‘Don’t blame IT systems for bureaucracy in personalisation’

IT company Face's managing director, Dr Paul Clifford responds to the accusation that personalisation assessment process has led to more bureaucracy

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Face Recording and Measurement Systems was criticised in responses to Community Care and Unison’s annual personalisation survey for producing assessment tools that generated bureaucracy. In a response, the company’s managing director, Dr Paul Clifford, rebuts this accusation and argues that the causes of bureaucracy in personalisation lie elsewhere

[Who do you think is to blame for the bureaucracy in personalisation? Have your say on CareSpace.]

Personalisation has the potential to greatly enhance the quality of life of service users who access social care.

Yet despite an initial show of enthusiasm from social workers, managers, service users and carers, progress has been slow.

Why is this? It is all too easy to blame the difficulties on “bureaucracy” and “old ways of thinking”. In contrast, we at Face believe that many problems have been caused by personalisation’s strongest advocates. Rather than focusing on the desired outcome of increased choice and control for the service user, they have focused excessively on process – and it is this, ironically, that has proved to be the greatest obstacle to progress.

What is wrong with assessments?

Proponents of personalisation rightly criticise some assessment tools for being insufficiently outcomes-focused and for not giving sufficient weight to the views of the service user.

However, rather than proposing that assessment tools be re-designed to meet these requirements, they insisted that personalisation required the use of brief self-assessments.

This is in itself is problematic as brief self-assessments do not meet the legal requirements of community care assessments. So local authorities who adopted these brief self- assessments therefore introduced a second assessment system to run in parallel with their community care assessment process.

Furthermore, self-assessments were often so brief that they contained insufficient detail to enable support planning to be undertaken. Consequently, in-depth assessments had to be undertaken at the support planning stage. Instead of one assessment system, councils effectively found themselves with three.

The introduction of the term “supported” before the term “self-assessment”, belatedly acknowledged some of these difficulties, but there is no getting back those wasted years, and the problem of multiple assessment systems remain because few supported self-assessments are adequate for complex cases.

Perhaps the greatest irony of is that there is no hard evidence that service users prefer brief self-assessments. As part of our consultation process Face asked service users whether they would prefer a shorter or a longer assessment tool. They told us that they preferred assessments to be more specific to prevent councils making decisions about them with insufficient information.

Finally, there is the critical matter of quality. High-quality assessment remains the cornerstone of good practice. A recent Community Care article spoke dismissively of ‘standardised assessment forms’. Readers may be interested in the details of the Department of Health accreditation process for such forms.

This accreditation involved a panel of 17 stakeholders, including service user representatives, carer representatives, professionals and policymakers, who rated the extent to which the submitted assessment tool met 13 criteria for being ‘person-centred’. The Face assessment was rated excellent in meeting all criteria by each stakeholder.

More broadly, the reality of conducting high-quality assessments is that service users are often unsure of their own needs and will understate or overstate them, Also, partners and other carers have slightly different perceptions to the service user, and because needs are complex and fluctuating the best solution is not always obvious to anyone concerned.

We believe that a high-quality assessment that accurately captures the subtleties of complex needs and situations is critical to maximising the quality of life of the most vulnerable people in society.

Resource allocation

Personalisation can only survive if it can be implemented in a manner that controls costs, especially in the current financial climate. So an effective and well-designed resource allocation system needs to manage costs effectively while devolving control over direct expenditure to the service user.

Unfortunately, personalisation has been severely undermined by the use of over-simplistic methods of resource allocation. Evangelists proposed the completion of a simple co-produced self-assessment questionnaire which generated a personal budget based the number of points scored on each question.

There was no evidence base to suggest that this approach worked then nor that it was financially sustainable. Nor is there now.

Nevertheless, the seductive simplicity of the approach and an unthinking rejection of any alternative led most councils to spend huge amounts of time and money attempting to develop questionnaires that allocated money fairly using this approach.

Finance directors in charge of hundreds of millions of pounds of public money have been asked to ratify a system that was demonstrably failing. Not surprisingly many have refused to do so, resulting in many of these systems being dropped at the last minute.

Many councils have discovered that use of simplistic methods of assessment and resource allocation leads to overspending of social care budgets.

The result of an inaccurate RAS calculation is not just financial. If the RAS cannot be relied upon then councils are forced to control costs during the support planning stage and beyond. This undermines the outcomes focus of support planning and is hugely bureaucratic. Indeed, some councils have even had to re-introduce panels to review the multitude of cases where the RAS is inaccurate.

An alternative approach

In our view poor assessment and inaccurate allocation systems are in danger of derailing personalisation. So what is the alternative?

We believe that personalisation requires accurate assessment and a well-developed resource allocation system. Personalisation also needs to be part of routine processes such as community care assessment and working with health care partners.

Based upon these principles we have been working closely with 25 councils for over three years to develop methods of assessment and resource allocation system that work. The development work was completed in 2010 and the assessment and RAS have now been successfully rolled out across many councils

The assessment undertaken is proportionate to need. For simple cases a few brief questions may be sufficient; where needs are broader but still straightforward (the majority of cases) a brief holistic assessment is adequate.

Where cases are more complex a more detailed community care assessment is completed, perhaps even supplemented by specialist assessments where required.

This three-tier approach is not bureaucratic and can be conducted in a number of ways, including the use of supported self-assessment. If assessment tools are person-centred, meet the statutory duties of councils and the needs of healthcare partners working with the same service users, the result is a simple, efficient system that minimises burden on practitioners and service users alike.

These assessment are used to calculate the budget required, based on scientifically validated methods which also take account of local variations in economic conditions and policy. The result is that service users receive their budgets in a timely and straightforward manner; local processes are streamlined; and finance directors are satisfied that the approach is sustainable.

Furthermore, we are regularly contacted by service users and carer representatives who are calling on their councils to use Face assessments.

Conclusions

Sadly, the architects of much of the increased bureaucracy sometimes associated with personalisation have been personalisation’s strongest advocates. The dogmatic emphasis on a process of their own devising rather than on achieving the desired outcome has delayed implementation in many places by perhaps a couple of years and has led to widespread disillusionment and exhaustion.

This wasted effort could have been avoided had personalisation been allowed to develop in a manner that was open to creative solutions integrated with broader policy, rather than ignoring such niceties as the requirements of the Community Care Act and prudent financial governance.

Related articles

Community Care and Unison’s State of Personalisation report 2011

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