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Twenty nine ways to make personalisation real

This blog post has been written by our associate Andrew Tyson.

Andrew is a health and social care practitioner based in Brighton. He works as an independent facilitator, trainer, writer and speaker and is a registered social worker and accredited interpersonal mediation practitioner.

www.andrewtyson.org.uk

The Making it Real markers were launched on 17 May.  Martin Routledge blogged about them here on the same date. The markers were called 'making it real' for a reason, the reason being that in some places and to some people personalisation feels anything but real: to some it is a good idea, poorly implemented or one that has been de-railed by the cuts agenda; to others it was always regarded with suspicion, a Trojan horse for privatisation or the end of the welfare state.

In Control firmly believes - alongside Think Local Act Personal and our many friends and allies in the disabled people's movement, in provider organisations and in local councils - that we can and must make personalisation real.   We know that when implemented well it enables people to take control of their lives, to contribute to the community and to begin to discover what it means to be human. But we also know that these are tough times and that everyone is under pressure.

How do we go about doing this?  What in particular is it that councils can do to help? Over the past 12 months we have been working with councils and others in the North West of England to engage with those with something to say about personalisation and personal budgets (personal budget holders, families, staff, senior managers) to identify the best practice - and by doing this to show how some of the most challenging issues can be addressed. Our report of the work is published is now available.  Here are some top tips from the report.

Issue One Minimum Process: in some council areas we have made things more complicated, not simpler. The process someone needs to go through to get and manage a personal budget puts many people off.  Councils have been overcautious and have heaped new processes on top of old, instead of replacing the old with the new.

What should councils do?

  • Provide local leadership through promotion of the values of empowerment, co-production and informed choice and control. Visit community associations, speak at local events, use the local media and websites.
  • Invest in, support and quality-assure advice services available to all. Will need to include both actual buildings-based services, (CABx, young people's and culture specific advice agencies) and electronic (web-based) sites and portals.
  • Provide seed funding for user-led organisations and for centres for independent living. Ensure that you support those organisations that have the passion to empower people; ensure that they do not exclude anyone.
  • Review the provision and reach of 'basic support services' (cleaning, shopping etc.) across the council area. Take account of coverage, quality and pricing. Where services are deficient in any way, consider what options are open to the council. Make it clear to all that the capacity to help people to stay in their homes and communities is everybody's business and the sign of a healthy community. Help people to feel good about this sort of work.
  • Keep under constant review the policies and procedures which regulate the 'front doors' to council advice and support. Ensure in particular that contact centres provide an excellent customer experience and that staff are very well informed about how local statutory, voluntary and privately provided services operate.
  • Ensure that there are also good specialist advice services available for help with housing,  benefits, employment, law and particularly to assist people to manage their health and social care needs. There should be a mix of electronic and 'real' resources available and they should provide a genuinely personalised response to all.
  • Check how easy it is for people to access and obtain simple equipment and services, basic daily living equipment and basic help in the home. Where there are difficulties or shortfalls in availability or access, consider your options.
  • Also check how other forms of 'social capital' such as Timebanks, LETS, Homeshare services, Shared Lives and others work with and on behalf of (potential) users of the social care system. Where there are deficits, find ways of stimulating the market.
  • Ensure that reablement services are efficient, effective and provide good coverage of the whole locality.
  • Consider how well your local reablement model works: is it genuinely person-centred, is it effective in getting people thinking about personal budgets at the right stage and in the right way, is it confined to older people's services or does it extend more broadly? Take whatever action is indicated.
  • Think about the availability, usage and efficacy of telecare services. How are new developments evaluated and made available to people? Do these extend across all need groups? How do councils know find out about them, signpost people and talk to them about the cost issues? Is this adequate?
  • Look at situations where short-term interventions are required by council and other statutory services to prevent long-term service use. Are these effective? Are they multi-agency (particularly with health and housing colleagues)? Do they cover the whole of the council area?
  • Check that the financial assessment process works well, that its purpose is clear for all concerned and that there are no lengthy delays.
  • Check that the process for auditing personal budgets is proportionate and works well.
  • Evaluate the role of care managers and social workers. Are they making best use of their skills and experience? Are they focused on complex cases and are they working effectively with these cases? What role do they take in relation to support planning and brokerage? Are there differences cross user groups, and if so can these be justified?
  • Ensure that the review process works well for all concerned: particularly for people using services (to ensure that they get what they want and need, they are working towards agreed outcomes, are safe and have the opportunity to make changes as necessary), and for the council who are getting value for public money.
  • Ensure that there are good local services to help people understand and manage their personal budgets and to think through and design services that meet need. Where there are gaps (geographical or in terms of service coverage), consider what action is necessary.

Issue Two: Managed personal budgets: there has been increasing public criticism of those personal budgets which are not direct payments and especially those that are managed by council staff.  Some people say that in some places these arrangements give no more choice and control than directly provided services.

What should councils do?

