whole (whether provided directly by statutory services or funded by themselves). All of which will contribute toward achieving the Local
Strategic Partnership’s vision that:
In 2016 Ealing will be a successful borough at the heart of West London, where everyone has the opportunity to
prosper & live fulfilling lives in communities that are safe, cohesive & engaged 4
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(1) Personalisation Briefing for Commissioners, SCiE (2009); (2) Commissioning for Personalisation: A Framework for Local Authority Commissioners, DH (2008); (3) Ealing’s
Blueprint Strategy for Personalisation, Ealing Council (2009); (4) Sustainable Community Strategy, Ealing Council (2006 – 2016)
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2 A Shared Approach
The ethos underpinning this commissioning outline is one very much based on a common set of values that are shared equally across the community, health
and social care domains. These values, which are reflected in the ‘Blueprints’ core community development concept 5, are premised on the notion that all of
Ealing’s residents, irrespective of illness or disability, should be supported to 6:
• Live independently;
• Stay healthy and recover quickly from illness;
• Exercise maximum control over their own lives and where appropriate the lives of their family members;
• Participate as active and equal citizens, both economically and socially 7; and
• Have the best possible quality of life that retains maximum dignity and respect.
These values accompanied by authentic partnership working with local NHS services and other key statutory agencies; third and private sector service
providers; individuals and carers; and the wider community will be central in creating and sustaining a new high-quality care system that is fair, accessible and
responsive to the needs of those who rely on local services.
It is anticipated that a ‘shared approach’ to improving and supporting the health and wellbeing of the whole population will underpin the future commissioning
activity of all organisations in the borough; and furthermore embed:
• A common approach for involving all stakeholders in identifying and co-producing sustainable solutions;
• A joint approach to identifying local patterns of need and demand 8;
• A shared approach to local priority setting;
• New shared information protocol’s;
• A common performance management process, with local area agreement indicators and local health commissioning priorities at the heart of this 9;
• New integrated workforce development planning;
• New commissioning standards and arrangements based on a common commissioning framework (regardless of services being commissioned individually
or jointly)
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(5) What is Community Development? Community Development Exchange (2006); (6) Putting People First Concordat: A Shared Vision & Commitment to the Transformation of Adult
Social Care, HM Government (2007); (7) Communities in Control - Real People, Real Power, C&LG (2008); (8) Guidance on Joint Strategic Needs Assessment, DH (2007); (9) Delivering
Excellence for Ealing: Commissioning Strategy Plan, NHS Ealing (2009 – 2013)
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3 Why We Need to Change…
There are broadly four main reasons why we need to change Ealing’s pattern of service provision and investment in the future:
• Society has undergone significant change since the original conception of the welfare state. People are living longer than ever before, and the proportion of
older people in society is growing. Consequently health and social care services continue to face ever-increasing demands for support and assistance 10. In
parallel the Government has indicated lower levels of financial growth available from 2011onward, reflecting the tightening of public expenditure due to the
current economic situation in the UK. Therefore improving the health and wellbeing of the population in a financially sustainable way is a goal (and a
challenge) for us all.
• The Government has indicated that Council’s and local NHS services must re-orientate health and social care systems to focus together on greater
prevention and health promotion. This means undertaking a clear shift in spending toward early intervention 11.
• National policy has made it increasingly clear that public-sector agencies will be judged on the extent to which they apply an ‘enabling’ commissioning
approach to delivering better outcomes for local people. National programmes such as Putting People First, World Class Commissioning and the
Commissioning Support Programme have entrenched commissioning as a key mechanism for reshaping services to achieve an improved quality of life for
adults and children alike. These outcomes are defined in key policies such as Our Health, Our Care, Our Say; Every Child Matters; and Independence,
Wellbeing and Choice. As a result Council’s and other public agencies have increasingly been directed under this policy-set to delegate greater choice and
control (including budgets) to individuals and their carers so that they can secure the services they want for themselves.
• People increasingly expect more choice and control over all areas of their lives, including public services. Locally, people have told us that they want better
access to mainstream services; greater choice and control; improved support for self-funders; and more culturally appropriate and socially inclusive services
12.
Future commissioning activity therefore must be based on a robust understanding of local needs and demand; a new emphasis on prevention and early
intervention; the development of flexible outcome-based support options; the active participation of all stakeholders including local people (and their carers
where appropriate) who are service users; and crucially sustainability and the cost effective delivery of services 13.
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(10) The Case for Change: Why England Needs a New Care & Support System, DH (2008); (11) Our Health, Our Care, Our Say, DH (2006); (12) Ealing’s Blueprint Strategy for
Personalisation, Ealing Council (2009); (13) Commissioning for Personalisation: A Framework for Local Authority Commissioners, DH (2008)
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4 National Commissioning and Performance Drivers
Ultimately the focus of Ealing’s shared commissioning outline (and future commissioning arrangements) will be to work toward the successful implementation
and delivery of a number of overlapping national policy objectives. Here the outline document touches on the more prominent national commissioning drivers
that directly impact on the local personalisation agenda (full national policy detail can be found in the ‘Blueprint’ strategy document). These key strategic drivers
include:
The Commissioning Framework for Health & Wellbeing 14. Following on from the White Paper, Our Health, Our Care, Our Say, the Department of Health
published the Commissioning Framework for Health and Wellbeing. This outlined an understanding of what commissioning is and what it should deliver. In
addition to these parameters it also suggested the following outcomes:
Commissioning for the health and wellbeing of individuals means helping citizens to:
• Look after themselves and stay healthy and independent;

• Participate fully as active members of their communities; and
• Choose and easily access the type of help they need, when they need it.
The guidance further suggested that these outcomes and requirements could best be met by encompassing the following eight steps:
• Putting people at the centre of commissioning.

• Sharing and using information more effectively.
• Assuring high-quality providers for all services.
• Recognising the interdependence between work, health and wellbeing.
• Developing incentives for commissioning for health and wellbeing.
• Making it happen – accountability.
• Making it happen – capability and leadership.
• Understanding the needs of populations and individuals.
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(14) Commissioning Framework for Health & Well-being, DH (2007)
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World-Class Commissioning 15. Ealing’s commissioning approach for personalisation has equally been designed to ‘fit’ with the Department of Health’s vision
for world-class commissioning. The vision outlines what it means to be world-class commissioners and how world-class commissioning will positively impact
upon the population’s health and wellbeing. It is a shared vision, which has been developed jointly by the Department of Health and the wider health and social
care community, and is delivered by the NHS at a local level. The central aims are that:
• People will live healthier and longer lives;

