NDIS & LEARNING FROM THE UK
EXPERIENCE OF
PERSONALISATION:
A PROVIDER PERSPECTIVE
Peter Gianfrancesco
galeru@btinternet.com
www.galeruconsultancy.com
© P. Gianfrancesco 2014
OVERVIEW
 About
me
 The UK & ‘Personalisation’
 What we did well (and what we did wrong)
 Insights arising from our experience
 Lessons for NDIS providers
 My emphasis is on the longer term view
of market engagement
 A provider emphasis and focus
GENERAL
NDIS concept exists elsewhere
 Implementation plans & progress are impressive
 Not much written about ‘provider experience’
 Most critical part of model is provider response
 Observations about MH NFP sector in Oz
 Getting ‘fit’ for the NDIS will improve you
 NDIS ‘fitness’ will result in a stronger NFP sector
 England is a good place to learn from
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Phase 1:
Implementation
EASY
Phase 2:
Consolidation
Regulator
Provider
Consumer
Helpful
Lots of Regulation
Stimulates & Supports
Providers
Separation of Funding
Learning
Anxious
Short Term Focus
Products emerge from existing capability
/ structures
Confused &
Anxious
Wants more of
same
Provider familiarity
Market De-regulation
Integration of Funding
Less inclusive
Internal Cultural Change
Increasing competition
Emerging product innovation
More provision across disability types
New Partnerships
Emerging new providers
Emerging new workforce
Confident
Exercise influence
Provider swapping
Buys traditional
care
Less Helpful
Relaxes Regulation
Market Driven
Model has shaped provider culture
Increasingly innovative products
Competitive Market
Non MH providers
Providers compete on added value
New workforce
Discerning
Expects more
May not choose
MH
HARDER
Phase 3:
Market
Maturation
HARDES
T
Gianfrancesco 2013
Time
THE EVOLUTION OF A MODEL
Over time………(if all goes well)
 Regulators
(the NDIA) relax control
over market conditions (rules)
 Consumers
(customers) exercise
more authority and discernment in
relation to purchasing
 Providers
adapt, innovate and extend
their markets
UK EXPERIENCE AS A PROVIDER
PERSONALISATION – THE ENGLISH
EXPERIENCE
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A national policy approach with strong political support
Implementation devolved to 250+ Unitary Authorities
Introduced on a national scale 5 years ago
Tariffs and products (regulation) determined locally (with some
exceptions) or by provider
Consumers ‘hold’ the budget (reality is different) or get a ‘notional’
budget
Brilliant when it is allowed to be used creatively (the Lathe example)
It has not worked that well in mental health because of the chaotic
implementation and existing care planning biases
Being used to drive price down and eligibility up in some places
Implemented at a time of great financial austerity, loss of contracted
care and regulatory capacity
 Smaller
providers demonstrated faster
market entry, greater innovation and
better quality but were often outlasted
in the market (by larger providers)
because of their more fragile
infrastructure capacity, cash flow and
(typically) higher supply costs
 We
should seek to counter this trend
because quality, localism and innovation
are critical to the success of the model
WHAT WOULD HAVE HELPED US
CLEAR NATIONAL TARRIFFS
 SUPPORT FOR PROVIDERS
 SUPPORT FOR CUSTOMERS
 INDEPENDENT CARE PLANNING
 BETTER TRANSITION FROM CONTRACTS
 BETTER PLANNING AND LESS MARKET CHAOS
 MORE STRATEGIC AND LESS REACTIVE SUPPLY
 TIME TO UNDERSTAND WHAT WE WERE DOING
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WE SURVIVED AND
THRIVED!
SO WHAT DID WE DO?
WHY US?
THE 5 C’S
Cultural
confidence and
readiness
Customer service and focus
Capability was understood
Capacity was identified
Costs were known (eventually!)
CULTURAL CONFIDENCE &
READINESS
Who
are we here for?
Who could we be here for?
What are the cultural barriers?
What values must we preserve?
What can we move on from?
CUSTOMER SERVICE & FOCUS
Who are our customers?
How do we reach them?
How can we provide GREAT
customer experience?
What do our customers tell us they
want?
What more can we do to add
value?
CAPABILITY
What
is it we ACTUALLY do?
What is it that makes a
difference?
What else are we good at?
Who else might benefit?
How willing are we to focus our
development on the things that
REALLY matter to customers?
CAPACITY
How much can we provide?
How productive do we need to be?
How can we be more efficient?
What new partnerships emerge?
What are the markets we are
seeking to appeal to?
What else do we need and how will
we pay for it?
COSTS
How
much does it cost us to supply?
Can we supply within the market
tolerances?
Do we ‘loss lead’?
Do we subsidise care?
What assumptions do we make about
our supply model?
What are our ‘lines in the sand’
KEY QUESTIONS WE CONTINUALLY ASKED….
 Why
are we considering entering this market?
