Recently in Personalisation Category

This video may cheer you up if you have a spare few minutes - it collects some short clips of carers, parents of disabled children and service users talking about things they have achieved in their communities off the back of In Control Partners in Policymaking courses. These provide training in support planning, influencing policy and organising support groups for users and carers locally, among other things.

On Friday, The College of Social Work held a summit on the future of adult social work attended by senior managers, civil servants, academics, social work representatives, users and frontline practitioners.

There was a remarkable degree of consensus about what needed to happen: practitioners needed to be liberated from bureaucracy, rationing and risk aversion to exercise professional judgement to better support service users.

But there was less clarity about how we should get to this point.

No Munro review for adult social work

Children's social work has had its own inquiry - the Munro review - to address the self-same issues of bureaucracy and the erosion of professional judgement. But no such review is in the pipeline for adult social work.

The College is keen to influence the forthcoming White Paper on adult social care in a more social work-friendly direction. And the signs on this front are good.

Care services minister Paul Burstow said last week that social work would be at the heart of the paper, with an emphasis on community development, not care management. His message was echoed at Friday's summit by DH official Glen Mason but there was no more detail on what the White Paper would say.

No reserved tasks for social workers

Indeed, Mason was clearer on what the White Paper would not say: that there would be no legislation to establish specific roles and tasks that only social workers can do. This was in response to one summit attendee who felt that such provisions would help carve out a status for adult social work, drawing on the experience of statutory child protection work in raising status.

This means that, whatever the White Paper says about social work, it will be up to individual organisations - particularly local authorities - to put this into practice.
Mason said he felt that most directors of adult social services understood the importance of social work.

However, some in the audience did not share his optimism, particularly in relation to directors who did not have a social work background.

(Image from Rex Features)

Two blog posts about personalisation have caught my eye this week.

Former head of In Control Simon Duffy (left) - one of the pioneers of self-directed support in the UK - has written a piece about where things have gone wrong with personalisation, under the arresting title: "Is personalisation dead?".

The essential narrative was that we had an ambitious, challenging movement for full citizenship for disabled people through giving them control over their lives, including their care and support; this was captured by government, turned into a policy programme ("personalisation"), subverted and reduced to bureaucracy and renewed control from the state over disabled people's lives.

It's a powerful critique of how government has subverted what it sought to champion in the way it made personalisation official policy, though one Duffy and others have made before.
What is particularly fascinating is an anecdote he recounts about an encounter with a civil servant during Ivan Lewis's reign as care services minister in 2008:

Whilst sitting outside [Lewis's] office one of the senior civil servants rushed into the room to insist that I did not describe 'Individual Budgets' as entitlements. I was told the government were against 'entitlements' and that this was not how the idea was to be understood. Shortly afterwards we were ushered into Ivan Lewis' office and Ivan began the meeting: "So let me get this straight - the basic idea is that people are told their entitlement up-front and then supported to spend it how they wish..." I smiled, "Yes, that's right Minister..."

Duffy's point is that Lewis's vision of entitlement lost out to the nameless civil servant's - hence older and disabled people are either ineligible for personal budgets or restricted in the way they use them, particularly because, their entitlements, under adult social care law, are to services, not resources.

He says that it is only through entitlement to resources that the vision can be recaptured. Duffy's current venture - the Centre for Welfare Reform - is doing a lot of practical work in this direction, which we have featured. I guess the message is don't expect this sort of drive to come from government.

Another person giving a lot of thought to personalisation's present and future - though not its past - is Martin Routledge, a former DH civil servant now at In Control and a leading light in sector coalition Think Local Act Personal, whose job it is to make personalisation work.

One of the biggest topics in this area at the moment is making personalisation work for hitherto excluded groups: people who lack capacity, many people with mental health problems, those with dementia and people who challenge services or have particularly complex needs.

Routledge is honest enough about the challenges - how professionals deal with cuts, question marks over individuals' capacity, a lack of supportive families, crisis situations - but is optimistic that there are solutions, individual service funds (ISFs) for one, in which providers manage a budget with a service user. This has been tested in residential care by the provider Dimensions, with positive results, and Routledge says he is working on testing ISFs with home care providers.

I'll be interested to see what comes out of this work as making personalisation work for these groups is one of the biggest issues for Community Care readers.

Routledge is also very supportive of the point of Duffy's article (of essentially giving people an entitlement to resources, which they are then free to use without controls) and is pushing councils to make progress on this area. So perhaps personalisation's future can recapture some of its past.

Bit of a news round-up this morning rather than one of my lengthy rambles:

Adult social care funding

The government has been urged to implement the Dilnot commission's proposals on care funding reform by chiefs of 41 councils across the South and Midlands, amid ongoing concerns that it won't, reports The Daily Telegraph.

Meanwhile, the Local Government Association has awarded £1m to 50 councils in a bid to generate £50m in efficiency savings in adult social care. Under its adult social care efficiency programme, the authorities will be supported to implement measures that have been proven to release savings.