• Health inequalities will be dramatically reduced;
• Services will be evidence-based and of the best quality;
• People will have choice and control over the services that they use, so they become more personalised;
• Investment decisions will be made in an informed and considered way, ensuring that improvements are delivered within available resources; and
• Primary Care Trusts (PCTs) will work with others to optimise effective care.
Commissioning for Personalisation: A Framework for Local Authority Commissioners 16. Builds on the Putting People First Concordat between
Government, Local Government and their partners for the transformation of adult social care. It sets out the need for significant change in the following areas:
• The extension of choice and control to all citizens with care or support needs;
• The importance of information and advice for citizens with care or support needs, regardless of whether they are state funded or using their own resources;
• The importance of services that promote independence and prevent people needing ongoing care or support where this can be avoided;
• The importance of ‘universal services’ in the lives of all citizens, especially those with care and support needs;
• The importance of all stakeholders working together to shape communities, with the needs of citizens at the centre; and
• The continued importance of ensuring the cost effective delivery of services.
The National Programme for Third Sector Commissioning 17. The Improvement and Development Agency (IDeA) is managing the National Programme for
Third Sector Commissioning. The programme forms a critical strand of Partnership in Public Services: An Action Plan for Third-sector Involvement 18. The three
main outcomes of the programme are to:
• Increase awareness and understanding of the value of commissioning services from third sector providers;
• Secure greater third sector involvement throughout the commissioning cycle; and
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(15) World Class Commissioning – The Vision, DH (2008); (16) Commissioning for Personalisation: A Framework for Local Authority Commissioners, DH (2008); (17) National
Programme for Third Sector Commissioning (2nd Phase), IDeA (2009); (18) Partnership in Public Services: An Action Plan for Third-Sector Involvement, Cabinet Office (2006)
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• Improve bidding practice from third sector organisations.
To make this vision a reality Council’s (and other public agencies) are asked to embed the following eight principles for good third-sector commissioning:
• Understanding the needs of users and other communities by ensuring that, alongside other consultees, you engage with the third sector organisations, as
advocates, to access their specialist knowledge.
• Consulting potential provider organisations, including those from the third sector and local experts, well in advance of commissioning new services, working
with them to set priority outcomes for that service.
• Putting outcomes for users at the heart of the strategic planning process.
• Mapping the fullest practical range of providers with a view to understanding the contribution they could make to delivering those outcomes.
• Considering investing in the capacity of the provider base, particularly those working with hard-to-reach groups.
• Ensuring contracting processes are transparent and fair, facilitating the involvement of the broadest range of suppliers, including considering sub-
contracting and consortia building, where appropriate.
• Ensuring long-term contracts and risk sharing, wherever appropriate, as ways of achieving efficiency and effectiveness.
• Seeking feedback from service users, communities and providers in order to review the effectiveness of the commissioning process in meeting local needs.
The Commissioning Support Programme 19 is sponsored by the Department for Children, Schools and Families and the Department of Health and covers
the commissioning of all services for children, young people and their families, including both health and education. Commissioning priorities (16) for children and
young people in recent years have focused around the importance of an integrated approach to meeting their needs based on five shared outcomes, which aim
to ensure that children and young people:
• Remain healthy;
• Stay safe;
• Enjoy and achieve;
• Make a positive contribution; and
• Achieve economic wellbeing.
Within the children’s commissioning programme itself, there has been an emphasis on the value of making services more personal for the end user. It also
_______________________________________________________________________________________________________________________________
(19) Joint Planning & Commissioning Framework for Children, Young People & Maternity Services, DfES & DH (2006)
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focuses on the need for early intervention and prevention; engaging and empowering service users; narrowing the gap for vulnerable and disadvantaged
groups; and the integration of services to provide a more holistic response to needs.
In addition to the aforementioned national commissioning drivers, data from the following key performance indicators (which are drawn from the National
Indicator Set 20) will also provide a wider context in which to measure future commissioning and programme implementation progress:
• NI 125 achieving independence through rehabilitation / intermediate care

• NI 130 the proportion of eligible service users with a direct payment and / or an individual budget
• NI 134 number of emergency bed days
• NI 139 people over 65 who say that receive information, assistance and support to live independently at home.
• NI 145 settled accommodation for adults with learning disabilities
• NI 146 employment for adults with learning disabilities
• NI 149 settled accommodation for adults with mental health problems
• NI 150 employment for adults with mental health problems
5 Local Independence, Health and Wellbeing Objectives
Ealing’s commissioning activity will also be influenced by a number of key local independence, health and wellbeing objectives. Both transitional and future
commissioning arrangements will in particular look to incorporate and contribute toward achieving the Local Area Agreement aspirations as outlined in the
borough’s Sustainable Community Strategy 21; and the Commissioning Strategy Plan priorities 22 recently published by NHS Ealing. The six local area
agreement themes include future commissioning working toward:
• Making Ealing a better place to live;

• Creating a great place for every child and young person to grow up;
• Providing efficient, well-run services that are good value for money; promote a cohesive and engaged community; reduce inequalities and balance
community interests;
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(20) The New Performance Framework for Local Authorities and Local Authority Partnerships: Single Set of National Indicators, CLG (2007); (21) Sustainable Community Strategy,
Ealing Council (2006 – 2016); (22) Delivering Excellence for Ealing – Commissioning Strategy Plan, NHS Ealing (2009 – 2013)
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• Making Ealing one of the safest places in London;

• Ensuring Ealing is a thriving place to live and work; and
• Reducing health inequalities and promoting the wellbeing and independence of adults and older people in the borough.
In parallel Ealing’s local health priorities have been organised around addressing health inequalities and the need to improve the health and wellbeing of the
whole population. As a result future commissioning arrangements will also, where appropriate, take into account NHS Ealing’s strategic ambitions, which are to
improve:
Priority 1: The health of the whole population by increasing life expectancy; reducing health inequalities, and improving health and wellbeing.
Priority 2: The quality of healthcare, including patient experience
Priority 3: The treatment of vascular disease such as coronary heart disease, stroke and hypertension
Priority 4: The diagnosis and care of diabetes
Priority 5: The diagnosis and care of dementia
Priority 6: The quality and care of maternity and children’s services
It is equally anticipated that future commissioning activity will also establish clear links with other major local strategies and service area plans, these for
example will include:
• The Quality of Life for Older People & Carers Strategy;

• Ealing’s Supporting People & Housing Strategies;
• The Local Regeneration Strategy;
• Ealing’s Children’s Commissioning Strategy;
• The Joint Dementia Care Action Plan; and
• The forthcoming Joint Health & Wellbeing Strategy, which is due to be published by early 2010.
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6 Ealing’s High-level Direction of Travel
Ealing’s vision for personalisation is a transformational one. As such the Council wishes to see a major shift in the focus and ethos of adult social care over the
next 5-years to one that:
• Facilitates equal access to universal services, information and advocacy;

• Is premised on the notion of prevention, early intervention and reablement;
• Ensures people have greater choice and control over meeting their needs; and
• Builds social capital and capacity within local communities.
Ultimately it is against these core outcomes that our future success will be judged.
So what will be different in the future?
6.1 A universal offer
In conjunction with the Council’s ‘targeted offer’ for FACS 23 eligible individuals Ealing’s personalisation programme, in the future, will aim to address the needs
and aspirations of the whole community.
From April 2011 everyone will have access to the right forms information and advice (including independent advocacy should they need it 24) to help them make
informed decisions about their own health and wellbeing. Ealing residents will also benefit from new integrated health and social care contact and signposting
arrangements; as well have equal recourse to the Council’s needs assessment and resource allocation functions (including for those who self-fund).
People will additionally have a wider choice in how their care and support needs will be met; and will be able to routinely access mainstream services such as
transport; leisure and education; housing; and opportunities for employment to support their ‘whole’ quality of life.
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(23) Fair Access to Care Services Guidance, Ealing Council (2005); (24) Disability Rights Commission: Delivering the Choice & Voice Agenda: The Role of Independent Advocacy
Services (2006)
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Universal Offer
Access to universal information & services
for all (including self-funding customers)
Employment
Joint Needs
Support
Assessments Health Independent Resource
Advice Advocacy Allocation Financial
Crisis Youth
System Advice
Intervention Housing Services
Support Support with Leisure
Training &
Access to Benefit Services
Adult
preventative Access to Maximisation
Learning
services Information & Social
Signposting Support Networks
Transport
Planning &
& Blue
Support for Brokerage
Badge
Financial Carers
Assessment in Contract &
line with Provider
Council’s Customers eligible for Management or
Contributions full or partial Advice
Policy social care funding (FACS)
Individual Budgets Case

