Barbara McIntosh and Helen Sanderson review the findings of a major evaluation of person-centred planning for people with learning difficulties and find grounds for optimism among the challenges
Five years after the government published the white paper Valuing People, which aimed to place people with learning difficulties at the centre of service planning, there are encouraging signs for service users, but areas of concern remain.
This first and only evidence-based evaluation of person-centred planning (PCP) has been carried out by several organisations working in partnership in four sites. Called Impact of Person Centred Planning, it found that person-centred approaches can radically improve an individual’s quality of life and identify health needs that might have gone unnoticed.
Each site had links to staff from the research project who provided training in PCP. Facilitators from each site, including staff and family members, were trained over 18 months and a person-centred plan was developed for 65 people.
The research highlighted that people with learning difficulties who had a person-centred plan experienced a 30 per cent increase in the size of social networks, 2.4 times more contact with family, 41 per cent increased contact with friends, and a 35 per cent increase in activities.
If facilitators and their managers were committed to PCP, people with learning difficulties were more likely to have their own plans. There were key factors that made a difference: facilitators should be committed to person-centred planning and, to achieve this, they should be chosen carefully. Facilitators should have planning as part of their formal job role as the research found that this was more effective when people had dedicated time and support and an acknowledged planning role.
The research suggested that managers should be supported to work in a person-centred way in their own team. Managers should also be involved in planning. They needed support to understand how to implement person-centred plans as PCP should have an impact on how a manager looks after their staff.
The most positive changes to service users’ lives came about when they were leading their own plans.
However, there are barriers to this type of working that need to be overcome. Local authorities are deemed to be the leads in supporting people with learning difficulties but their large size
sometimes results in a bureaucratic and hierarchical culture. Working in an individualised way and creating unique opportunities for one person at a time can mean a big change from the previous culture of large day centres and group homes. Care management, which is often crisis-driven and led by financial restrictions, can appear to be a counter-culture to person-centred approaches. High staff turnover and delays in appointing key managers also complicated the implementation phase.
Other issues that proved challenging included:
Another area of concern was the capacity for change in organisations and the willingness to work differently. Services need to invest more in leadership and in skills in developing PCP and to build the capacity of first-line managers to use person-centred thinking and planning.
The implementation of PCP needs to happen over an extended period rather than two or three months. It requires persistence, patience and great commitment from staff, families and people with learning difficulties.
Engaging families, working with them as colleagues and supporting them to lead in developing and implementing their relative’s plan proved to be successful in one site. Families requested to be linked with a paid member of staff who could ease their way back into accessing services.
An important issue was to learn from the outcomes of the planning and to use learning from person-centred plans to feed into the organisational planning of the local authority.
The increasing number of people with complex health care needs came to light during the project and highlighted the idea that the integration of health action planning with PCP is essential to meet the needs of this growing group of people.
The successful implementation of PCP depends on organisations and individuals adapting current systems to work with families, stay focused on outcomes for individuals and ensure that organisations invest in continued skills development for staff. A shared commitment to person-centred working from families, organisations and staff means that people with learning difficulties can have greater choice and an improved quality of life.
Barbara McIntosh is co-director at the Foundation for People with Learning Disabilities. She previously worked at King’s College and at the King’s Fund. She has worked in the learning difficulties field for the past 12 years and has worked in local authorities as well as the health service. Helen Sanderson is an expert adviser on person-centred planning to the Valuing People Support Team. She is co-author of the Department of Health guidance on person-centred planning. She leads the development agency, HSA, and also works for a service provider in Greater Manchester.
Training and Learning
The author has provided questions about the article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals
This article examines how successful the government’s 2001 white paper, Valuing People, has been in helping services implement person-centred approaches to improve the quality of life for every person with a learning difficulty. Research funded by the Department of Health shows that person-centred planning has led to significant changes in the areas of social networks, contact with family, contact with friends, community-based activities, scheduled day activities and levels of choice. But are services delivering this to individuals?
H Sanderson, J Kennedy and P Ritchie, People, Plans and Possibilities: Exploring Person Centred Planning, SHS 1997
B McIntosh and A Whittaker, Unlocking the Future, Developing New Lifestyles with People who have Complex Disabilities, The King’s Fund, 2000
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