Sacked sheltered housing manager

A sheltered housing manager - sacked for breaching moving and handling policies when helping an incontinent resident on to a commode so she could wash her - is seeking to appeal against a tribunal decision that she was not unfairly dismissed, reports The Evening Standard. More than 3,400 have signed a petition in support of Sue Angold.

Direct payments, fraud and abuse

This Guardian article on the risk of financial abuse and fraud from personal budgets and direct payments (and this related one about how poor direct payment monitoring was identified in a serious case review of a service user's murder by his son)  is generating quite a lot of chatter. Top social work blogger Ermintrude2 has done a strong blog post on this topic today, arguing that it is wrong to link risk and abuse to any particular method of delivering social care (i.e. personal budgets) and there is no evidence to suggest that personalised methods of delivery are more risky.

Carers charities merge

The Princess Royal Trust for Carers and Crossroads Care are to merge in April. The charities - two main providers of services for carers - have long worked closely together and, in the current climate, the merger is no surprise. Princess Anne - president of the trust - will be president of the new, as yet unnamed, charity.

An interesting looking paper from the National Development Team for Inclusion argues that current plans to introduce payment by results for mental health services risks undermining personalisation for the group.
It suggests some ways in which the two policies can be made compatible and mutually supportive.
The NTDi has also launched a discussion forum on the issue.

In Control is looking for people to share their experiences of what works in terms of implementing personal budgets for a piece of work it is preparing.

Besides the funding gap, this is perhaps the most important issue in adult social care (in England at least) at the moment so it would be worth having your say, particularly given In Control's wider influence in this area as pioneers of personal budgets and a core member of Think Local Act Personal (the sector-wide coalition to aid implementation).

Email your thoughts to andrew.tyson@in-control.org.uk and martin.routledge@in-control.org.uk

Findings of fault with councils' provision of information and advice on care are nothing new (for example) but charity Independent Age thought it worth highlighting unpublished research from the CQC into authorities' failing in this area.

The 2010 study involved 7,500 mystery shopping calls to assess the quality of information and advice given by English councils. The reason it was left on the shelf (with the exception of a reference to the high-level findings in CQC's state of care report for 2009-10 - see page 46) was because of the government's decision to end CQC's role in assessing councils' adult social care functions in November 2010.

However, explaining her decision to commission a report on the research, Independent Age chief executive Janet Morrison said: We commissioned this report because we felt it would be an appalling waste NOT to do anything with research that took the Care Quality Commission (CQC) nearly a year to undertake and involved around 7,500 detailed mystery shopping calls."

The findings are that:-

• Only five of the 150 councils were rated as good or excellent in exploring users' needs at first contact.
• Only 30 out of 150 were rated good or excellent when it came to asking about needs before financial circumstances.
• Only eight out of 150 were good or excellent at providing information to allow a caller to follow up on initial advice
  

This begs several questions, the two most compelling of which are, what has happened to council provision of information and advice since this research was undertaken; and, perhaps more importantly, what pressure/scrutiny has been brought to bear on them to do so in the absence of the CQC?

Assessment of local authority adult social care functions is now the responsibility of the sector as a whole, through an Excellence Board for adult social care that includes the great and the good (Association of Directors of Adult Social Services, Local Government Group people).

It may well be that sector-led improvement is having a more positive effect than CQC-led scrutiny. However, one consequence of the change, is a loss of transparency that makes it very difficult to work out whether or now and how far councils are improving.

Personalisation pioneer Simon Duffy (formerly head of In Control, now boss of think-tank the Centre for Welfare Reform) has just published a paper on what other countries can learn from England's experience of implementing self-directed support. It seems particularly pertinent for Scotland as it seeks to roll out the approach.

His key message appears to be one of early promise and enthusiasm not being delivered upon, mainly because of personalisation being captured by central government from disabled people and local practitioners. This resulted in the ambition of giving disabled people genuine citizenship (how Duffy has always characterised personalisation) being converted into targets and processes (that were simply layered on top of other processes in the social care system) that in many cases delivered nominal self-directed support without real control for people.

Worth a read if you have time.

One of the central conundrums of personalisation is how people with personal budgets can make judgements about the calibre of unregulated services that they might wish to purchase.
One solution is the Support with Confidence scheme, which accredits providers of support services to help users make more informed choices. It is delivered by councils who have signed up to the scheme, through partnerships of adult social care and trading standards departments.

Accredited organisations must:-
• ensure that they and their staff are properly trained for their work.
• undertake any appropriate training.
• submit criminal records checks and clearance.
• provide references as part of their application.
• respond promptly and appropriately to customer complaints.

Organisations are then monitored by the council in question.

It also, importantly, applies to personal assistants - perhaps the fastest growing part of the social care provider market but one that is entirely unregulated. Providers regulated by the Care Quality Commission can also apply.

There are obvious issues, of course, notably that first your local council has to sign up to Support With Confidence and then convince local providers of support that it is worth their while going through the accreditation process.
But it seems potentially a useful solution to the issue of judging quality in a personalised world.