Personalisation for all?

A regular and understandable challenge to the shift towards personalisation comes from those who point to groups of people clearly not benefitting well at present. Sometimes challengers suggest that personalisation is not relevant or not wanted by some groups. In other cases people point to groups they believe are being neglected and denied the opportunities that personalisation can bring. In both cases, a common difficulty is to see how the methods of personalisation could apply in certain circumstances such as when the money available is low, individual decision making is an issue, people don't have supportive families available, crisis situations etc. If you extend into other areas of public service there are also groups for whom the application of personalisation may be resisted on the grounds that people should not be allowed to self-direct.

So what should we do? Some would suggest that "personalisers" should just butt out of certain situations. One recent contributor to the Community Care Carespace Forum for example recently posted "For the most part…………older vulnerable adults (in general) are not interested in choices about their care, not interested in what they might do with their budget money and they almost certainly do not want the responsibility of the admin of such budgets... all they require (in general) is to have the needed care & support arrive at the agreed time, day in, day out and preferably with the same care worker".

For others though the question is "how?" It is clearly true that some situations and circumstances it is really hard to see how things can be personalised - how can you personalise a 15 minute commissioned session of homecare? What do you do when low paid staff turnover at a rapid rate and receive little training? We must not kid ourselves that money is not an issue or that miracles can be performed through magical methods whatever the resource situation. At the same time these difficulties can't lead to inaction - surely we all have a responsibility to see what can be done to improve people's experiences through personalised approaches being developed and adapted to work in new situations.

The positive news is that we and others are getting on with finding solutions. There are now quite a few years worth of helpful learning and experience about methods and approaches that can help bring personalisation to places it has not previously reached. There is also a growing will to do so. In just this past week I myself have been involved in encouraging and practically focused discussions and planning with serious people determined to extend personalisation into home care for older people, support for people with cancer and to residential and nursing care for people with dementia. Two weeks ago at our In Control leadership event we were inspired by a presentation by Helen Sanderson and Steve Scown about the ground-breaking and courageous work that Dimensions have started - using an as yet little implemented form of personal budgets - Individual Service Funds (ISF). Over this next year we are going to work with partners to explore the application of ISFs to homecare.

Looking beyond social care there must also be real possibilities to apply self-direction and personalisation into new areas of public policy where people find themselves trapped, the state often spends enormous sums and existing forms of intervention often don't work well enough. In Control has worked on a small scale, for example in criminal justice and substance misuse in recent times. Work that my colleague John Waters initiated in London with rough sleepers showed very encouraging results. We are aware of others starting to explore the potential of personalisation in these areas.

We know that others feel the same way we do on this matter and that encourages us that we may be on the cusp of breakthroughs over the next few years. In the meantime watch this space over the next few months for news of practical projects and developments from us and others, and if you are thinking or working on similar lines please let us know.

Martin Routledge

8 comments for “Personalisation for all?”

Robin Bush

posted 24 January 2012 at 16:41:56

An interesting and thought provoking blog contribution Martin and one that raises a number of significant issues. Your point about "challenges not leading to inaction" can not be stressed enough. It is vital that as providers we seek innovative and meaningful ways to develop person centred approaches in all our services. I would be interested to explore further the Carespace entry that you quote. In my experience I have yet to meet anyone (in general or otherwise) in receipt of service who doesn't have an opinion of how their support should be delivered. I'm guessing that the issue is likely to be lack of support around understanding their options, rather than not being "interested in their care". As for the Individual Budget Issue or ISF's it is important that social care professionals do not use this as a barrier to person centred services. Just because someone does not want to utilise a Personal Budget does not mean that they should not receive person centred services. Providing Person Centred Services relies on a firm value base and solid organisational values, the avenue by which that support is paid for, is largely immaterial.
Bev

posted 24 January 2012 at 20:49:13

Dear Martin

I read with interest and support for the Personalisation as I am a carer for my son who is disabled and my father who is chronically ill.

I would like to come at Personalisation from two points of view, well three really. One is my sons person centred support, dreams, hopes and aspirations, and that I believe we are all individuals with a choice and I support this, but feel that other parties e.g. services, health, education, social clearly dont understand the meaning of this and still dominated from a financial point instead of need. Your point is very relevant in our current climate that we cannot ignore financial aspects, but I feel that money is wasted time out of number in the way that services dont join and pool together innovative ideas, there are a lot of do gooders jumping on the bandwagon offering services now, but equally a lot of jobs worths running the show. We all have to learn I am well aware of that, being a carer qualifies you for many occupations along the way. What I dont see are opportunities for companies to invest in the personalisation scheme e.g. shops, supermarkets, pubs, clubs etc, there could be a lot more innovative ideas instead of modernising the status quo, and falling back into models of care that we need to get away from. For eg. a large supermarket chain could invest and take the time to set aside a couple of hours per week to train support and educate in a two way situation staff and disbled customers on learning important life skills for when their carers are not around to support them, the same goes for all lifeskills, this could really promote jobs and skills and inclusion, just a thought, part of the customers budget could pay for 2 hours shopping independence, and equally give the carer a break, (saving money). My second point of view is carers issues are different to those of the customers, I feel that were we are now has taken such a long time to get to this point, carers are moulded into fight or flight mode, and dont know how to trust and let go. There has to be more support for carer awareness and how their career in caring is embedded within them and support in being able to let go amongst society. After all no one likes being told how to do their job. Equally there has to be an understanding that the hours that are not covered by the personal budget actually do fall back on the carers shoulders and are not taken into account when assessing for Personal Budgets. My third point is about Personal Assistants, whilst I appreciate many clients require support in undertaking PA's from the DP side of a Personal Budget, were is the voice and choice for the customer when their carer is in the background, there is an utter shortage of peer groups and independant skills groups that enable the clients to show that actually they are able to and have a voice, and want a life, to help customers make their own mind up on what PA assistants can offer/support them in. My husband has worked many years in a PA capacity, there is a sheer lack of what the Personalisation indicative budget is about, how to use it, who and what's its for from the carers, and lets face it when you have umbrella training one for all and then social workers enter the community and deliver it using their own definition of who has what and how, its no wonder people get confused and shut down. This is 2012 gatekeepers to budgets are not what is needed, innovative ideas a willingness to learn and get out of the box, a set of ears and a sense of humour are modern day credentials. In my life I have had a few tastes of relying on others through illness and I found it frustrating, demoralisting, depressing to name but a few feelings. We have got to keep fighting for what is right, but never lose sight of life would be very boring if we were all the same.
Ermintrude

