Personalisation has made lives more difficult for the people it is supposed to help while adding red tape to the process, writes social care consultant Andrew Tyson
Personalisation needs to be kept simple but the opposite is happening in practice. In our understandable desire to control budgets, we have added in particular to “front-end” assessment protocols and introduced more complex audit systems for direct payments users.
We have also sometimes greatly restricted the ways we allow people to use personal budgets and introduced burdensome systems to monitor and sign them off. This was never the intention, it is unnecessary, and it does not happen everywhere across the country.
Here is a short prescription drawing on the best local authority practice. To be clear: there are some new things that we need to invest in, but there are others we should stop doing.
● Stick to a straightforward, non-bureaucratic process. In Control’s original model had seven steps: my money (supported self-assessment and resource allocation); making my plan; getting my plan agreed; organising my money; organising my support; living life; and seeing how it worked (review).
This is complex enough. There must be structures in place to support people at each step – people need information, advice and assistance to make plans that are robust and safe; there need to be community organisations to organise money and support; there has to be a healthy and diverse provider “market” from which people can buy; we will always require skilled staff to provide extra help for some so that they stay safe and are guided through the system.
But we no longer need or can afford “parallel systems” (self-directed and pre-existing) or multiple assessment processes or overly complex regulation of providers.
● Keep the assessment process simple. Ask what you really need to find out from people through this process. We use the term supported self-assessment because self-directed support is based on the premise that most people know what they want and need, but most also require assistance from family, friends, peers or indeed from professionals to think this through. Most will also need help at a later stage in the process to shape these ideas into a viable support plan.
The best supported self-assessment protocols are short, have a clearly defined transparent purpose and are written in plain English. Good assessments tend to be supported by the availability of wider public information, including leaflets and online information. So, by the time the service user speaks to an assessor or completes a self-assessment form, they already have a good idea about what is feasible.
● Invest in user-led organisations and the third sector. One of the early misapprehensions about self-directed support was that it was a system that handed over the money and left people to their own devices. Nothing could be further from the truth.
There is now increasing evidence – for example from the recent Office for Disability Issues support planning and brokerage demonstration project in Essex, Richmond and Southampton – that investment in user-led organisations is a critical part of the self-direction jigsaw. The report of this project shows that, for the most part people trust their fellow users to provide them with sound advice. Good user-led organisations are flexible and naturally ‘person-centred’ and these organisations know – without being told – that different approaches are needed for people with different impairments and in different circumstances.
● Avoid restricting what people can buy with their personal budgets. Of course, personal budgets should not be available to people to make any purchase that breaks the law – illegal drugs for example – or which is harmful to their health or well-being.
But the issue of over-restriction is a key concern for the viability of personal budgets. One reason that they have been cost-effective in many places where there are few restrictions is that they enable people to be imaginative, to make a little go a long way, to buy a friend a meal occasionally rather than rely on paid support for everything; or to purchase a piece of daily living equipment online rather than through the local authority’s approved supplier.
There are important checks and balances built into the seven-step process. Most important is the scrutiny and sign-off of the support plan. The key question in this is whether this a realistic plan to deliver agreed outcomes. If the answer is yes, then the purchases the plan entails should not be questioned.
● Talk, learn, review. Don’t cut corners on the review process. In Control has long argued that the review stage is vital. If this is given due weight and done well, many of the anxieties that are expressed about “handing over public money” or “exposing people to risk” fade.
This is the point where interpersonal skills, not least professional social work skills, come into their own: the best reviews are ongoing conversations – not one-off meetings and certainly not paper exercises – between a representative of the funding authority and the individual: are things working, what are we learning, what needs to change?
Many argue that local authorities no longer have the resources for this kind of protracted exchange. As with everything else in this prescription, the formula needs to be leavened with a degree of common sense: some cases are complex and need more oversight and discussion than others.
But it was ever thus: the difference now is that self-directed support has roots in a model which, in essence, proposes that we trust the people who use our services – and this approach brings plenty of opportunity to slaughter some of the sacred cows from the old system.
Just don’t dispense with relationships: after all, if social care isn’t about people, what is it about?
Andrew Tyson is a registered social worker, consultant and former policy lead at In Control
What do you think? Join the debate on CareSpace
Keep up to date with the latest developments in social care Sign up to our daily and weekly emails