Personalisation means…. Starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about what, who, how and when they are supported to live their lives. Addressing the needs and aspirations of whole communities to ensure everyone has access to the right information, advice and advocacy to make good decisions about the support they need. It means ensuring that people have wider choice in how their needs are met and are able to access universal services such as transport, leisure and education, housing, health and opportunities for employment regardless of age or disability. (Personalisation briefing, SCIE, 2009)
Beliefs for social care Disabled people are vulnerable and should be taken care of by trained professionals. Existing services suit people well – the challenge is to assess people and decide which service suits them. Money is not abused if it is controlled by large organisations or statutory authorities. Family and friends are unreliable allies for disabled people and where possible should be replaced by independent professionals. Duffy, 2005, p10
Beliefs for self-directed support Every adult should be in control of their life, even if they need help with choices. Everybody needs support that is tailored to their situation to help them sustain and build their place in the community. Money is most likely to be used well when it is controlled by the person or people who care about the person. Family and friends can be the most important allies for disabled people and make a positive contribution to their lives. Duffy, 2005, p10
Valuing People (DH, 2001) Four key principles: Rights Choice Independence Control
In Control 2003 Joint leadership of Mencap and the Valuing People Support Team Resources from buildings and pre-paid services to individuals Six local authorities responded to in Controls invitation to pilot (and fund) new ways of working in their own areas.
Spot the difference Old professional gift model: State uses the money it receives from taxes to slot people into pre- paid services through the work of professional assessors and gatekeepers Care manager identifies needs, then services, then funding New citizenship model: Disabled person is at the centre of the process, is part of the community and organises the support they need and want Individual identifies their needs, is given an indicative budget and then plans provision to meet the identified needs: self-directed support.
Seven steps to self-directed support Set a personal budget Plan support Agree plan Manage personal budget Organise support Live life Review and learn
Setting the budget Initial assessment screening to check eligibility Completion of self-assessment questionnaire Number of points scored is multiplied by the price point to give the budget available to meet the needs identified.
Funding for Individual Budgets Variety of existing funding streams: Adult social care Community equipment Independent Living Fund Access to Work Supporting People.
Government support for personal budgets Demonstrated in four government publications in 2005: Independence, Wellbeing and Choice (Green Paper) Pilots in 13 sites Improving the Life Chances of Disabled People (Strategy Unit Report) Assessment and advocacy Opportunity Age (DWP report) Labour Party manifesto
Putting People First (2007) Signatories: Six government departments National health and social care organisations Local government The time has now come to build on best practice and replace paternalistic, reactive care of variable quality with a mainstream system focused on prevention, early intervention, enablement, and high quality personally tailored services. In the future, we want people to have the maximum choice, control and power over the support services they receive. (HM Government, 2007, p2)
Transformation agenda Based on Putting People First and guidance in local authority circulars Transforming Adult Social Care (2008 and 2009) System wide transformation aiming at personal budgets for everyone receiving social care funding except in emergency situations. Social Care Reform Grant provides ring-fenced funding for three years from 2008 to support local authorities to make the changes needed. Has prompted new Fair Access to Care eligibility criteria guidance, with the consultation period ending in October 2009.
Expansion beyond adult social care Pilot of personal health budgets announced in Health Bill 2009 Proposes provision for direct payments by health authorities £520m from health to local authorities Childrens Services pilots Other local and national government departments
Social works contribution A preventative approach The ability to work with complex situations and with different agencies and sectors The capacity to perform a wide range of tasks including brokerage and advocacy Flexibility and accountability GSCC (2008)
Statutory role in seven steps When a decision is made about the amount of the personal budget When the support plan is agreed (including ensuring the plan is safe and that people have any necessary representation) When the plan is reviewed
New roles for social workers Advisers Navigators Brokers Service providers Risk assessors and auditors Designers of social care systems
Resistance from social workers Suspicion about governments motives Lack of training and information Workload implications Inadequate funding of direct payments and personal budgets Concern that directly provided services and the people using them will become the poor relation Fears that service users will be left vulnerable to abuse or at risk of significant harm Issues around exploitation of care workers and women Concern that some people will be packed off with a personal budget because they are seen as trouble-makers Doubts about individuals managing their own support and budgets PA recruitment difficulties Desire to maintain professional status and role Glasby and Littlechild (2009, p )
Managers concerns All of the above, with emphasis on: Protecting in-house services Controlling expenditure through a traditional gatekeeping role Safeguarding at the expense of rights and responsibilities Protecting their resources from an increased risk of fraud and financial abuse
A way forward Ensure that: Social workers are involved in planning change Points of resistance are treated as indications that important issues need to be tackled Implications for individual workers are addressed Social workers have the skills and support needed to work differently.
References Duffy, S (2005) Will in Control at last put people in charge of their lives? Community Living, vol 18, no 4, pp Glasby, J and Littlechild R (2009) Direct Payments and Personal Budgets: Putting Personalisation into Practice Bristol: The Policy PressGSCC (2008) (Digitised chapter on Blackboard) The GSCC response to putting people first making it happenhttp://www.gscc.org.uk/Policy/Consultations/ResponsePuttingPeopleFirst [ accessed on 1/12/09 SCIE (2009) Personalisation: a Rough Guide London: SCIE (See SCIE website) Legislation, reports and guidance LAC (DH) (2008) 1 Transforming Social Care LAC (DH) (2009) 1 Transforming Adult Social Care HM Government (2007) Putting People First: A shared vision and commitment to the transformation of Adult Social Care, London: HM Government DH (2001) Valuing people: a new strategy for learning disability for the 21st century. Norwich: The Stationery Office DH (2005) Independence, Well-being and Choice, London: The Stationery Office DH (2006) Our Health, Our Care, Our Say, London: The Stationery Office DH (2009) Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care, London: The Stationery Office HM Government (2005) Opportunity age: meeting the challenges of ageing in the 21st century, London: Department of Work and Pensions Prime Ministers Strategy Unit (2005) Improving the Life Chances of Disabled People, London: Prime Ministers Strategy Unit