 What are our ambitions as a provider?
 Do we have a duty to supply?
 What happens if we choose not to?
 How does it fit with our organisational purpose?
 Can we afford to do it?
 Do our values limit our market?
 What hidden capability is there?
 What would we do with the profit?
 How would we manage revenue loss?
OUR CONTEXT
IN NORFOLK, ENGLAND…
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Population of 1 million people
In any given year:*
 120,000 people experience a mental health problem
requiring help
 45,000 see a GP ONLY
 15,000 use public or NGO mental health services
 Less than 5,000 eligible for a personal budget
 60,000 people may need help, get nothing or have
no eligibility but many have a capacity and desire
to purchase
 The market opportunities here are pretty obvious?
WHAT WE DID….
WE….
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Sought to engage with the larges market possible CONSISTENT
with our values and purpose
For us this meant everyone? (Universality)
We developed a broad product range
We tested this with existing and potential customers
We packaged the offer differently for different markets?
 People with personal budget, employers, general public
We developed a safe but less qualified workforce?
We went to market before we understood everything?
We learnt about supply on the go and reviewed our offer continually
THE OFFER
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Psychological Therapies
Individual Recovery Support
Complementary Therapies
Learning & Personal Development
Residential Care
Wellness Retreats
Befriending
Personal Assistants
Carer Support
Condition Specific Packages (eg: Depression)
Community Engagement
Fitness & Nutrition
Giving Back
Packaged and delivered through
three distinct sub-brands
LIFEHELP
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Part of Norwich Mind (A$5M)
New brand and product range developed
 Psychosocial support, packages, psychological treatments,
complementary therapies, training courses, nutrition, fitness,
general wellbeing
Offered universally
600+ customers first two years
25% clients hold a personal budgets
40% have care purchased for them (notional budget)
25% self fund
10% free
Profit is used to provide free care to 10% of the clients who would
otherwise receive nothing
ADVANTAGES OF UNIVERSAL SUPPLY
Larger Market
 Less Stigma
 Less Regulation
 Greater Public Benefit & Impact & Reach
 Customer Expectations Higher
 Better Organisational Profile
 Fewer people excluded from available care
 Larger profit, greater potential to subsidise
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The key things we learned
Staff are much more productive
 Staff are more flexible and multi-skilled
 Staff have become innovators and promoters
 The workforce is more diverse and more casualised
 Volume matters as does a broad customer base
 Mixed economy of purchasers is critical
 MAXIMISING market size is key
 Financial planning and management is very complex
 Client retention is good
 Clients say the service works and they welcome the
choice
 Staff are satisfied
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11 insights
Mental Health NGOs often
‘punching below their weight’
Our offer will always be 90%
relational and 10% technical
There is very little product
delineation amongst mental health
providers - the key difference, the
real value is in the person you
supply to assist the customer
Market the ‘relational promise’
Celebrate and share success
through story telling…real people,
real lives
Keep your values and history at the
heart of your message and as the
key driver for your business model
Add ‘delight’ and value at every
opportunity
Remember that customer
experience is at least as important
as efficacy for most customers
Continually innovate and evolve
your offer and expect others to
copy you
Listen carefully to what customers
tell you before deciding what a
‘qualified workforce’ is
Make part of your offer the opportunity
for the customer to ‘pay it forward’, to
give back, to be involved
Supply Challenges – What we learned in the UK
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Our workforce had to increase productivity by 20%
‘Standing’ liability needs to be minimised
Customers demand different qualities to those that organisations often hold
dear….eg:
 Less qualified but experienced in life (not necessarily ‘lived experience)
 Flexible and responsive
 Relationally competent
A new paradigm of staff deployment
 Move away from traditional structural model (teams)
 Multi-skilled staff covering full range of client needs are more efficient
Big increase in infrastructure demands
Requires a different understanding of outcome
Workforce has become more casual and/or self employed and generally
operating at a lower level of qualification but with new sought after attributes
Organisational complexity increases
Creativity needed to continually add value
Greater reliance on technology to support distant delivery
Very hard to supply remotely unless additional investment (by sponsor,
provider, regulator or co-purchasing)
SUMMARY OF KEY POINTS
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It’s bloody hard!
NDIS offers great opportunity BUT it should not be your only
market
The implementation approach seems sound
Providers need to think differently
 In terms of who they supply to
 In terms of brand and marketing
 In terms of supply and productivity
Early to market is important
Competition is inevitable and GOOD (particularly in urban
settings)
Funding will be more complex and chaotic
Customers will benefit if suppliers adapt
Preparing for supply will improve your organisation
FURTHER INFORMATION
 www.norwichmind.org.uk
 www.personalhealthbudgets.england.nhs.uk
 www.mind.org.uk
 www.scie.org.uk/topic/keyissues/personalisation
 www.thinklocalactpersonal.org.uk
 www.whitecoat.com.au
 www.patientopinion.org.uk