Virtual Budget; Review &
Cash Payment;
Individual Service Fund Monitoring
demonstrates, for illustrative
Figure 1:
purposes, an emerging universal offer
Targeted Offer that will be available and how this wider
offer will work in conjunction with
Ealing’s FACS targeted offer.
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Figure 1: Developed by Ealing’s Personalisation Programme Team (2009)
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6.2 Prevention and Early Intervention
In the future, local health and social care services will identify those in need of support at a much earlier stage. As a result Adult Services’ and NHS Ealing will
jointly aim to offer improved health promotion and signposting arrangements; as well as provide a greater range of co-ordinated preventative and early
intervention services. Joint intervention within this context of will be premised on a paradigm of prevention at all levels 25 i.e.
• Primary prevention (promoting wellbeing): stopping healthy people becoming unhealthy by preventing problems from arising in the first place.
• Secondary prevention (early intervention): improving the situation for people with high-risk factors or long-term conditions that are established but not yet
causing problems.
• Tertiary prevention: preventing established conditions from getting worse.
In particular, new rehabilitation and reablement services will be in place to ensure that those Ealing residents who have particular needs associated, for
example, with their mobility or in carrying out daily-living tasks or following a period of ill health, regain their skills and confidence and return to independent
living as quickly as possible.
Equally; home-treatment and recovery services, new supported housing options and flexible floating support services will play a vital role within any new ‘whole
system’ prevention and early intervention approach. These services will focus on providing either targeted or around-the-clock provision as needed, whilst
supporting people to retain maximum independence and control over their lives.
These new co-ordinated services and systems will, from the outset, help people remain independent by:
• Undertaking proactive health promotion; and making greater use of ‘universal services’
• Providing comprehensive health and wellbeing information and advice
• Signposting people to community or locality-based support options
• Providing intensive (time-limited) one-to-one support
• Maximising the use of community equipment and major adaptations
• Making full use of assistive technologies such as telecare and telehealth
• Supporting people with housing support and ‘small maintenance’ related tasks
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(25) Making a Strategic Shift to Prevention & Early Intervention, DH (2008)
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Emerging Prevention & Wellbeing Offer
NHS Occupational
Therapy
Raises bed and
armchair
Disabled Facilities
Grant Supporting People
Funds a Funds
walk-in shower housing related support
Adult Social Services

Warmfront
Provides equipment &
Help fund and fit
fixed-term intensive
central heating
reablement
Home Improvement
Housing Department
Agency
Organises Age Concern
Organises the
kitchen repairs Assist with
benefits maximisation
walk-in shower At an individual level, the contribution of
resources from across a future ‘Prevention and
Early Intervention’ system may well begin to
look like Figure 2 opposite
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Figure 2: Drawn from Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society, CLG (2008)
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6.3 Choice and Control
In the future, health and social care services will continue to move more toward greater self-directed support rather than care needs being solely managed by a
care professional. In Ealing people with eligible support needs will have access to new individual budgets (which they can choose how to deploy themselves)
from which to purchase the appropriate support they want. In the future individual budgets in addition to social care monies will potentially combine a number of
other key funding streams such as an individuals personal top-up; supporting people monies; disabled facility and community equipment grants; access to work
and independent living funds; and newly introduced personal health budgets to purchase ‘whole life’ packages of support.
To assist people in managing their own support package individuals will be able to choose who they will be supported by 26 e.g. directly by themselves or their
carers and families; neighbourhood or local networks; user-led or voluntary organisations; independent support planners and brokers; or council workers such
as an identified support manager.
C o u n c il m a n a g e d
s e r v ic e v ia
C o u n c il F ra m e w o rk V ir tu a l B u d g e t
C o n t ra c t ( s ) o r
C o u n c il S p o t P u r c h a s e
C u s t o m e r c o n t r o lle d
In d iv id u a l s e r v ic e v ia S e r v ic e
Budget C o u n c il m a n a g e d In d iv id u a l S e r v ic e F u n d P ro v id e r
F r a m e w o r k C o n tr a c t o r Figure 3: illustrates the individual budget deployment
C o u n c il S p o t P u r c h a s e
options (and associated management methods) that
will be available in part from April 2010; and in full
from April 2011.
C o n tr a c t f o r s e r v ic e
Cash Paym ent b e t w e e n ‘C a s h ’ H o ld e r &
S e r v ic e P r o v id e r It is anticipated that by April 2011 at least 30% of all
A p r il 2 0 1 1 adult social care customers will be in receipt of an
individual budget
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(26) Care Services Improvement Partnership: Brokerage & Individual Budgets, CSIP (2007); Figure 3: Model drawn from Contracting for Personalised Outcomes – Learning from
Emerging Practice, DH (2009)
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6.4 Social Capital and Community Capacity Building
Social capital is often described as the ‘social glue’ that helps people, organisations and communities to work together towards shared objectives. It is often
defined as the social ties and networks that come from everyday contact between people as a result of their forming social connections and networks based on
mutual trust, shared values, and reciprocity 27.
The government has promoted the importance of social capital throughout a number of key policy initiatives in recent years. This is due to the recognition that
social capital has been linked with a range of positive outcomes including better government, economic growth and lower levels of crime. Additional research
has also shown that people with high-levels of social capital are happier, healthier and wealthier 28. There are three categories of social capital i.e. bonding,
bridging and linking. These are explained further in the box below.
Bonding – based upon enduring, multi-faceted relationships between similar people with strong
mutual commitments such as among friends, family and other close knit groups.
Bridging – formed from the connections between people who have less in common, but may have
overlapping interest, for example, between neighbours, colleagues, or between different groups within
a community
Linking – derived from links between people or organisations beyond peer boundaries, cutting
across status and similarity and enabling people to exert influence and reach outside their normal
circles
As such the Council fully recognises the importance of social capital in building strong and prosperous communities. For this reason Ealing will, in the future,
actively seek to commission services that promote greater opportunities to develop social capital, particularly in those areas with the greatest need.
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(27) Communities in Control - Real People, Real Power, CLG (2008); (28) Neighbourhood Management & Social Capital, CLG (2007)
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Community Capacity Building
To ensure sustainability, commissioners in the future will aim to improve the capacity of local communities to determine their own future 29. Along with
commissioning direct services, commissioners working in collaboration with other council departments and public agencies, will take steps to support a local
community’s ability to improve the quality of life of, and opportunities available to, local people. Ealing in particular will be interested in procuring services that
are innovative and which seek to bring about real change in the ways that services have been delivered in the past. Therefore, there will be a focus on
commissioning services, which empower people to take a positive role in their community (as defined by them); build self-esteem; and which look to facilitate the
development of local networks.
Ealing’s future approach, in line with this capacity building ethos, will also look to provide increased access to training and guidance opportunities to local
community groups and user-led organisations. As a consequence Adult Services (working in partnership with other council departments and public sector
partners) will work with umbrella organisations such as Ealing Community Network (ECN) to offer a range formal business support and training opportunities to
develop new ‘micro’ initiatives 30 in the borough such as new locality based support services or social enterprises’, which may more effectively respond to
identified local needs or better engage with Ealing’s traditionally hard-to-reach communities.
Delivering the strategic shift to personalisation…
Will require a ‘whole-system’ approach to succeed. Ultimately it will involve commissioners securing resources from a variety of sources, including Ealing’s full
range of council services; along with other core public-agency services such as those provided local benefits and employment agencies, leisure and education
services; and local community safety and regeneration partnerships. In addition Ealing’s integrated health and social care commissioners will, over the next 18-
months, look to identify and prioritise key areas of change; and determine those resources that will require re-engineering or releasing from across the wider
health and care system to be redirected to enable investment in new care and support models that will encompass all levels of need.
This strategic shift will also have major implications for service providers, as well as for wider North West and West London sub-regional structures. All of which
will have to review and re-shape existing provision and contractual arrangements to provide more flexible outcome-based service options. Each will then need to
effectively promote these options directly to local people who will increasingly be making their own purchasing decisions rather than relying on large-scale
contracts negotiated by the statutory-sector.
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(29) The well-connected community: A networking approach to community development cited in Cohesion Guidance for Funders Consultation, CLG (2008); (30) Supporting Micro-
market Development, DH & NAAPs (2009)
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7 The future commissioning landscape in Ealing
7.1 A New Commissioning Framework
In planning for the implementation of personalisation there has been a growing recognition of the need to develop new structures that empower people to make
use of and develop their capacity to self-direct their own care and support; and where possible to directly shape the services they receive. However, it is equally
recognised that changing services purchased with an individual budget and developing an appropriate market to underpin this (whilst also retaining the need for
securing a strategic shift in resources toward prevention and early intervention) requires new models of commissioning at the individual, operational and
strategic level.
N e w M o d e l o f C o m m is s io n in g
M u lti-le v e l c o m m is s io n in g
A re a -w id e , re g io na l a n d
S tra te g ic jo in t co m m is sion ing
O p e ra tio n a l L o ca lity b as e d co m m iss io ning a nd

s u pp o rt to citiz en co m m is sio ning
C itiz e n C itiz e ns direc tin g th e ir o w n

s u pp o rt with Pe rso na l o r
In d iv id ua l Bu d ge ts
S o u rc e: D e p a rtm en t o f H e a lth
illustrates a new multi-level commissioning