  • Review the range of management options available for users of managed personal budgets. Where there are gaps, commission/encourage the market to fill them. Ensure that all need groups are supported. Ensure that managed personal budget arrangements provide assistance for those who require support to make decisions.
  • Review the impact/effectiveness of each management option using some simple tests. What do users say, in particular about choice and control? Take remedial action as necessary.
  • Review the use of approved provider arrangements. Do they remain fit for purpose in relation to the growth in use of managed personal budgets? In particular do they enhance or inhibit choice and control? Make changes as indicated by the review.
  • Review the use of framework contracts in the same way. Do they enhance or inhibit choice and control? Consider the merits of outcome based commissioning.
  • Review the use of individual service funds and the specifications and contract compliance arrangements which support these. All contracts with providers should now be constructed to deliver clear personalised outcomes, and monitoring arrangements need to capture this activity. Providers may need to support to take on individual service fund requirements and changes to contracts. Consider commissioning user-led organisations to help.
  • Review arrangements to support user-led organisations and encourage them to focus their activity on enabling people to manage personal budgets. Provide additional support to ULOs as required.

Issue three: the workforce: the success of personalisation in social care is almost entirely dependent on the knowledge, skills and confidence of the workers employed to manage the process as well as those provider staff who work with people on a day-to-day basis.  In some places today morale is low and some staff find it hard to see that personalisation will make any difference.

What should councils do?

  • Refresh and reinforce local leadership and ownership of personalisation through a programme of clear communications with staff (face-to-face, written, and electronic) which emphasises the overarching importance of sticking to core values in tough times.
  • Make use of the Making it Real marker 'I statements' to review user views of workforce effectiveness and to take action based on review results.
  • Review process and practice for 'sign-off' of support plans and personal budget allocations to ensure that the focus remains maximum choice and control, whilst taking necessary steps to manage budgets.
  • Review practice across the council to check that the best practice in relation to personal budgets is common and available to all.
  • Review induction, training and support arrangements for professional staff to ensure that these reflect and reinforce council policy on value-driven personalisation in tough times.
  • Work with local private and voluntary providers of social care to ensure their managers and staff understand key values and priorities; and that they have access to council training materials and resources, wherever this is feasible and affordable.

We know that none of this is easy, and that a simple prescription isn't the answer.  But what we also know is that people are telling us that all of these things are happening in some places and that they do make a difference. Are you doing them?

Andrew Tyson

 

5 comments for “Twenty nine ways to make personalisation real”

  1. Gravatar of Jenny CarterJenny Carter
    posted 13 September 2012 at 14:24:46

    All good in theroy but if people do not speak up for themselves or supported to personalisation cannot be achieved.

  2. Gravatar of Lynn James-JenkinsonLynn James-Jenkinson
    posted 14 September 2012 at 10:33:13

    Thanks Andrew, I totally believe that everyone should have power and control over how they live their life with the support they choose, when they choose it. My concern at the moment is that rather than 'the success of personalisation in social care is almost entirely dependent on the knowledge, skills and confidence of the workers employed to manage the process as well as those provider staff ' it is almost entirely dependent on individuals, their friends and families having the skills, confidence and knowledge to wrestle power and control to where is should be, with them. How do we support IC highlight the barriers and help the public sector believe and trust enough to remove them. Happy to help as this is so important in my front room and the front rooms of many of my friends and family.

  3. Gravatar of katie clarkekatie clarke
    posted 21 September 2012 at 15:50:38

    We are frustrated, disempowered, and out of control due to the lack of clarity, honesty, information, and of course budget cuts.
    for years our daughter has had a budget that has met her needs and enabled her to get excellent support to do lead her "extra ordinary life". We have done joints talks around the country including In Control events.

    Now we are having to resort to writing to local councillors and MPs, heads and directors to try and see sense after the RAS came out at a very very low indicative budget when we were asking for an increase not a decrease!
    The lack of understanding from the social worker around complex needs, working parents, having a life, was shocking.
    If we do not get an increase I will have to give up work and become an unpaid personal assistant which neither my daugher nor myself wish for.
    we luckily know some amazing people in the world of personalisation and my daughter is fully aware of her rights and how her independence is on the line right now and in the hands of the local authority. the energy needed to carry on fighting and then having to complain is enormous. As if we did not have enough to do!
    any top tips would be much appreciated!
    thanks, katie

  4. Gravatar of stan ousbystan ousby
    posted 23 September 2012 at 17:25:26

    All well in an ideal world but we are edging on Institution Disability Discrimination, for vunrable person's who have not got a voice and will never have a fair playing field. Olympics were great but there are far more out there
    without a voice. Or realistic representations

  5. Gravatar of Aidan PollittAidan Pollitt
    posted 28 October 2012 at 00:12:50

    And now the government has dropped the target that required councils in England to give all users of social services a personal budget to buy their own care and support. They say that only 70% of people will be required to have one. And to add insult to injury they have hidden their incompetance and lack of true interest in personalisation behind an excuse that some people couldn't manage a personal budget !! Thereby blaming disabled people and elderly people for this. The upshot of which will be to have control taken away. How appalling is that.

    And no doubt next year they will drop it to 50%.

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Last Updated : 12 September 2012. Page Author: Laura Bimpson.