Some social care staff struggle to deliver person-centred care. But a report from the Joseph Rowntree Foundation offers advice on how many of the perceived barriers can be overcome with the right attitude and commitment
I don’t know how to start
Start by thinking how you would like to be treated and respected if you were a service user. Listen to each individual service user. You don’t have to stop being you and you don’t have to do the same thing with each person.
The people I work with like their service as it is
It can be difficult for all of us, at times, to accept when changes need to be made. But service users may well appear to like their service if they have no information about what else might be available, or how things work in other services and organisations or if they have not met other service users who might be living more independently.
It can also be difficult for service users, who depend on the support offered by staff, to say to those same staff that they do not like the service they get.
You need to keep on presenting options and supporting service users to explore alternatives and meet people who have made different choices. You can also support service users to join organisations led by their peers.
The people I work with can’t make choices
One of the really important values underpinning person-centred working is an understanding that everyone has the right to make choices and have their preferences respected, even if others make decisions on their behalf. This is a legal requirement under the Mental Capacity Act 2005.
Some people may need more support and information than others to make those choices and may need people on their side to represent those choices to decision-makers in services. The act contains clear procedures about what should happen if someone cannot make a particular choice for themselves.
The people/families/communities I work with don’t want people to be in control of their service
There are often a range of viewpoints about the choices a service user makes about their life. Some families feel very protective of their family member, some have bad experiences of being left to pick up the pieces when services fail or withdraw. Family members don’t always agree among themselves about someone’s service and there can be many vested interests and differences of opinion. This is a tricky area to negotiate.
Your job must be to support the individual service user and take a lead from them about how they want their family involved, or not, in their service.
It’s one more initiative and I don’t have the time
A person-centred approach is not about learning a set of procedures and approaches that include a lot of bureaucracy. Person-centred working is about the way you approach the service users with whom you are working. It has a clear values base including recognising people’s rights to equality and inclusion in our society and an understanding of the support they may need to achieve this. Training and resources can help but person-centred working can happen without anything more than a service user and a practitioner spending time together.
We’re not allowed to be flexible and help people take risks
Organisations can be hyper-sensitive about “risk”, enforcing over-the-top risk assessments and procedures that limit service users’ rights to choice and control. Find out more about the government’s personalisation agenda. This recognises that risk is a part of people’s lives. Also make sure you know how the Mental Capacity Act supports people’s right to make choices, even if others think these are unwise.
There’s not much choice around here
It may be helpful to support service users in taking small choices in the beginning. Perhaps your service does seem very set in its ways, but it is possible to start working with service users to think about choices they can make in their daily lives and supporting them to do some things differently. It may be as simple as what they want to wear in the morning or when they want their next cup of tea. The personalisation agenda now enables people to have more control over the money allocated to their support so they can design their own provision, if there is nothing they like locally.
Some service users are getting together to pool their money to set up new provision to meet their needs in the way they want.
I haven’t had any training about how to do it
All practitioners have a right to training. The government has set standards for the registration and inspection of social care services, which include the training and supervision of social care workers. However, person-centred working is not just about training but about an approach that is based on clear values of inclusion, respect, independence and personal choice. It is not just about learning a set of techniques. Don’t wait for the training course to start doing it.
I would like to do it but my managers won’t support me
Even if you are not given more time or resources, you can treat people as individuals, respect their rights and communicate well. You also have legal and moral duties to challenge bad practice in your organisation.
You can make sure you know about people rights, so that you can pass the information on and challenge when you see people’s rights being ignored or abused. Find out about local and national organisations led by disabled people and/or service users and help service users to network with others. Join with staff networks, coalitions and/or unions to work together for better services.
I don’t have the right information to advise people
There are ways of getting that information. You can find out about local services and organisations from your local authority or council for voluntary service.
You can search on the internet for a lot of information. You can join – or encourage the people you work with to join – national networks like Shaping Our Lives and People First.
My organisation is not person-centred
The service users we spoke to talked about how much they valued the practitioners who were prepared to treat them as individuals and to respect their ability to make choices and decisions.
It is possible to change your own attitudes and approach even if it does not reflect that of the organisation you work for.
I feel like I’m the only one who is person-centred
Be the only one and be proud of it! Then join with others, network, and make links with people in other services or areas. Find allies at all levels, in all ways and find ways to change things. Become a good source of information, a good networker. Don’t give up. There are lots of you out there
You can make a difference!
This is an extract from Person-centred support: a guide to person-centred working for practitioners, published by the Standards We Expect Project, funded by the Joseph Rowntree Foundation. The project has also produced a number of other reports.
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