The Social Care Institute for Excellence explains the history and rationale behind the personalisation of services
ersonalisation is about thinking about public services and social care in an entirely different way – starting with the person rather than the service. What this actually means for the social care workforce has, so far, been somewhat open to interpretation.
The Social Care Institute for Excellence’s new report Personalisation: a rough guide, launched last week at the National Children and Adult Services Conference (NCAS) in Liverpool, tells the personalisation story so far. It explores what it is, where the idea came from and where it sits within wider public service reform.
Personalisation originates at least in part from social work values. Good social work practice has always involved putting the individual first values such as respect for the individual and self-determination have long been at the heart of social work.
The underlying philosophy of personalisation is familiar. The British Association of Social Workers states that social work is committed to the five basic values of human dignity and worth social justice service to humanity, integrity and competence.
In terms of public policy, personalisation is not just about social care but is a central feature of the government’s agenda for public sector reform. The prime minister’s strategy unit report Building on Progress: Public Services (2007) described it as “the process by which services are tailored to the needs and preferences of citizens. The overall vision is that the state should empower citizens to shape their own lives and the services they receive”.
Its application to adult social care was announced in Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care (2007) – a ground-breaking concordat between central government, local government and the social care sector.
This officially introduced the idea of a personalised adult social care system, where people will have maximum choice and control over the services they receive. It links to wider cross-government strategy including the notion of “place-shaping” and the local government white paper Strong and Prosperous Communities (2006).
The New Deal outlined in the 2008 Carers’ Strategy has integrated and personalised services at its heart. Carers want recognition of their work and expertise, better service coordination, better information, improved joint working between staff and agencies, health and social care. Like Putting People First, the Carers’ Strategy has been agreed by several government departments and was the result of a wide consultation.
Staying with public policy, personalisation can be seen as echoing many of the themes of the community care reforms that followed the National Health Service and Community Care Act of 1990. The aim of these changes was to develop a needs-led approach, in which new arrangements for assessment and care management would lead to individuals receiving tailored packages of care instead of standard, block-contracted services.
In practical terms, a major impetus behind the development of individual or personal budgets has been the success of direct payments, which initially became available to disabled adults of working age in England and have since been extended to other groups. This success has stimulated much of the thinking around individual and personal budgets. As of March 2007, 54,000 people (including parents caring for disabled children and young carers) used direct payments.
Significantly, direct payments came about and were championed by disabled people. The service user movement and the social model of disability have been powerful driving forces. Personalisation has some of its roots in the disability, mental health survivor and service user movements which emerged in 1970s, where people took direct action and lobbied for change.
Independent living, participation, control, choice and empowerment are key concepts for personalisation and they have their origins in the independent living movement and the social model of disability. The current personalisation policy has been influenced very strongly by the practical work of the InControl initiative, established as a social enterprise in 2003, which has pioneered the use of self-directed support and personal budgets as a way to reform the current social care system.
Examples of personalised approaches
Person-centred planning was an approach formally introduced in a 2001 for people with learning disabilities. The person-centred planning approach has similar aims and elements to personalisation, with a focus on supporting individuals to live as independently as possible, have choice and control over the services they use and to access both wider public and community services and employment and education. Rather than fitting people to services, services should fit the person.
Person-centred care has the same meaning as person-centred planning, but is more commonly used in the field of dementia care and services for older people.
Person-centred support is a term being used by some groups who use services to describe personalisation.
Independent living is one of the goals of personalisation. It does not mean living on your own or doing things alone, but rather it means “having choice and control over the assistance and/or equipment needed to go about your daily life having equal access to housing, transport and mobility, health, employment and education and training opportunities” (Office of Disability Issues 2008).
Self-directed support is a term that originated with the InControl project and relates to a variety of approaches to creating personalised social care. InControl sees self-directed support as the route to achieving independent living.
It says that the defining characteristics of self-directed support are:
● The support is controlled by the individual.
● The level of support is agreed in a fair, open and flexible way.
