Personalisation, austerity and making progress

By Martin Routledge, head of operations, In Control

Can personalisation in social care succeed in a time of austerity? That question may well be the elephant in the room next week when Care Services Minister Norman Lamb chairs a national summit, facilitated by sector partnership Think Local Act Personal (TLAP), bringing together government, sector leaders, people using social care and those responsible for local delivery. There is an argument that cuts to local budgets, reducing services and poorly paid staff may make it extremely difficult to offer anything but the most basic assistance to disabled and older people. The Resolution Foundation last week published a report suggesting many home care workers are paid below minimum wage. Their spokesperson said "We hear a lot about the need for dignity in social care but how can we achieve that if care workers are under such pressure in their jobs and not even paid the basic wage?"

In such times, some may go so far as to ask what is the point even talking about designing and delivering support with and around a person, offering people control over how support is delivered? Shouldn't the only focus be on making sure there is enough money in the system?

These questions cannot and should not be dodged but perhaps especially in times like these, it remains vital to look at what is working better and how this can become more the norm. Data is often pretty scarce in social care, but recent research from the National Personal Budget Survey of over 3000 people and carers is showing us what leads to the best results. It's becoming increasingly clear with personal budgets that there are strong connections between how they are delivered and the impact on people's lives and also that experiences vary greatly from place-to-place. For example, where an older person is fully involved in planning their support they are four times more likely to report greater independence. Some places are achieving this for the many, some are not.

To give another example, the number of people getting cash direct payments to steer their own care varies strongly both from place to place and across different groups of people. For example in 2012/13, 28.4% of eligible people with a learning disability got their personal budget as a direct payment, but only 8.6% of people with a mental health problem. It can't be right for such big differences to exist - they mean people getting very different experiences. The summit will need to address this. The Department of Health should make sure that the Care Bill and its regulations and guidance drive best practice. Council leaders must challenge and support their peers to emulate the best. Providers, their staff and personal assistants can improve their support using good practice approaches and practical tools. Groups like TLAP should spot and share promising approaches and evidence.  At a local level, councils should regularly check results with local people, benchmark and plan improvements. At the moment only a minority seem to be doing this.

Bringing this all down to earth, what does this all mean for personalising homecare? Well of course the minister recently chaired another summit in an atmosphere of anxiety that "the next Winterbourne might be in homecare". This all became very real for my family last Christmas when my mum was diagnosed with late stage cancer. Our experience confirmed that despite local agencies charging essentially similar rates, there are big differences in how they work. At one extreme we had the agency that didn't see anything wrong with phoning us up to tell us they were being commissioned by the primary care trust and would be sending someone round that evening despite us knowing nothing about them, never having met anyone from the agency and having had no discussions about my mum or her care. At the other end was the agency my mum eventually used - they spent time getting to know her and us, responded to her wishes about the make-up of the team, when they would come and how to support her well. These might seem like obvious things but they are both crucial to person centred care and not always present.

To try and do something about this I met the management team of the United Kingdom Homecare Association. We talked of the barriers to achieving support truly designed around people's individual needs and wishes when resources are so stretched. We agreed there were no easy answers but that we must try to support positive change. We also agreed it was vital to think about the issue from both a provider and commissioner perspective, but that user experience is central. We decided to develop a homecare version of the well regarded Progress for Providers (P4P) personalisation resource and to support the development of an approach called Individual Service Funds (ISFs) for people who want to have a lot of control over their homecare but don't want to take their personal budget as a direct payment.

Progress for Providers allows organisations to check how personalised they are, with ideas on how to make further progress. It looks at the support being provided to the person and also how to make sure families are properly involved in making the support as good as it can be.  One provider used P4P to design a new homecare service and is now using person centred practices to deliver personalised care. For example working with Hilda they are pleased about the effects on her well-being of things like: carefully finding out what is really important to her; designing the support in detail to respond to this; matching her to spend time with key staff with similar interests and adjusting rotas to make this possible; setting up simple but creative and effective communication with Hilda's family so they can be well involved.

These might sound like obvious things but my experience and that of many others is that they are far from universally present and systematic action by providers and commissioners is needed to make them standard. The summit hosted by Norman Lamb next week will have succeeded if it helps make this happen.

You can also read the article on the Guardian Homecare Hub.


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Last Updated : 09 September 2013. Page Author: Laura Bimpson.