Figure 4:
model for personalisation and highlights the
interdependencies between the three levels of
intervention.
_______________________________________________________________________________________________________________________________
Figure 4: Drawn from Commissioning for Personalisation: A Framework for Local Authority Commissioners, DH (2008)
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In response to this new model of working Figure 5

Analyse Plan opposite illustrates a new commissioning framework
Strategic for independence, health and wellbeing that
Commissioning incorporates the three commissioning functions.
(area-wide, regional, joint / integrated commissioning)
Stakeholder
High Level
Engagement It is expected that Ealing’s commissioners will utilise
Demand and
Supply Analysis Operational
Shared
Gap Analysis
this framework in full from April 2010.
Commissioning
Co mmissioning Shared
(locality based commissioning) Commissioning
Strategy
In conjunction with this new framework it is anticipated
that new organisational structures will be in place,
Provider
performance
Co-produced
purchasing plan
Co-designed
Outcome-based
which better reflect a modern health and social care
fedback into devised from Services landscape. Development in this area is at an early
strategy Individual commissioning
Commissioning strategy stage but emerging discussions suggest that future
(micro-commissioning) commissioning will be shaped around:
Self-Directed Support
Outcome-based
• Strategic commissioning and policy;
Support Planning Outcome-based • Operational commissioning and contracting;
Contract Specification
Monitoring Support Brokerage Process • Individual commissioning; and
• Provider management.
Budget &
Joint Contract / Provider Resource
Review market Purchasing Plan Management Allocation
performance Review
Market
Review Development
Commissioning
Strategy
Capacity
Building
Ealing’s new commissioning framework has also been

Review Do designed to reflect Adult Social Services integrated
commissioning arrangements with NHS Ealing
_______________________________________________________________________________________________________________________________
Figure 5: Drawn from Key Activities in Commissioning Social Care: 2nd Edition, CSIP (2008)
19
7.2 The shift to outcome-based commissioning and contracting
A critical component of the new commissioning landscape is that it will be first and foremost focused on achieving ‘real’ outcomes for local people. This move
toward outcome-based commissioning (ObC) signifies a clear shift away from conventional health and wellbeing approaches, which have traditionally been
dominated by activity-based arrangements such as hours of contact, service waiting times, numbers of complaints etc. Although these indicators are important,
they do not answer the most central of questions ‘what does the service achieve for individuals’.
Outcome-based commissioning therefore focuses not simply on activities and processes, but crucially on results. The core concept here will be to embed a shift
in thinking and practice from how a service operates i.e. what it does, to one that focuses on what it achieves.
offers a common definition for outcome-based commissioning

Figure 6:
and contracting
_______________________________________________________________________________________________________________________________
Figure 6: Taken from Outcome-based Commissioning & Contracting, RIPFA (2006)
20
As a result of this shift toward outcome-based activity, commissioners will explicitly seek to secure services and resources that support individuals to achieve
outcomes that directly contribute toward their independence, health and wellbeing. Within the wider context of Ealing’s new multi-level commissioning
framework ‘outcomes’ will in the future be categorised into three equal aspects:
• Individual outcomes e.g. maintenance outcomes: that enable people to live at home despite failing health; and change outcomes: that people experience
improvements in the quality of their life that leads to greater community involvement and less dependency on statutory services.
• Service level outcomes e.g. that people are supported with specific tasks, such as benefits maximisation
• Strategic outcomes e.g. that more people are helped to live at home
Notwithstanding the enormity of the change agenda involved with implementing personalisation, Ealing will continue to ensure that it maintains safe and
qualitative outcomes for all individuals (and their carers) in line with its duty of care and other key statutory responsibilities. Therefore, outcome-based
commissioning will continue to operate within the context of:
• Existing and future ‘Safeguarding Adults’ Guidelines;

• Existing and future Quality Assurance / Outcome Framework(s); and
• Ensuring, or offering detailed advice and guidance on, ‘fit for purpose’ skills training and key operational requirements for service providers and personal
assistants alike
7.3 New Commissioning Principles
As Ealing moves from a ‘traditional’ model of commissioning toward disaggregating increasing proportions of its resources to both realign with prevention and
early intervention and to support individuals to make their own purchasing decisions; commissioners will need to identify new ways of working in partnership with
all stakeholders to ensure that an effective range of options are in place throughout the ‘whole’ system. As such two key tasks have been identified as central to
this undertaking:
• Firstly, ensuring the right balance of investment between universal services, prevention and early intervention and self-directed support. Achieving this
balance may well require a transparent process of disinvestment away, for example, from traditional models of care toward more flexible community based
care and support options.
_______________________________________________________________________________________________________________________________
21
• Secondly, shaping the market so that high-quality and responsive care and support services are available for individual budget holders and self-funders
alike.
In underpinning these tasks Ealing’s future commissioning activity will be guided and characterised by the following principles, which will endeavor to 31:
• Apply a commissioning process that is premised on the notion of prevention, promoting independence, choice and control.
• Recognise and value diversity; and tackle inequality
• Empower people to direct their own support to better meet their needs (including those who self-fund)
• Build on people’s existing capacities and social networks
• Enable meaningful stakeholder participation in the commissioning process through active co-design and co-production
• Ensure that there is choice in the deployment and support options available for people to determine arrangements that best suit them
• Work to personalise universal as well as specialist services to reduce barriers for people with support needs wishing to access them
• Work across all sectors to maximise opportunities to secure new resources
• Maintain a diverse view of the market that supports equity of opportunity for the voluntary and community sectors (including small and social enterprise)
• Establish mechanisms for collecting (and sharing) local intelligence and feeding this into the commissioning cycle
• Prioritise support for user-led organisations and ‘micro-initiatives’ when developing the market
• Ensure that commissioning and contracting arrangements reinforce local ‘safeguarding’ procedures.
• Ensure ‘quality outcomes’ are at the centre of all developments
• Ensure the cost effective delivery of services
• Procure services that minimise damage to the environment
7.4 Identifying future patterns of need and demand
Ealing is a thriving, diverse and prosperous borough with a population of some 309,000 people that continues to change and grow. It’s competitive economy;
good schools and a high-quality environment make it the place of choice for many to live, work and visit. However this traditional image of the borough masks
significant areas of deprivation and inequality. A substantial number of local people face poorer health, education, housing and employment opportunities.
Finding solutions to these challenges depends not only on good partnership working, but also on robust understanding of needs and demand.
_______________________________________________________________________________________________________________________________
(31) Commissioning Principles drawn from Commissioning for Personalisation: A Framework for Local Authority Commissioners, DH (2008) and the Commissioning Framework for
Health & Well-being, DH (2007); and World Class Commissioning – The Vision, DH (2008)
22
Thus a central feature in the development of future commissioning will be the Joint Strategic Needs Assessment (JSNA). The JSNA is seen as the means by
which local NHS services and Council’s can describe the future health, care and wellbeing needs of their local populations. The outputs of which include
statements that identify future investment and spending decisions, contracting and market development programmes. Consequently the JSNA describes the key
health and social issues that affect local populations and defines the strategic direction of services that will affect local health and wellbeing. Locally, Ealing
Council and NHS Ealing produce it jointly under the aegis of the Local Strategic Partnership 32.
The JSNA, in particular, considers a range of factors, including:
• The burdens of disease and ill-health;

• Services currently provided, their effectiveness and costs;
• The views of patients, service users and the wider public;
• Levels of need and provision in comparable areas; and
• National policy and guidance.
The JSNA is not a commissioning plan in itself or a statement of commitments to develop particular services. However, it is anticipated that it will underpin the
development of Ealing’s future commissioning arrangements by highlighting key issues such as:
• Continuing inequalities in health status and access to services