● Any additional help needed to plan, specify and find support should be provided by people who are as close to the individual as possible.
● The individual should control the financial resources for their support in a way they choose.
● All of the practices should be carried out in accordance with an agreed set of ethical principles.
Delivering personalised social care
Individual budgeting is a common approach (see box). Others include personal budgets and direct payments. A direct payment is a means-tested cash payment made in the place of regular social service provision to an individual who has been assessed as needing support. Following a financial assessment, those eligible can choose to take a direct payment and arrange for their own support. The money included in a direct payment only applies to social services.
Originally, the term personal budget only applied to social care funding but now it is used interchangeably with individual budget. It is the funding given to someone after they have been assessed which should meet their needs. They can have the money as a direct payment or can choose to manage it in different ways. What is important is that these budgets give people a transparent allocation of money and the right to choose how this is managed and spent.
Another term being used in discussions about personalisation is “co-production”. Co-production is a fairly recent term that is used as a new way of talking about direct participation and community involvement in social care services in the UK. It has also been called “co-creation” or “parallel-production”, and can be seen as a way of building social capital.
Research on co-production has shown that front-line workers should focus on people’s abilities rather than seeing them as problems and should have the right skills to do this. It has also said that developing staff confidence is very important.
Co-production should mean more power and resources being shared with people on the front line – service users, carers and front line workers – so they are empowered to co-produce their own solutions to the difficulties they are best placed to know about.
● Personalisation: a rough guide and Choice, control and individual budgets: emerging themes from www.scie.org.uk
● Expert guide to personalisation at www.commu nity care.co.uk/109083
● Social workers’ attitudes towards personalisation at www.communitycare.co.uk/109761
● See online version of this with links to referenced reports at www.communitycare.co.uk/prough
● Department of Health web home page for personalisation at www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/index.htm
● Putting People First at www.communitycare.co.uk/ppfdoc
Wwhat is an individual budget?
Individual budgets (IBs) are just one way of approaching personalisation, but they have been the focus of much of the conversation about personalising services.
Unlike direct payments, IBs, which have been piloted in 13 local authorities, set an overall budget for a range of services, not just from social care, from which the individual may choose to receive as cash or services or a mixture or both.
IBs combine resources from the different funding streams to which an assessed individual is entitled. Currently, these are:
● Local authority adult social care.
● Integrated community equipment services.
● Disabled Facilities Grants.
● Supporting People for housing-related support.
● Access to Work.
● Independent Living Fund.
The local authority is primarily responsible for ensuring an appropriate range of support is available for people who use services.
IBs aim to align assessments from the different funding streams, encourage self-assessment (where appropriate) and introduce transparent resource allocation systems (RAS), so people know what resources are included in their IB.
IB holders are encouraged to devise support plans to help them meet desired outcomes and they can purchase support from social services, the private sector, voluntary or community groups or families and friends.
Assistance with support planning may come from care managers, independent support planning/brokerage agencies, or family/friends.
IBs can be deployed in different ways:
● By the individual as a cash direct payment.
● By the care manager.
● By a trust.
● As an indirect payment to a third party.
● Held by a service provider.
what does personalisation imply?
Personalisation means starting with the individual. This person has strengths, preferences and aspirations as well as needs and a circle of family, friends and other resources and support mechanisms around them.
It introduces the requirement for greater personal responsibility and for individuals to draw on their own resources, as well as those available through statutory and other services, to meet their needs in the best possible way.
The individual is at the centre of the process of identifying their needs and making choices regarding their support and care.
In this way services are tailored and developed around the requirements of the individual instead of the individual having to fit in with the requirements of the service.
The traditional service-led approach has often meant that people have not received the right support for their circumstances or been able to help shape the kind of help they need.
All citizens should be able to access universal services such as transport, leisure and education facilities, housing, health services and opportunities for meaningful occupation.
Personalisation also means finding new collaborative ways of working and developing local partnerships, which produce a range of services for people to choose from
Finally carers need to be supported in their role, while enabling them to maintain a life beyond their caring responsibilities.