In 2008, care provider Dimensions decided to transform itself in line with the personalisation agenda. It has now recounted its journey in a book. Natalie Valios reports
Making it Personal, a book charting learning disability provider Dimensions’ journey from traditional care to personalisation, contains the following frank admission:
“Most of the people we support do not live on their own and have neither had an opportunity to choose who they live with, nor who provides them with support. The sort of world we are moving towards is one where people who are supported by a provider will expect to have choice about these most fundamental aspects of their lives. This is a long way from where we started out and, to be honest, is still some way from where we are.”
With the emergence of the government’s agenda to personalise care in 2007, it was clear life was going to become different for people needing support, and therefore for providers, says Dimensions’ executive director, Steve Scown, who wrote the book.
“It wasn’t necessarily about what was wrong [with our services], but more a case of what wouldn’t be right,” he says. “[In the future] people would have far greater choice and control and, on the whole, that would mean they wouldn’t choose what we were providing.”
Dimensions supports about 2,500 people with a learning disability or autism in their own homes, shared living or residential care.
For Scown, personalisation would entail seeing service users and their families as Dimensions’ customers, not council commissioners – at least for people in their own homes who can access personal budgets.
He called in Helen Sanderson of Helen Sanderson Associates, which provides training and consultancy on person-centred thinking and planning.
Scown gathered a group of Dimensions’ heads of business services and senior operational colleagues together and Sanderson brought the story of Jennie – a woman with autism with whom she works closely – to the meetings to help them identify what would need to change if Dimensions was to provide her with the services she wanted.
It was an eye-opener. “Having a real life example showed what would need to change,” says Scown. “We realised that what we could offer wouldn’t be what Jennie would want.”
The problem was that most of Dimensions’ services were commissioned through council block contracts which didn’t allow for individual support packages. For most people served by Dimensions, all elements of their support were “bundled” together into a package delivered by the same team, preventing them exercising choice over their care.
“It meant looking at how they could design a service based on someone’s person-centred plan using money from their personal budget,” says Sanderson. “Dimensions doesn’t have a lot of experience in doing costed support plans, so they had to learn how to marry the money and the plan.”
Jennie’s story led to a major change: the offer of a personalised menu of support to people, rather than a “bundled” package.
Dimensions now offers three categories of support that people could purchase with a budget: a one-off service, such as an assistive technology assessment; fixed-term support with an agreed end date or outcome, such as short breaks; and continuing support, such as personal care.
It became clear that families would prefer contact with one person to discuss options, co-design the support package, agree the contract and price and set up the package. For this, the support adviser role was created; two are in post, with two more starting soon.
When Scown was explaining to someone who didn’t work in social care what they were doing she described it as “changing from wholesale to bespoke retail” and that, he says, sums it up. “We’re going from a business-to-business model to a business-to-customer model, because what a local authority is looking for is very different from what a customer is looking for.”
The challenge ahead is changing services for those in traditional residential care services. Scown says: “How will we really enable someone who lives with four other people to choose who supports them? How do we shift the power and control? We don’t have the answer yet.”
Making It Personal points out that personalising residential services will require working with local authorities, because they, not individuals and their families, remain the purchasers.
For now, Scown feels it is too early to say how the changes have affected Dimensions’ relationship with its own staff, the people it supports and commissioners. But what he can say is “we are seeing people with a greater degree of control, achieving better outcomes and who are happier. And that can’t be bad”.
Published in Community Care 6 May 2010 under headline ‘New Dimensions’
Points for providers
● Thinking from a customer’s perspective is essential.
● Meeting the expectations of an individual with a personal budget requires the whole organisation to change.
● Ensure that leaders are actively involved so they can drive change and energise staff.
● Communicate early, clearly and with graphics to get the message across to staff and managers.