• Opportunities to provide more services in primary care and reduce reliance on hospital care in the longer term
• Hidden need, particularly undiagnosed long-term conditions such as diabetes and cardiovascular disease
• The benefits to be gained from integrating health and social care and from promoting health, well-being and independence and preventing disease
• Changes in Ealing’s population that arise from migration, ageing and other factors
• The influence of major determinants of health such as income, housing and education
• Rising levels of demand in particular areas of health and social care, including acute and emergency care
7.5 Stakeholder Engagement
Putting People First guidance states 33 that real change can only be achieved through the participation of all key stakeholders throughout every stage of the
_______________________________________________________________________________________________________________________________
(32) Ealing’s Joint Strategic Needs Assessment, Local Strategic Partnership (2008); (33) Putting People First Concordat: A Shared Vision & Commitment to the Transformation of
Adult Social Care, HM Government (2007)
23
personalisation process. It is essential therefore that participatory mechanisms are in place to ensure that future commissioning activity is co-designed and that
commissioning plans and strategies are genuinely co-produced.
Ealing already benefits from a series of well established and effective integrated health and social care partnership boards; and a series of service area
stakeholder and provider forums that ensure the full engagement of all key stakeholders in the local integrated commissioning process i.e. people with support
needs; carers and families; community and voluntary sector organisations; local service providers; and other key Council departments and public agencies. A
central task for Adult Services and NHS Ealing will be to ensure that these existing ‘fora’ are reviewed (and where appropriate refreshed or redesigned) prior to
April 2010 to ensure that each is congruent with Ealing’s personalisation objectives; the NHS’ public and patient engagement strategy
8 Commissioning for independence, health and wellbeing beyond 2011…
It is anticipated that Adult Services’ and NHS Ealing will work with all key partners and stakeholders throughout 2010 to design and put into place a new 10–year
Shared Commissioning Strategy for 2011 and beyond. At its heart will be a shared vision to support Ealing’s local communities to achieve the highest levels of
health and wellbeing possible; and the development of an effective range of sustainable world-class services options that will in the future be available across
the ‘whole system’.
This initial shared commissioning outline is the starting point for achieving this vision.
_______________________________________________________________________________________________________________________________
24
Appendix 1
Transitional and integrated commissioning intentions (2009 – 2011)
This section of the outline document highlights the key commissioning intentions and priorities for 2009 – 2011 that will underpin the transition toward
implementing the Adult Services Personalisation Programme, whilst maintaining the Department’s and NHS Ealing’s core integrated ‘business as usual’ (BaU)
commissioning activity over the next 18-months.
The transitional / integrated commissioning areas covered in this appendix are:
• Resources
• Cross-cutting themes and priorities
• Older people
• Mental health
• Physical disabilities and long-term conditions
• Learning disabilities
• Substance misuse
• Carers
• Market development
• Workforce development
The commissioning intentions and priorities outlined in this appendix have also been designed to reflect the requirement to deliver on the local NHS
Commissioning Strategy Plan priorities within the framework of World-Class Commissioning; and the ‘transforming adult social care milestones’ issued by the
Association of Directors Adult Social Services (ADASS), the Department of Health and the Local Government Association (LGA) on the 9th September 2009.
_______________________________________________________________________________________________________________________________
(34) Progress Measures for the Delivery of Transforming Adult Social Care Services; ADASS, DH & LGA (2009)
25
Resources
Ealing currently spends in the region of £638 million every year on health and social services in the borough – that’s almost £ 1.75 million every day. In 2009,
some £522 million was being spent by NHS Ealing and £116 million by Ealing Council. Of this funding the vast majority of spend has been on crisis
intervention i.e. those services that treat illness or respond to complex social problems.
Total Health & Social Care Spend in Ealing
NHS Ealing – Commissioned & Provider Services £522 million
Ealing Council – Adult Social Services £69 million
Ealing Council – Children & Families £47 million
Total £638 million
The next step for Ealing’s integrated commissioners and transition leads will be to undertake detailed modeling of the resources available across the ‘whole’
health and social care system; and set out in detail how these will be used to deliver the transformation of health and wellbeing services in the borough
(including those transitional arrangements for young people with care and support needs).
26
Cross-cutting themes & priorities
By December 2009 Ealing’s Commissioners and Transition Leads will:
• Ensure that the move toward personalisation and the offering of individual budgets is well understood by all stakeholders; and that local service users (and
carers) are involved in the development of best practice via the establishment of a new Individual Budget Service User and Carer Forum.
By April 2010 Ealing’s Commissioners and Transition Leads will:
• Support the introduction of individual budgets being used by at least 10% of existing and / or new service users (and carers) by April 2010.
• Design and implement new organisational structures that are congruous with the commissioning and contracting of services at the individual, operational
and strategic levels.
• Review all existing stakeholder engagement ‘fora’ to ensure that they are in accord with Ealing Council’s personalisation objectives and the NHS Ealing’s
public and patient engagement strategy.
• To secure formal agreement between Ealing Council and NHS Ealing to jointly develop new enhanced contact centre functions for the future.
• Through the Social Care Transformation Grant fund new time-limited contact posts to underpin an enhanced contact centre function; and fund 2 new
funding officer posts to undertake ‘in-year’ financial assessment, review and benefits maximisation functions.
• Develop a new web interface, resource directory and universal signposting tools for April 2010.
• Commission additional capacity within the Council’s internal reablement team to begin to underpin a ‘shift’ to prevention and early intervention.
27
• Have began the shift of existing ‘block’ care and support contract arrangements to either ‘zero’ guaranteed minimum volume (GMV) or framework based
arrangements in readiness for the first phase implementation of the personalisation programme in April 2010.
• Work with other West London health and social care partners to develop new flexible cross-borough service specifications that underpin the shift toward
personalisation and greater patient choice, which are in turn both sustainable and offer value for money.
• Develop a joint Adult Services’ and NHS Ealing action plan setting out the anticipated shift of initial investment from ‘traditional’ service areas toward
preventative and rehabilitative interventions. The action plan will also set-out a clear agreement between the Council and NHS Ealing as to sharing risks
and benefits to the ‘whole system’.
• Develop an action plan that sets-out how Ealing Council (and its core partners) intend to create universal information and advice services.
• That all transitional / integrated commissioning activity takes into account those priorities identified through the local Joint Strategic Needs Assessment
(JSNA) process.
• Support the extension of individual budgets being used by at least 20% of existing and / or new service users by October 2010; rising to a minimum 30%
of existing by April 2011.
• Have identified an effective preventative and early intervention service model (as well as specialist / crisis intervention services) that will not be purchased
through individual budgets; and set out in detail the required re-engineering or re-allocation of resources necessary to support these new arrangements.
• Proactively involve service users (and carers) and service providers in the design and delivery of new care and support options.
28
• To participate in the Council-wide review of information and advice services in the borough; and feed its findings / recommendations into the
commissioning cycle.
• To work with all partner agencies and stakeholders in co-designing and putting into place a new 10-year Shared Commissioning Strategy from 2011 and
beyond.
• Work with all partners to review and contribute to an annually updated Joint Strategic Needs Assessment (JSNA).
29
Older People
The central aim is to commission effective needs-led services of the highest quality for older people and their carers to enable them to live independently
improve their quality of life and contribute to their wellbeing and whole life experience. These priorities have been developed in partnership with the Older
Peoples’ Partnership Board, the Integrated Commissioning Group for Older People’ Services, and the Older People and Carers’ Network.
By April 2011 Ealing’s Commissioners for Older People and Transition Leads will:
• Implement recommendations of the Audit Commission Review of Health Inequalities linked to needs identified in the JSNA.
• Produce a new Joint Older People’s Strategy.
• Examine and develop the local market to ensure that high quality, flexible and responsive services are available for individual budget holders and self-
funders alike.
• Examine new collaborative ways of working that support people to engage in the design, delivery and evaluation of services. Service users and carers in
particular will be engaged in:
The re-tender of floating support and extra-care services at Sunningdale and Moorlands.
The design of staff training and induction.
A new consultative forum for older people with mental health needs.
• Develop a range of services for people to choose from and opportunities for social inclusion and community development through:
Developing new health and social care grant service specifications for 2011.
Further develop community health promotion e.g. leisure and sports activities, falls prevention, nutritional advice etc.
Monitor and develop the Michael Flanders Centre co-located service provision
30
• Reviewing service areas to identify service improvements and efficiencies. Services to be reviewed are:
Intermediate care services and implement recommendations

