“Explore the role of models of commissioning such as service brokerage and direct payments in the provision of services for people with a learning difficulty/disability”
This essay will discuss how service brokerage helps in the provision of services for people with a learning disability, by starting with commissioning in relation to services. Followed by an explain on how personalisation is about giving people the power and responsibility to choose what services they want and control over how they are delivered. Subsequently describing service brokerage and how it would help people with learning disabilities.
The term “Commissioning” is described as a process of assessing how a persons need is to be met, through priorities and choices, and allocation of resources. Once this stage has been achieved decisions are made on how services will be delivered, planned and developed by monitoring and evaluating the delivery and effectiveness of services. All the stages in the commissioning process are interlinked and dependent on each other to ensure the best outcome for people.
In recent years, the Government has publicised a number of initiatives that would change the way that services for learning disabled people are planned, commissioned and provided, to ensure that learning disabled people have greater choice and control over their lives through personalisation.
Personalisation is a moderately new term and has generated different thoughts on what it will mean and how it will work in practice. The idea of personalisation has become central to the Government’s policy on social care reform in helping people to become empowered by shaping their own lives and the services they receive (Cabinet Office, 2007, Building on Progress: Public Services).The Government White Paper ‘Our health, our care, our say’ (2006) gives details of the Governments vision to create real changes, by allowing people more choice and greater access to both health and social care services. This transformation of social care and the personalisation agenda is reinforced in the Government’s strategy ‘Putting People First’ (Department of Health White Paper, 2007).
Personalisation reinforces the idea the individual knows best what they need and how those needs can be best met. This allows people to be responsible for themselves and can make their own decisions about what they require, but that they should also have information and support to enable them to do so. In this way services should respond to the individual instead of the person having to fit with the service. Brokerage is a way in which people with learning disabilities can be helped to navigate the social care system. Support planning and brokerage is likely to be of benefit to anyone who receives social care funding, those people who privately pay for their own care, people who are looking for unpaid informal support as well as people who use other sources of funding to assist with leading their lives the way they want to
‘Brokers provide information, advice and technical assistance to develop, cost, negotiate, implement and mediate PLANS as required by individuals.’
Salisbury B. and Webb P. (2003)
Service brokerage was developed in 1978 in British Columbia, by The Woodlands Parents Group, a body of parents who were concerned about the lack of quality of life their children were experiencing in an institutionalized setting. They established a voluntary, community-based brokerage agency called the Community Living Society (CLS). The society was authorised to act as a planning and linkage medium, enabling individuals with learning disabilities (and their families) to navigate what seemed to be a difficult system; to empower decision-making control in identifying and acquiring services that would enable them to live more dignified and self-determining lives in their own communities.
It has since been developed and refined and adopted by projects in the United States and a few in the UK, as service brokerage in Britain has until now been the interest of a select few policy makers and academics. However, some schemes do not entirely follow the Canadian model; and, equally, some schemes which are not called service brokerage may integrate the main features. Whilst the language of brokerage may appear new, the functions of brokerage are not and many people will have been receiving this sort of support as part of their existing support arrangements. Therefore this can make Service brokerage a term that can be used to mean many different things to many different people.
The role of the broker is: an intermediary who arranges a contract between a purchaser and provider of services. However, in the term of provision of services to people with learning disabilities, the role of the broker has developed to have a wider scope. While the role has been accepted in principle by the government, the details remain undecided in policy, and the cause of much debate and confusion. In that various functions of brokerage could be carried out by a variety of different personal supporters to the individual, as support staff employed by service providers, local authorities can perform brokerage tasks. Because of the roles that support brokers play, the decisions that they make on behalf of the individuals they support can lead to conflicts of interest.
Therefore, ideally an independent professional should be the best option to provide support brokerage to people with learning disabilities, i.e. free from accountability or loyalties to the council authorities or service providers, so that they are able to focus on the requirements of the person they are assisting. The independent broker would be directed by the ‘customer’ and accountable to him/her and working only for their best interests. The broker may also have to work with the family or personal circle of supporters, whilst recognising that the family especially may have conflicting interests to those of the individual. As a broker s/he should remain focused on the aims of the individual and work to their direction; at the same time, it will be important to maintain respectful contact with others concerned and to mediate and negotiate resolution of any conflict.
Freedom from conflict of interest and accountability to the individual establishes a good basis for trust. The broker’s ethical standards must ensure that they operate within the limits agreed by the individual and within appropriate boundaries of the role and that the relationship is free of any exploitation or abuse. Although working independently, the broker will be able to be more effective if seen by all as competent and trustworthy.
“People who become brokers (or offer brokerage support) will need to become expert information gatherers and interpreters” (CSIP. 2007:11)
A support broker is trained to co-ordinate the process of organizing and maintaining a support package for an individual, By supporting individuals make informed choices about their care needs and choosing what services & support that best fits those needs, including arranging complex care packages, service finding, service arranging, short term enabling community support and signposting Brokerage can be provided by people who are specifically trained and employed as brokers or by members of the individual’s family or friends who may not be paid to undertake the role.
The National Brokerage Network promotes a training package, which includes reflective practice and an ongoing commitment from the broker that continual self development is expected. In addition to this a mentoring and supervision programme is also promoted. The National Brokerage Network an authoritative voice for the development of brokerage in the UK, will take a lead role in lobbying politicians and policy makers with the views of the support broker movement and hopes to provide strong leadership and guidance in the development of the growing network.
However service brokerage does have its limitations, in that service users have never heard of it. This is mainly due to organisations that represented service users, not being made aware of brokerage or being provided inadequate information about how it worked. Meaning most organisations did not see it as a priority. Service brokerage was meant to increase empowerment for service users, however the lack of promotion in the United Kingdom has left service users excluded and not empowered. Yet other organisations that represent people with learning disabilities are opposed to service brokerage, viewing it as foreign import that has no place in the United Kingdom or in the plans for helping people with disabilities lead an independent life. There is a danger that professionals will take over the role of broker in brokerage, employed by service providers or local authorities, this can lead to a conflict of interests when planning for people with learning disabilities.
Brokerage does have good points when it comes to helping in the provision of services for people with learning disabilities, in that a broker is directed by the person with learning disabilities to carry out the tasks necessary for greater control and choice in their lives. In situations where a person may have no informal network of support, a broker can provide the support to carry out the brokerage tasks. An independent broker who is not employed by a service provider or by local authority is outside of the perceived conflict of interests i.e. connection to resources and or the provision of services, and therefore in a better position to give advice, support and implement plans. Brokers are in a good to position to navigate the provider market and see what is available, how the services can be provided and developed and respond to the individuals requirements. The development of brokers can lead to a wealth of local expertise of both support services and/or community resources
If brokerage is to achieve its aims, the following key points will require attention or further exploration: brokerage needs to be clearly defined and explained so that the function is understood by people who may need to use brokerage services. Brokerage needs to be advertised to the general public as well as to people with learning disabilities, as many people have never heard of service brokerage or know of its existence.
Brokerage allows for personalisation of services for someone with a learning disability, as the person can choose what services they want and how they would like them, this helps the learning disabled person have control over their life and chose how they would like to live their life from day to day. This allows people to be responsible for themselves and can make their own decisions about what they require, the broker provides the information and support to enable them to do. Brokerage is a way in which people with learning disabilities can be helped to navigate the social care system.As Support Brokerage is a key element that enables Personal Budgets and Self Directed Support to work.