Personalisation is a social care approach described by the Department of Health as meaning that “every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings”.
While it is often associated with direct payments and personal budgets, under which service users can choose the services that they receive, personalisation also entails that services are tailored to the needs of every individual, rather than delivered in a one-size-fits-all fashion.
It also encompasses the provision of improved information and advice on care and support for families, investment in preventive services to reduce or delay people’s need for care and the promotion of independence and self-reliance among individuals and communities.
As such, personalisation has significant implications for everyone involved in the social care sector.
Personalisation and service users and carers
The key test of personalisation’s success is the extent to which it improves the lives of service users and their carers. There is evidence that this is taking place as a result of personal budgets but also concerns that a number of groups - people with dementia, those with other mental health problems and those who lack mental capacity – are not yet benefiting from this approach.
Service users and carers also complain of poor-quality information and advice on social care, an issue that particularly affects self-funders.
Personalisation and social care professionals
Personalisation is having a significant impact on the roles of social care professionals, particularly those employed within council adult social care teams, including social workers. The core functions of care management – assessing service users, drawing up a care plan and purchasing services to meet needs – are all transformed through personal budgets.
Users should assess their own needs, with or without support, play a full part in drawing up a wide-ranging support plan, rather than a narrower care plan, and directly purchase or choose the services they want.
As a result, councils have created a range of new roles to support service users in carrying out these tasks or commissioned external organisations, including user-led organisations, to do so. In some areas this has meant reductions in the use of qualified social workers and a rise in the use of non-professional staff.
Many social workers have also complained that personalisation has increased the level of bureaucracy in their role, particularly through the introduction of long and complex assessment forms.
However, some commentators argue that personalisation presents an opportunity for a return to “true social work”, with practitioners working to help families and communities support themselves and build independence, rather than become dependent on services purchased through a care management approach.
This idea is being promoted as a key plank in moves to transform the care system from being one based on crisis response to one that promotes independence and well-being – the central idea of the UK government’s 2012 White Paper.
Personalisation, commissioners and providers
The role of commissioner changes radically under personalisation.
Instead of purchasing services in bulk from available providers and fitting eligible service users into those that best meet their needs, commissioners must shape the social care market to promote the availability of a diverse range of high-quality services from which service users can choose.
The UK government’s 2012 draft Care and Support Bill proposes placing a duty on councils to ensure service users can access a diverse market of providers, and the accompanying White Paper suggests they produce a market position statement, setting out how they plan to implement the duty.
Personalisation also requires a change in approach from care providers. As councils devolve purchasing responsibility to service users, providers can no longer rely on block contracts with local authorities.
Instead, councils are setting up framework agreements, under which providers are accredited to provide services of a particular quality at an agreed price but are not guaranteed business, as decisions on whether to use them rest with service users. This should make providers more responsive to service users’ needs and wants and drive innovation.
However, this trend has had casualties, particularly in the closure of services that remain in demand but can only be sustained by a critical mass of service users, such as day centres. In such cases, the service becomes viable if a minority of users cease to use it regardless of the majority’s wishes.
To help families choose between services, the government is seeking to improve information and advice on care services, through a variety of means:-
- A duty on councils to commission a comprehensive information and advice service, backed up by £32.5m in funding to set up online information services;
- A national portal carrying information and advice on care and support;
- The latter would include profiles of all registered residential and domiciliary care providers carrying basic information, such as compliance with Care Quality Commission standards, and, where available, additional information on quality, including user reviews.
Personalisation in England, Scotland and Wales
Personalisation has advanced furthest in England where it has been government policy to transform social care in line with the agenda since 2007. The latest statement of policy is the 2012 White Paper and its accompanying draft bill, the key measures in which are:-
- A target of having all ongoing users of community-based, council-funded support on personal budgets by April 2013 – a measure announced in 2010 – and legislation to make personal budgets mandatory for all people with a care plan;
- Testing the extension of direct payments to residential care;
- Duties on councils to commission services that prevent, reduce or delay the need for care, backed up by a national care and support evidence library – with information on preventive interventions that have been found to work – and a pilot to test the use of social impact bonds to encourage investment in prevention.
The delivery and implementation of personalisation is being supported by the Think Local Act Personal Partnership, a coalition of sector bodies.
The Scottish government is also rolling out personalisation, through its 2010 self-directed support strategy and subsequent Self-Directed Support Bill, published in 2012. The bill would provide people with a right to a personal budget, but also the right to leave the management of their care and support to their local authority, who in turn would have to consult with them about decisions.
In Wales, personalisation is often referred to as citizen-directed support, signifying an approach that places less emphasis on service users purchasing support from a market and more on building strong communities within which people support each other. The Welsh government promoted this approach through its 2011 10-year social services strategy and 2012 draft Social Services (Wales) Bill. The bill includes plans to give Welsh ministers powers to extend direct payments, potentially into residential care and for the purchase of local authority services.
Community Care special reports