Personalisation

Expert Guide to Personalisation

Personalisation is a social care approach described by the Department of Health as meaning that “every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings.”

Its overall aim is for social care service users to have control over how money allocated to their care is spent. It includes within its remit direct payments, individual budgets, personal budgets, user-led services, self-directed support and the In Control pilots. Self-assessment will also be a cornerstone of personalisation. Giving service users the opportunity to assess their own care and support needs and decide how their individual budgets are spent are central planks of the agenda. 

Latest articles on personalisation

As the personalisation agenda advances, the role of advocacy and support brokerage will be of increasing importance. If personalisation is to achieve its core aims, it will be essential that those accessing individual budgets can refer to sources of advice and support. Councils will also have to strike the right balance between giving people the freedom to choose their own care and protecting clients and their budgets from abuse.

For all these reasons personalisation is considered a major cultural shift for social workers. Many care managers are likely to find that their jobs change significantly under personalisation as more emphasis is put on self-assessment by users, who then buy in their own services with support from a new breed of "brokers".

There are significant concerns about whether personalisation will lead to a reduction in the number of adult social workers in post by 2011.

This view was held by 58% of adult social workers who responded to an exclusive Community Care poll in October 2008.

A number of councils have transferred care management functions, at least for service users with lower level needs, from social workers to non-qualified staff, including the Wirral, Devon and Thurrock. This has left social workers managing more complex cases, handling safeguarding issues and checking the quality of support plans drawn up with users by other staff.

And as the first year of the Putting People First programme drew to a close, in March 2009, significant questions were being asked about the future of adult social work.

In March 2009, British Association of Social Workers professional officer Ruth Cartwright warned that some councils thought social workers were "too expensive" for the personalisation era and were cutting or freezing posts.

She warned the Social Work Taskforce, set up in January 2009 to examine the long-term future of the profession, was the "last chance to save adult social work" in some areas, however this was rejected as "scaremongering" by the Association of Directors of Adult Social Services.

At the very least, social workers were after more information and training on personalisation. An exclusive poll of 400 council social workers and managers by Community Care, the Department of Health and the Social Care Institute for Excellence in February 2009 found 46% felt their personalisation training needs had not been met and 56% felt there was insufficient guidance.

Opportunity not threat

But social care consultant Melanie Henwood has argued that this is an opportunity rather than a threat for social work. "This is a real chance for social workers, not the beginning of the end. It marks a new phase going back to casework with families rather than being gatekeepers rationing resources."

Not everybody is convinced. Ray Jones (right), a former social services director, is among the doubters. He told Community Care in June 2008: "I'm concerned that personalisation could be under-funded. The social care funding issue has been kicked into the long grass - we were promised a green paper this year now there's a consultation about a consultation and the resulting legislation is likely to fall foul of the general election. And if it means raising taxes to pay for social care, which political party is going to do that?"

Jones also raised concerned that disability-related social security benefits, received as of right by those who meet the criteria, could be transferred to the new system. "This would be to move from a rights-based system to a discretionary system of funding where the council decides whether it can afford to pay," Jones says. "We need a rights-based national system for deciding on individual budget payments, leaving councils responsible for things like advocacy."

What is certain is that personalisation will only work if eligibility thresholds for services are lower than they are now. Henwood has said: "It would be very regrettable if gatekeeping remained paramount because eligibility criteria are so tight. We mustn't raise people's expectations and then say personalisation doesn't apply because they don't qualify."

If the resources are in place, assessments and support plans will focus on quality of life rather than on tasks that users need to have done for them. Annual reviews of each service user on an individual budget, to monitor progress towards outcome targets, will ensure public money has been well spent, although headlines in the Daily Mail about alleged misuse of funds are inevitable.

The government's personalisation vision is set out in the 2007 Putting People First report.While the government has said it is fully committed to taking the agenda forward some social care workers and union representatives have raised fears over its effect on service users and staff terms and conditions.

In May 2008, speaking at a Community Care conference, the government personalisation programme manager Martin Routledge summed up personalisation as offering people "practical ways to live their lives rather than receive a service." He said it would move social care away from the "us and them" mentality of workers and service users.

Speaking to Community Care in July 2008, the then care services minister Ivan Lewis (right) said councils could lose their adult care commissioning role if they did not deliver on the personalisation agenda from 2008-11. By 2011, the Department of Health wants all publicly-funded users to have personal budgets, except in emergencies.

To help the process along, the government appointed Jeff Jerome as its first personalisation "tsar". He told Community Care in June 2008:

"We need to work out where the social work role is essential and where it's not. What personalisation is about is allowing users to have a slice of the public sector budget without always having to stay heavily involved with care managers and social workers if they don't want to. What social workers need to do is focus on those people who need large amounts of support."

But the government may have its work cut out in selling personalisation to the social care sector. The exclusive Community Care poll in October 2008 found social workers were evenly split as to whether personalisation was the right way forward. Only one in ten social workers felt it was appropriate to extend personalisation to all service users.

Focus on individual and personal budgets

It seems likely that differences remain in different people's understanding of personalisation. Jill Manthorpe, director of the social care workforce research unit at Kings College London, points out that personalisation is more than just individual budgets.

"It's interesting why certain elements are talked about much more than others," she says. "Only part of personalisation involves this notion of personal budgets. There are several streams, including reducing loneliness and isolation, increasing inter-generational activity, investing in community services and giving more personal control."

But Gary FitzGerald (right), chief executive of Action on Elder Abuse, claims that government only cares about the self-directed support side of personalisation. "Unless there is the framework around that which includes active advocacy and a safeguarding agenda, then cash for care is dangerous, and that's almost exclusively what the government is pushing," he says.

"They are taking the perspective of adult physical disability and applying it without any consideration across the board to people who are in highly vulnerable situations. If they were being selective and discerning about the approach, they wouldn't be getting this extremely cautious reaction from social workers in your survey or us."

Video: What will personalisation mean for social workers?

Direct payments, personal budgets and individual budgets

While personalisation encompasses much more than direct payments, personal budget and individual budgets, they are a central part of the agenda.

Direct payments are cash payments given to service users in lieu of community care services they have been assessed as needing, and are intended to give users greater choice in their care. The payment must be sufficient to enable the service user to purchase services to meet their needs, and must be spent on services that users need.

Like commissioned care, they are means-tested so assume that, in many cases, people will contribute to the cost of their care.

Direct payments confer responsibilities on recipients to employ people or commission services for themselves. They take on all the responsibilities of an employer, such as payroll, meeting minimum wage and other legislative requirements and establishing contracts of employment.

Some of these services can be contracted out and many councils have commissioned support organisations to help service users handle these responsibilities.

Personal budgets are an allocation of funding given to users after an assessment which should be sufficient to meet their assessed needs. Users can either take their personal budget as a direct payment, or - while still choosing how their care needs are met and by whom - leave councils with the responsibility to commission the services. Or they can take have some combination of the two.

As a result, they provide a potentially good option for people who do not want to take on the responsibilities of a direct payment.

Individual budgets differ from personal budgets in covering a multitude of funding streams, besides adult social care: Supporting People, Disabled Facilities Grant, Independent Living Funds, Access to Work and community equipment services.

The government has only called for the roll-out of personal budgets - not individual budgets. The latter were piloted in 13 areas until the end of last year and an evaluation on the pilots is due out this summer.

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Social Care Institute for Excellence progress report on personal budgets

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