Foot care services and implement recommendations
Reorganise older peoples continuing care team and panel process
Functional mental health services
Day services for dementia
Admission avoidance review and re-specification of admissions avoidance schemes linked into work on transforming primary and community services
• Service areas to be developed further over the next 18-months include:
Ealing borough stroke services

Comprehensive Falls service
Telemedicine and telehealth services
Reablement service expanded to support more people to live independently
Increase intermediate care provision to support hospital discharge and prevent hospital admission
Implement the recommendations in the dementia strategy
Primary care services for care homes through a Local Enhanced Scheme
• Older People Services Commissioners and Transition leads will use the framework established for personalisation of adult social care for the development
of personal health budgets initially targeting those people with long term neurological conditions, in particular stroke
31
Physical Disabilities & Long-term Conditions
The transitional / integrated commissioning priorities and intentions for people with a physical disability and / or long-term condition have been developed in
partnership with Ealing’s Long-Term Conditions (LTC) Partnership Board.
By April 2011 Ealing’s Commissioners for Physical Disabilities & Long-Term Conditions and Transition Leads will:
• Prevention and wellbeing:
Develop a Joint Integrated Strategy for Telecare / Telehealth / Careline to promote early intervention and independence.
Develop and implement ‘retail model’ as part of Transforming Community Equipment Services (TCES) to promote prevention, choice and independence.
Develop and implement future options for Wheelchair Services in partnership with Ealing PCT to ensure a high quality, responsive service to individuals.
Develop a programme of services for health and well being for people with PD/LTC, such as self management programmes with a variety of providers
• Needs assessment:
Develop a joint LBE / NHS Ealing Sexual Health & HIV Needs Assessment - to inform the JSNA and future priorities for integrated strategic commissioning
intentions and any changes in models of services.
Undertake a ‘stock-check’ of currently commissioned services for PD/LTC to inform and identify any gaps or required changes for integrated
commissioning beyond 2011. This will also include future demand and financial modelling.
Better identify the transition from children’s to adults and adults to older people in terms of future demand and supply
Identify the need for community services for people with Acquired Brain Injury, and those physically disabled people with challenging behaviour.
• Information, advice and advocacy, including signposting:
As part of the personalisation programme to ensure a consistent approach to the provision of information, advice and advocacy, including signposting
32
Mental Health
Ealing commissions a broad range of services for adults with mental health problems. The provision of health and social care services is currently integrated
between West London Mental Health Trust and Adult Social Services, with services commissioned from both the statutory and non-statutory sectors. The
purpose of these services are to ensure that equitable community-based and high-quality services are available to people with mental health needs, their
carers and families.
By April 2011 Ealing’s Commissioners for Mental Health and Transition Leads will:
• Produce a new Integrated Commissioning Strategy for Adult Mental Health in line with the emerging national 10-year plan for mental health services ‘New
Visions in Mental Health’ and identified local priorities.
• Develop new specifications for Area Based Grant in 2011 to procure high quality preventative and support services that support the personalisation
agenda for individuals with mental health disorders in the community.
• Examine and develop the local market to ensure that high quality, flexible and responsive services are available for personal budget holders and self-
funders in Ealing.
• Engage service users and carers in the planning and delivery of service by delivering:
User involvement in the monitoring and evaluation of a range of service areas e.g. inpatient services, residential care, voluntary sector monitoring reviews.
Consultation with service users on the emerging mental health strategy for adults.
Involving service users in the partnership structures and local commissioning team meetings.
Commissioners will learn from the user experience of the personalisation pilots to inform the type and range of services that will need to be commissioned
in response to individuals expressing potentially very different choices about their care.
• Examine and develop new methods to ensure that people have access to information and advice to make good decisions about their care and support:
33
Publish an updated Carers Handbook

Ensure that Admissions Packs are available for service users and carers on admission to inpatient services
Ensure that local mental health services will provide wi-fi internet and computer access to service users within inpatient services
Disseminate the updated directory of counselling services within the Borough
• Develop a range of services for people to choose from and opportunities for social inclusion and community development through:
Further developing community health promotion – including promotion of leisure and sports activities and physical health monitoring
Continuing to prioritise investment in vocational and educational support services for clients with mental health disorders
Reviewing existing day service provision and align locally the commissioning of day services with best practice standards that deliver meaningful
outcomes for service users.
• Reviewing service areas to identify service improvements and efficiencies. Services to be reviewed are:
Community Mental Health Team services

Reorganise the Continuing Care panel process in respect of mental health service users
In partnership with Learning Disabilities - evaluate the ASSIST project for clients with Aspergers syndrome and higher functioning Autistic Disorders.
Implementation of the action plan for inpatient services provided by WLMHT (in line with the action plan in response to the CQC investigation)
Implementation of the Home Treatment Team audit recommendations.
Implementation of the recommendations from the HASCAS independent inquiry into the care and treatment of Mrs. S
Physical Health services provided to clients with mental health disorders.
• Service areas to be developed further are:
Developing a pathway for Personality Disorder services in Ealing

Primary Care Mental Health & Wellbeing
Services for adults with Attention Deficit Hyperactivity Disorder (ADHD)
Jointly with Learning Disability services – Mental Health services for clients with a Learning Disability
Psychological support services for clients in the community with severe and enduring mental health disorders
34
Learning Disabilities
The transitional / integrated priorities for Learning Disabilities have developed in partnership with the Learning Disabilities Partnership Board. The board has
representatives from service users, carers, voluntary sector services, service providers, the Council and NHS Ealing.
By April 2011 Ealing’s Commissioners for Learning Disabilities and Transition Leads will:
• Respite care:
Review in-house and external respite services in line with the Council’s personalisation objectives to offer more choice e.g. supported holiday’s,
modernised residential respite provision, home and activity based services, and new options for BME and women only respite provision.
To further develop Ealing’s Adult Placement Scheme.
• Housing and supported living:
Extend current external supported living block contracts for up to 2 years from April 10; with the aim of moving to framework arrangements after this time.
Continue with current residential contract from April 10; with the aim of moving to framework arrangements after this time.
With the Transition Leads to pilot Individual Services Fund’s (ISF’s) with a small number of residential / supported living providers during 2010/11.
Spot purchase individual placements in regard to Tertiary Assessment and Treatment Services (TATS) and Forensic Services
Commission dedicated support options for young people in campus provision
Fund a Housing Advice Worker to promote shared-ownership and private-rented accommodation options
• Day services / employment:
Establish a framework agreement with NAS for provision of day services for people with ASC and challenging needs
Implement greater individual community based packages for people with more complex needs using individual budgets e.g. My Time, NAS, Out and About
35
• Transport:
Call-off on the SEN contract until Aug 2010 to provide transport services for young people going to college; then to move to framework contract for
transport for 4 years
Fund a travel ‘buddy’ service
• Health:
Fund ‘Treat Me Right’ or similar to work on improving services for people in Ealing Hospital, GP surgeries and inpatient and community MH services
Fund NAS to deliver the ‘ASSIST’ service for people with HFA and aspergers.
Jointly explore transitional issues with older people and mental health services in regard to older people with LD and dementia / mental health issues.
• Information, advocacy and advice:
Fund support to be provided by the ‘Partners Power Group’, and look to fund a new ‘Peer Advocate’ Scheme
Fund a transition project with Mencap / Connexions
• Support / Person Centred Planning (PCP):
Fund a fixed-term Support / PCP facilitator to work with people with complex and challenging needs via LDDF Funding
36
Substance Misuse
The DAAT aim to further build and improve on the access that service users have to drug treatment and the beneficial outcomes that they enjoy from
treatment. Improved service user involvement is seen as one key element in making those improvements as relevant to the users as possible.
By April 2011 Ealing’s Commissioners for Substance Misuse and Transition Leads will:
1. Further increasing the numbers in effective treatment

