Personalisation - a practitioner's view
A REVOLUTION of change in the Provision of Social Care Services
By Chas Mead, Associate Trainer
My own background
As a practitioner in NHS mental health services, I have been privileged to have been part of the early plans in the introduction of Personalisation Agenda and initially had worries about self managed budgets and direct payments. I soon realised that this was a view of a service led ideal, well meaning but repressive and reactionary to change. I know someone who has secured funding to arrange respite at the seaside when they become ill, instead of waiting for endless arrangements within inpatient services, they can recover in one third of the time and within a socially included environment which is safe, as agreed by the care plan and funded by a Direct Payment. Others may receive finance for a car to enable far reaching access, thus gaining better wellbeing and feeling socially included, instead of visiting a day centre which they may have done for years.
I also know of several people who are customers of mental health services and have become governors of a Mental Health Foundation NHS Trust. They flourish with passion to help make things better for others, even in this difficult financial world. They feel and are accepted with total equality and are valued for their individual skills and expert knowledge.
I attended a course several years ago which was a pilot introduction to a personalised approach to supporting individuals, called 'Recovery and Wellbeing Trainer'. The experience had a profound effect on the way I worked in Care and has helped me to break away from my mostly unconscious prejudices, created within a long career in residential and day care support. I realised at that time that these prejudices had created a strong and defensive service led attitude.
I am often surprised about how so many providers believe that they work within a person centred way, yet are unwittingly influenced to defend old established services when assessing care needs, these tendencies are common and exist within powerful and sometimes inflexible service led frameworks. Personalisation demands a review of services and how skills can be enhanced by specialist training for practitioners, together with customers. These could include the use of an imaginative and person centred training course, in which the use of sensitive role playing, workshops and discussions are facilitated to gain an insight into other people's perspectives and needs.
Why is Personalisation important?
Personalisation issues are very wide and complex and the Coalition Government, although recently formed, seems to be very serious in continuing with this revolutionary drive towards decentralized funding, away from 'old established service led thinking'. Personalisation will lead toward establishing flexibility, more choice of a variety of services which customers can better focus on, according to their very personal needs and desired outcomes. Once approved, these packages are financially managed by individual service users or customers. I hope that this article gives a brief insight into the customer benefits of personalisation and some thoughts about business issues for service providers.
The personalisation agenda is causing a major shift in the way social care and care providers plan and deliver care and resources and these can be viewed, for the sake of this brief article, within two areas of change and major improvement:
1/ Personal advantages:
There are many far reaching Global expectations for improving health care to individuals and this has created a radical rethink, causing robust changes in Provision. These changes are underway within tight deadlines and all services and improvement in quality standards are being seriously measured. These include improvements toward customer's better social inclusion, providing more diverse needs and customer and stakeholder representation on the planning, management and governorship of services.
There are new meanings of what is called 'person centred planning' and support for customers purchase, delivery and self management of personal care (self funded from Direct Payment System). This offers a new way of making better personal choices, to a much improved and a wider range of services within the NHS, Local Government and in the rapid increase in growth from third sector, voluntary and privately owned organisations.
All Personal Care Plans will be monitored to determine good standards and all providers will also become far more accountable to the individual customer for delivering expected and agreed outcomes; if the services are not satisfactory then the customer may look elsewhere for their care package!
2/ Escalating costs and outdated systems:
Central Government and Service Providers have fully acknowledged the fact that England and Wales are experiencing a huge increase in its aging population, which the existing system of Social Care Provision cannot possibly finance. The increases for an aging population are due to some very good reasons for celebration, but the crisis in funding, added to the realisation that many direct services are often inflexible and rigid, are driving major change.
Many direct services in Social Care are seen as being 'service led', losing touch with individual need and the modern expectation of being rapidly adaptable to suit changing market needs.
A few facts about the reasons for UK population increases:
'I don't like the thought of getting old until I think of the alternative' (W.Allen)
A cause for celebration, Infant mortality/ 1000 live births: 1948 = Girls (39) Boys (30). 1996 = Girls (7) Boys (5)
Successful NHS – Proportion of deaths below age 65 in England and Wales 1948 (40%) 1996 (7%)
'Old is the new Middle Age' Life expectancy at Birth: 1900 = Females (49 years), Males (45 years) 2002 = Females (81 years), Males (76 years)
'The shape of Society is changing' Population structure of England and Wales: Age 0-4 increased by 9%. Age 80+ increased by 240%.
Change towards the wide meaning of Personalisation is not just based on a Demographic view, but also because people are living longer but in poorer health. There are also far more diverse communities, each with differing needs.
Changes in service provision
The uncomfortable truth, that the majority of people agree, is that 'the history of adult social care is located in the work house and therefore we have been supporting an unfair 19th century model and charging policy' these models are widespread and are no longer sustainable.
There has been a rapid increase in raising the level of uptake from Direct Payments to service users, to be used for personal care, these changes are not new to Learning Disability Services, but are fast becoming widespread as the accepted norm in other services (Mental Health etc); these changes are demanded by Government to meet targets by defined dates. This drive has caused positive and radical changes in how direct and secondary services are provided by Local Government and the NHS. The whole structure of Service provision in Care is changing and for some Authorities and Trusts is very advanced. The method and strategies for these changes in each area of the UK are extremely varied, often chaotic with little apparent vision; whole direct services are being sold off to the third sector and for others who are skilled in Change management, the changes can be inspiring and are less painful.
Other service areas such as residential care, supported housing, respite and domiciliary care services have traditionally been service led according to models established by commissioners and regulators. The personalisation agenda requires service development, which includes the commissioning process, to reflect what individuals really want according to their basic needs, preferences and aspirations. There has been a genuine and powerful move towards gaining feedback and developing focus group structures, toward improving customer representation at every level.
Personalisation agenda and change is creating many challenges and exciting opportunities across the support and care sectors and these are a small example of some key issues that service providers face:
- Customers will expect and seek individual support and will move beyond traditional definitions of care.
- Personalisation provides opportunities for the care and support sectors to offer a wider range of work through the development of the personal assistant role and brokerage skills.
- Services will be accountable on the outcomes agreed and chosen by customers. Services that are best at evidencing results will have a competitive edge.
- There will be major opportunities for organisations to specialise in diversity and changing needs.
- Recruitment, retention and development of new skills for staff will become critical issues for the market as a whole and on an individual provider basis.
- There will be investment in new accounting systems able to help support direct payments and personal budgets.
- A new age of business managers are being recruited by many organisations to re-shape into modern and efficient provision (growth of NHS Foundation Trusts) that are learning new marketing and liaison skills with diverse partnerships.
- Commissioning will no longer been seen as controlling agents they will better facilitate market shifts and needs. Providers will become lean organisations with far more freedom for innovation to serve the diversity and preferences of customers.
Summary
Impact currently offers an introductory course about Personalisation and is in the process of developing further courses, more focused on developing personal 'Skills and Awareness'.
I hope that this very brief article, compiled and shaped by Charles Mead may be helpful in stimulating ideas and thoughts about further discussions and the way we may approach Personalisation issues.
There are many sources of information about Personalisation issues and agenda; these include:
Social Care Institute for Excellence: http://www.scie.org.uk/
National Institute for Clinical Health and Excellence: http://www.nice.org.uk/
© Impact Training 2008