posted 28 January 2012 at 10:16:31

I am currently working on an ISF project but it's almost been in spite of the local authority not because of them or the people who advise them. It's been a hard battle from my position as one frontline social worker to get the idea some traction and I think I'd like to see more positive appreciation of, yes, social workers like me who do want this to work despite the faulty tools and poor systems we have been given by those who have designed systems that don't work equally across all client groups. I work with older adults but I think the focus on personal budgets at all costs for everyone has left a lot of scars because it hasn't been the best system for all and we have been told to implement managed budgets which are no different.
Until there is an understanding from management and government that well implemented and fairly implemented personal budgets that use all systems of implementation not just direct payments or managed budgets (i.e. use of ISFs) will actually cost more to deliver - at a time when care costs are being cut - there will continue to be opposition.
What I'd like to see is more appreciation, understanding and work with front line workers like me who want to make a difference and have pushed hard but constantly seem to be wrongly accused of 'being negative' because we are easy targets. Help us, In Control, don't blame us. That's my plea.
Patricia

posted 30 January 2012 at 11:41:03

As someone new to the care system but adamant that all those needing care and support should have choices, I am exhausted at the amount of fighting I've had to do to engage local councils in recognising, acknowledging and actually utilising the personalisation agenda. It it woeful that older adults are only seen as some'thing' to be washed and fed and not some'one' at another, equally important, stage of life. This particular stage of life includes reduced mobility and impaired cognitions, this does not reduce them to non-human beings. I will continue to drive this agenda for my relative to ensure he still has a life worth living. Shame on those who think otherwise.
rob lawson

posted 01 February 2012 at 14:30:45

Does anyone feel that independent advocacy should be available particularly for people with a learning disability as part of the support planning process.I have seen many plans that have been done with very little input from an independent and it has led to packages not fit for purpose.This is not a criticism of social workers/other professionals!
Investment for this would safeguard the individuals wants,needs and aspirations and help support people to wade through some of the red tape that surrounds the personalisation agenda.
Angela Broadbridge

posted 01 February 2012 at 15:35:18

Rob, agree with your comment, Gateshead Advocacy Information Network has been delivering a 3 year project exploring and promoting the role and value of Independent Advocacy in personalisation across all service user groups and we advocate that IA be promoted throughout all stages of the self-directed support process. We are about to publish our end of project findings, in the meantime you can find resources on our website at http://gain.org.uk/whatsnew.htm (under personalisation)
socialworkhelen

posted 24 February 2012 at 17:03:13

Too many LAs and others see personalisation as being linked with a RAS. In fact, a RAS alone is the least person centred tool without the support that enables a true person centred plan and continued meaningful reviews. I did this throughly in an LA years ago. When SDS first started we were able to take more time with service users making a solid plan. I have since heard that someone I worked with back then and who had been spending a DP on meeting outcomes but in their OWN way, using alternative services that suited them, has now been told they can no longer do this. They are being asked to pay back the money. They are being told this shouldn't have been agreed, that the LA 'doesn't spend money on those things' regardless of the fact it is meeting outcomes. They are understandably frustrated and upset. All this alongside a carer and cared for struggling with a long term illness. AND it makes me look incompetant! The LA has moved the goals posts in the era of spending cuts and now only wants people to use a DP very strictly on services it deems to be appropriate. That's not personalisation and I am afraid that's what is going to happen.
Sorry for the rant. I know there are a lot of good things happening but somewhere the rhetoric gets lost within systems and front line workers struggling against timescales and very tight control of funds at panels. In addition, some assessments have the RAS showing on the computer and when you print it, it magically disappears. LAs still don't trust their RAS and therefore social workers cannot have an honest up front conversation with people about their budget and how they would like to spend it. Personalisation could be achieved by giving social workers the power to empower, regardless of the use of a RAS. But that means allowing them more than an hour at assessment in face to face contact with someone. And it takes trust in their abilities and the skills they possess.
Rant over! Phew, I feel better now :-)
martin

posted 24 February 2012 at 17:12:12

Thanks Helen - been talking today will colleagues about original thinking behind RAS as a helpful thing for people and social workers and wondering if we can re-visit.