2. More service delivery in the wider community with better pathways out of treatment (including shared care)
3. Service user involvement that is integrated in all aspects of commissioning and delivery
4. Clearer and more effective alcohol treatment system
5. Develop a strong skilled and committed workforce
• Further increasing the numbers in effective treatment:
We aim to sustain our growth levels of numbers in effective treatment into 2010 and beyond. In addition to this we aim to continue to improve the rate of
successful discharge from treatment and decrease the rate of planned discharges from treatment thereby making the treatment system more efficient.
• More service delivery in the wider community with better pathways out of treatment (including shared care):
We want service users to experience treatment in community settings that are more accessible to them, both, in terms of location and the
environment/setting in which they receive treatment. We want to ensure service users are given every opportunity to re-integrate with communities,
through improving; pathways to education training and employment and links to housing. In light of the new welfare reforms we are forging stronger links
with Job Centre Plus.
• Service user involvement that is integrated in all aspects of commissioning and delivery:
37
Service users have a unique insight about the quality of service delivery and the experience of treatment from a user’s perspective. We want to increase
the numbers and the diversity of service users that we engage with. At the same time we are keen to increase the level of engagement from consultation
right through to shared decision-making and input in strategy and developments.
• Clearer and more effective alcohol treatment system:
As part of our drive to ensure that treatment journeys are as simply as possible for alcohol users we are re-tendering our specialist alcohol treatment
service. It is important that tier1 professionals including GPs understand where to refer people and that people get to the right place to receive the right
level of intervention.
• Develop a strong skilled and committed workforce:
Ealing DAAT will continue to run the annual staff survey to establish whether the key indicators to do with workforce development are improving. Ealing
continue to support a borough wide training programme for team leaders.
38
Carers
The overall aim is to commission services in line with the Government’s agenda as set out in its strategy for carer’s published in June 2008, together with local
priorities identified through the Carers Partnership Board based on feedback from local carers and an analysis of Ealing’s current provision.
• Continue to support the needs of carers, by ensuring they have an assessment in their own right and have access to services to ensure their own
independence, health and well-being whilst caring for a loved one. This will include setting and achieving ‘stretch targets’ for the number of carers
receiving an assessment of their needs.
• Offer carer’s access to a dedicated ‘one-off payment’ individual budget scheme from which they can purchase goods and services of their choosing that
best meet their needs. This scheme will in particular aim to support carers in accessing or sustaining employment and learning opportunities.
• Establish a multi-agency database of carers with the aim of using this to ensure carers are fully informed of services, which are on offer.
• Increase the numbers of carers in receipt of benefits as a result of a targeted uptake campaign; and run a series of ‘Caring with Confidence’ training
courses in conjunction with neighbouring boroughs
• Review investment in respite services following completion of a mapping exercise of existing provision.
• Continue to work on the re-location of Ealing Carers Centre to the West London Integrated Health Centre.
• Continue to promote and increase uptake of the Carers Emergency Card.
• Continue to work with GP practices to help identify carers and signpost them onto appropriate sources of support; and to explore the development of an
Expert Patients Programme / Self-Management Programme for carers of people with long-term conditions.
39
Market Development
Ealing Council aims to support a sustainable third and private sector that works closely alongside local public sector agencies, and that they both have a
strong voice and the capacity to make an essential contribution to the personalisation of services across the borough.
• Ensure that the move toward personalisation and the offering of individual budgets is well understood by both the third and private sector organisations in
the borough through the provision and servicing of dedicated third and private sector ‘provider forums’ for each of the Adult Service Services core business
groups.
• Review all health and adult social care grant funded third-sector and user-led organisations; establishing new third-sector commissioning priorities and
outcomes in line with the Council’s personalisation objectives; NHS Ealing’s strategic commissioning priorities; and the Public and Patient Engagement
Strategy.
• Support people to make informed decisions with their individual budgets by ensuring a diverse range of third and independent sectors support planning
and brokerage options are available from the 1st April 2010 onwards.
• To work closely with both third and private sectors to support a clear shift toward prevention and early intervention; and outcome based working practices.
• In particular support the development of a sustainable local third-sector and community / user led supplier market; and in doing so develop a new
Community & Third-Sector Commissioning Action Plan (in partnership with organisations such as Ealing Community Network), which include a clear offer
of capacity-building support such as assistance with new service design, procurement and business development.
40
• To work with local third and private sector organisations in developing transparent service options and pricing menus that support individual budget
holders to purchase their own care and support services.
• To act fairly to ensure that all third and private sector suppliers are able to bid for services / work where appropriate. This will include producing a shared
guide for all cross-sector service providers as to 'How to do business with Ealing Council & NHS Ealing’. In addition to offer new commissioning and
procurement 'open day' events that aim to bring individual budget holders, cross-sector service providers and public sector commissioners together.
• Work with all local service providers in regard to introducing new ‘individual service fund’ and ‘outcome-based’ contract and grant funding arrangements
from April 2011onward.
• Work with all external service providers (including those internally provided) to ensure that they adopt ‘outcome-based’ working and reporting practices in
line with local and national personalisation guidance.
• Undertake improved ‘service provider signaling’ by making robust information available to third-sector, user-led and commercial markets as to what local
people are spending their individual budgets on; and to work with a diverse range of service providers to stimulate the development of new service options
that people say they want. This will be directly supported through Ealing Council’s participation in a social market research exercise with DEMOS (an
independent national policy and research body).
41
Workforce Development
The transformation of adult social care will clearly have a significant impact on all local organisations and their workforces’. As a result staff from across the
‘whole system’ will be a key asset in delivering the vision for personalisation and self-directed support in the borough.
• Ensure that the Council’s Training Services and Human Resources functions are fully engaged in the Personalisation Programme.
• Have identified (and acted upon) the major training and workforce development requirements necessary for implementing Ealing’s personalisation
programme from the 1st April 2010.
• Develop a Shared Workforce Strategy that will ensure that Adult Social Care, Health, Third and Private Sectors are equally working towards developing
the type(s) of workforce that the will best create positive outcomes for the people of Ealing.
Through the implementation of a co-ordinated shared workforce strategy Ealing Council (and its partners) will aim to create a health and social care
workforce that is confident, enabled and equipped to deliver truly personalised support and understand the role they are making to support this
transformation.
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Appendix 2
Glossary of Terms
Advocacy
Help given to people to enable them to express their opinions and views e.g. about what community care services they require and / or rights to which they or
their advocate believes them to be entitled. An advocate can be a paid professional, friend or relative authorised to speak or act on behalf of a person.
Appointee
A person who has been nominated to do something on another person’s behalf.
Approved list
Approved lists are lists of contractors, suppliers and services vetted to the Council’s standards and technical capability, including financial, equality and health
and safety assessments.
Best Value (BV)

A legal requirement of all local authorities to make sure that they deliver value for money across their services. This is implemented by carrying out reviews,
consultations and monitoring of BV performance indicators.
Block Contract
An agreed level of service is purchased, usually at a fixed price over a set period of time. The contract will include a specification, or equivalent schedule,
detailing the service requirements.
Cash Budget
Where a customer (or their nominated appointee) receives their Individual Budget as a cash payment so they can arrange and pay for their own support.
Carer
A person providing care who is not employed to do so by an agency or organisation. A carers is often a relative or friend looking after someone at home who is
frail or ill; the carer can be of any age.
43
Commissioning
The process of identifying, purchasing and monitoring services to meet people’s needs. This can be done at an individual, operational or strategic level.
Community Care
Care or support provided by Social Service Departments and / or the NHS to assist people in their day-to-day living.
Contributions Policy
Outlines how we calculate how much, if anything, a customer will financially contribute towards their Individual Budget.
Consortium (Buying Consortium)

An arrangement to optimise buying power and make best use of scarce commissioning skills by aggregating the purchasing requirements of more than one
public sector organisations.
Consortium (Provider Consortium)

An arrangement between providers to work together to jointly bid for and deliver a service or services.
Contracting
The process of negotiating, developing, letting, monitoring, reviewing and ensuring compliance with written arrangements between service purchasers and
providers.
Council-Managed Budget
Where the council holds a customer’s Individual Budget and plans, organises and pays for the support on their behalf.
Customer
Any person who uses Adult Social Care Services.
Decommissioning
The process of planning and managing a reduction in service activity or terminating a contract in line with an organisations commissioning objectives.
44
Deployment
How a customer receives their Individual Budget - this can be as a cash payment, as council-managed services or as a combination of both.
Direct Payments
Financial payments giving recipients the means of controlling their own care at home, allowing more choice and flexibility. They are usually regular monthly
payments from Social Services enabling people to employ their own personal assistants for care, instead of receiving help arranged by Social Services.
Ealing’s Targeted Offer

