Personalisation is the headline topic for adult social care but, according to our exclusive survey, frontline social workers do not feel ready to deliver the new agenda. Andrew Mickel reports
Community Care’s exclusive survey has found that social workers are divided equally on whether the personalisation agenda is the right direction for social care. Only 11% of the 600 social workers who responded view the plan to extend personalisation to all users as appropriate. The figure rises to only 14% for those working for local authorities. A massive 96% of local authority staff fear it risks making users more vulnerable.
These findings show profound suspicion among the workforce about the personalisation agenda, but how we interpret them depends on one question. What do we mean by personalisation?
There are many terms surrounding personalisation but it seems little clarity about what some of them mean. While half of our respondents (and 70% of local authority staff) feel well-informed about direct payments, only 22% can say the same about individual budgets and 19% about self-directed support.
Jill Manthorpe, director of the social care workforce research unit at Kings College London, points out there is much more to personalisation than that.
“It’s interesting why certain elements are talked about much more than others,” she says. “Only part of personalisation involves this notion of personal budgets. There are several streams, including reducing loneliness and isolation, increasing inter-generational activity, investing in community services and giving more personal control.”
But Gary FitzGerald, chief executive of Action on Elder Abuse, claims that government only cares about the self-directed support side of personalisation. “Unless there is the framework around that which includes active advocacy and a safeguarding agenda, then cash for care is dangerous, and that’s almost exclusively what the government is pushing,” he says.
“They are taking the perspective of adult physical disability and applying it without any consideration across the board to people who are in highly vulnerable situations. If they were being selective and discerning about the approach, they wouldn’t be getting this extremely cautious reaction from social workers in your survey or us.”
FitzGerald says he doesn’t know of any local authorities that have managed to do more than work with the narrow definition of personalisation.
It is therefore of little surprise that our survey shows two-thirds of social workers view its implementation for all people, regardless of level of need, as inappropriate.
Concerns over the safety of clients explain why 69% of social workers want regulation of all service providers regardless of size. And 93% say that individuals hired by personal budget and direct payment users should be subject to mandatory regulatory checks. But that high figure represents the tip of the iceberg of interest in improving oversight of these new staff.
Lorraine Frisby is a personal assistant in Birmingham. While her employer, Sam, is both an old friend and a director at the city’s Centre for Independent Living, she worries that there aren’t standard checks to protect less competent users from unscrupulous PAs.
“From what I can see, there are none. I work for Sam and get paid through a trust, but I’ve never met anyone there. It’s left to Sam to hire and fire. There should be someone to answer to,” she says.
Future shape of workforce
The survey throws up other interesting expectations about the future shape of the workforce. Just over half of the respondents think there are going to be fewer social workers, but only 17% think that will be the case on their own team. This seemingly contradictory result means that either the workforce hasn’t faced up to the reality of losing jobs, or staff don’t really believe there will be redundancies.
But Tim, a social worker in an older adults care team, says that “personalisation is turning into the monster I thought it would be”.
“It’s a great idea if it can be made to work, but disastrous for us as a profession,” he says. “Assessments are being taken away from us, care planning is going to care brokers. It’s a lot like hand-building a car: at the moment we do everything, but it’s being turned into a conveyor belt where we do one bit of the job.
“At a professional level it’s the beginning of the end of social work, because ultimately many will be surplus to requirements.”
Survey respondents are clear that they will need significant training for the personalisation agenda to succeed. This is especially strong among local authority respondents where 77% thought they would need to know about employing personal assistants, how to deal with failed arrangements (89%), and about private sector care options (85%).
Manthorpe says that training will help win people over. “Quite rightly, social workers have realised that change shouldn’t be just a matter of rhetoric, but needs to be applied in day-to-day practice. Almost all social workers feel confident about their knowledge around direct payments it shows how well the ethos, the training and the experiences have touched absolutely everybody.”
The survey suggests that Manthorpe is right. While respondents were split about the direction of personalisation, 76% thought it important enough that they would take into account how ready an employer was when considering a job. That is not the sign of a workforce turning its back on personalisation.
But there is clearly a keen interest for some clarity as to what it is ultimately going to entail. FitzGerald says that it shouldn’t be left to government alone to decide its direction. “Local authorities and charities such as mine have to wrestle back the agenda of personalisation. We’ve got to be much clearer about saying it is about choice and control. That may include cash for care, but that shouldn’t be a blanket introduction across the board.”
Case study: ‘Freedom of choice is frightening for some’
Fenella Lemonsky: direct payments user
Mental health service user Fenella Lemonsky has a personality disorder and receives direct payments, which she uses to pay for a personal trainer. While this suits her, she is aware it isn’t a model that would suit everyone.
“There are groups of people,” she says, “who still need a statutory service that is managed by a local authority rather than being given a lump of money and being told to arrange their own.
“More mental health resources are being cut and while it might sound great that they’re not having an ‘institutional’ lunch, for some, the alternative of being given some money and told ‘you can go for lunch wherever you want’ is a frightening thought.
“Many people have a sense of safety about knowing they are going somewhere where they can be themselves and won’t be stared at.”
Personalisation: essential web links
Links to other top experts’ views:Andrew Cozens on why current concepts of personalisation do not go far enough