Information, funds and services that are only available to people who are eligible for social care support under Fair Access to Care Services (FACS) criteria.
Ealing’s Universal Offer

Information and services that are available for everyone, including self-funders.
Early Intervention and Prevention

Advice, support and practical help that:
• Enables people to continue to live their daily lives as normal;
• Prevents people reaching a crisis point; or
• Gives people the opportunity and confidence to regain some of the skills they may have lost and to gain new skills to help them maintain their
independence.
Extra-Care Housing
Also known as very sheltered housing. It is a style or housing and care for older people that falls between traditional sheltered housing and residential care
homes.
Fair Access to Care Services (FACS)

Criteria for establishing eligibility for adult social care
Financial Assessment
An assessment of a customer’s finances to identify how much they will be expected to contribute to the cost of their care and support services.
45
Floating Support
Housing related support that is not tied to a particular property.
Framework Agreement / Contract

Framework agreements can operate in different ways. A popular and useful form of a framework agreement is one in which the local authority is not compelled
to buy and the supplier appointed to the framework is not compelled to sell. However, should the customer have a requirement then the majority of the terms of
the contract (“the call-off contract”) have been resolved in advance.
Framework agreements can be procured to encompass multiple suppliers or a single supplier. The framework can also be divided into ‘lots’ for particular
requirements e.g. geographical regions.
Housing Related Support Services

Support services which are provided to a person for a purpose of developing that person’s capacity to live independently in accommodation, or sustaining his or
her capacity to do so.
Independent Sector
An umbrella term for all non-statutory organisations delivering public care, including a wide range of private companies and voluntary organisations.
Individual Budgets
Individual budgets provide the opportunity bring together a variety of income streams from different public care agencies to provide a sum for an individual, who
has control over the way it is spent to meet his or her care needs.
Individual Service Funds

A contractual arrangement that requires service providers to account for spending on an individual basis i.e. the money is attached to the individual for whom
the ISF is established and is accounted for in this way.
Intermediate Care Services

Care that bridges hospital and home-care and is often rehabilitative in nature.
46
Joint / Integrated Commissioning

The process in which two or more organisations act to co-ordinate the commissioning of services, taking joint or lead responsibility for putting into action.
Joint Strategic Needs Assessment (JSNA)

The JSNA is seen as the means by which local NHS services and local authorities can describe the future health, social care and wellbeing needs of their local
populations.
Local Area Agreement (LAA)

A Local Area Agreement is a three-year agreement that sets out the priorities for a local area in certain policy fields as agreed between central government, the
local authority and Local Strategic Partnership (LSP). The agreement is made up of outcomes, indicators and targets aimed at delivering a better quality of life
for people through improving performance on a range of national and local priorities.
Long-term Conditions
Those conditions (for example, diabetes, asthma and arthritis) that cannot, at present, be cured but whose progress can be managed and influenced by
mediation and other therapies.
Micro-commissioning
The process of meeting needs at an individual level.
Outcome
A positive change or benefit that a customer would like to achieve.
Outcomes-based Commissioning (ObC)

Commissioning and contracting which is based on results and not activities – for example, looking at what a service achieves, as opposed to how it operates.
Performance Indicators (PIs)

Measures used to judge whether objectives have been met.
47
Putting People First

The national agenda for the Personalisation of Adult Social Care.
Primary Care Trusts (PCTs)

Locally managed freestanding primary care NHS bodies responsible for delivering health care and health improvements to local residents. They commission a
range of community health services as part of their functions.
Procurement
The process of acquiring goods, works and services, covering both acquisition from third parties and from in-house providers. The procurement process spans
the wide cycle from identification of needs through to the end of the services contract or the end of the useful life of an asset.
Reablement
Support for people with poor physical or mental health to help them cope with their illness by learning or re-learning the skills necessary for daily living.
Resource Allocation System (RAS)

A system for calculating how much money is allocated from the available adult social care funds to provide a customer’s Individual Budget.
Service Providers
Any person, group of people or organisation supplying goods or services. Service providers may be in the statutory or non-statutory sectors.
Social Capital
The social ties and networks that exist within all types of communities.
Spot Contract
Services are purchased for an individual at an agreed price, which may be by reference to an agreed price list or negotiated individually. The contract is only for
that individual. There may be a standard service specification for some or all of the service – alternatively the requirements may be individually negotiated.
Support Plan
A plan that describes how a person will use their individual budget to meet their outcomes.
48
Support Brokerage
Assistance from an organisation or person that provides independent help to an individual to arrange and co-ordinate the support needed to meet the outcomes
identified in their support plan.
Tender
A formal offer to provide services as a response to a specification, usually for a stated price or in accordance with a schedule of stated prices.
Third Sector
Includes the full range of non-public, non-private organisations which are non-governmental and ‘value-driven’; that is, motivated by the desire to further social,
environmental or cultural objectives rather than to make a profit.
Universal Services
Services provided for the whole community, including education and health, housing, leisure facilities and transport.
49
For more information contact:
Ealing’s Personalisation Programme Team

(020) 8825 7698
personalisation@ealing.gov.uk
50

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Adult Services Personalisation Programme

Putting People First:

2. A shared approach 4 Transitional and integrated commissioning

8. Commissioning for independence, health and wellbeing beyond 2011 23

Within this context commissioning for personalisation can be defined as:

3 Why We Need to Change…

4 National Commissioning and Performance Drivers

• Look after themselves and stay healthy and independent;

• Putting people at the centre of commissioning.

• People will live healthier and longer lives;

• Improve bidding practice from third sector organisations.

• NI 125 achieving independence through rehabilitation / intermediate care

5 Local Independence, Health and Wellbeing Objectives

• Making Ealing a better place to live;

• Making Ealing one of the safest places in London;

• The Quality of Life for Older People & Carers Strategy;

6 Ealing’s High-level Direction of Travel

• Facilitates equal access to universal services, information and advocacy;

So what will be different in the future?

6.1 A universal offer

Individual Budgets Case

6.2 Prevention and Early Intervention

Emerging Prevention & Wellbeing Offer

Adult Social Services

6.3 Choice and Control

6.4 Social Capital and Community Capacity Building

Community Capacity Building

Delivering the strategic shift to personalisation…

7 The future commissioning landscape in Ealing

7.1 A New Commissioning Framework

O p e ra tio n a l L o ca lity b as e d co m m iss io ning a nd

C itiz e n C itiz e ns direc tin g th e ir o w n

illustrates a new multi-level commissioning

In response to this new model of working Figure 5

Ealing’s new commissioning framework has also been

7.2 The shift to outcome-based commissioning and contracting

offers a common definition for outcome-based commissioning

• Existing and future ‘Safeguarding Adults’ Guidelines;

7.3 New Commissioning Principles

7.4 Identifying future patterns of need and demand

The JSNA, in particular, considers a range of factors, including:

• The burdens of disease and ill-health;

• Continuing inequalities in health status and access to services

7.5 Stakeholder Engagement

8 Commissioning for independence, health and wellbeing beyond 2011…

Transitional and integrated commissioning intentions (2009 – 2011)

The transitional / integrated commissioning areas covered in this appendix are:

Total Health & Social Care Spend in Ealing

NHS Ealing – Commissioned & Provider Services £522 million

Ealing Council – Adult Social Services £69 million

Ealing Council – Children & Families £47 million

Total £638 million

Cross-cutting themes & priorities

By December 2009 Ealing’s Commissioners and Transition Leads will:

By April 2010 Ealing’s Commissioners and Transition Leads will:

By April 2011 Ealing’s Commissioners and Transition Leads will:

• Produce a new Joint Older People’s Strategy.

Intermediate care services and implement recommendations

• Service areas to be developed further over the next 18-months include:

Ealing borough stroke services

Physical Disabilities & Long-term Conditions

• Prevention and wellbeing:

• Information, advice and advocacy, including signposting: