I recently came across a powerful story about a young woman - Joanne - who has autism. She lived independently in a supported living flat, but began having major mental health episodes when a new tenant moved in upstairs and played loud music around the clock. The situation deteriorated and led to police visits, threats of suicide and finally, psychiatric treatment in hospital.  It was there Joanne was asked by the psychiatrist "what she dreamed of" to which she replied "to live somewhere quiet". 

I have noticed an unexpected outcome and I can't find the box I need to tick..........I noticed this 'outcome' gradually..... It sort of crept up on me, quietly; with no fanfare it slowly became more and more noticeable. Not just to me either. Others had noticed it too. Even though their children were all at different life stages, all doing different things, this 'outcome' had shown up in their lives as well.

The introduction of Self-Directed Support and Personal Budgets means that social care providers will need to make changes to their businesses as individuals begin to take control of their lives. Cambridgeshire County Council's programme of provider workshops has been described as "inspirational" and the online support materials as "comprehensive" and "just what's needed". How did this come about?

 

It can feel that personalisation is only ever discussed within the social care sector. So it was heartening to come across this blog from Matthew Taylor, chief exectuive of the influential  Royal Society for the Arts, Manufactures and Commerce, talking hopefully about this part of the transformation agenda.

The RSA is very concerned about developments in society but, still, it is encouraging that organisations like this are bringing the debate out of our ghetto

There I was sitting on the decking, cracking open a drink and watching three very nice chaps working down the bottom of the garden building a log cabin. Okay, it was damn windy, I had a cup of tea in my hand, they were in padded jackets and not stripped to the waist glistening in the sunlight, but it was as close to a "Pepsi moment" as I was going to get and despite the fact that it had begun spitting I wasn't going in for anything!!

Earlier this year I was commissioned by the Putting People First Team to find out some of the best ways to develop support plans with people who use mental health services.  One of the inspiring stories I heard was Kevin's: a man who loves the great outdoors, but who for 17 years also experienced major episodes of paranoia and was diagnosed with schizo-affective disorder.  This obviously had a big impact on his working life, leading to cycles of joblessness, homelessness and hospital stays. He would make a full recovery and return to work, but things would spiral, either from something going wrong in his job or stress in his personal life, and the cycle would start again.

With all the 'talk, hype, white papers, green papers, pink papers with blue spots' (I jest!)' basically words:- purpose, mission, objectives, political spouting and one-upmanship what does this 'Total Transformation; Putting People First, In Control, Right to Control etc etc process actually mean for those living through these ever changing times? It doesn't matter what the 'system' is called when you are 'living it', it matters, that it works for you.

By Kaarina Elisabeth

Personalisation, I am in no doubt, would transform the lives of mental health service users and lead to better outcomes. Before I'd even heard of self-directed-support, I was lobbying for it. Why, I wondered, does nobody listen to my own assessment of my needs? There is one reason that appears to preoccupy the minds of everyone I've met involved in commissioning services: that of risk.

Didn't hear it myself but looks like Radio 5 examined the tensions between safeguarding vulnerable adults and the roll-out of personal budgets/direct payments in the Donal MacIntyre programme yesterday.

By Mithran Samuel

Interesting interview in The Herald with head of Scotland's care regulator, the Care Commission, Jacquie Roberts, in which she emphasises how how much adult care services will have to change to deal with the demographic changes of the coming decades, particularly in rolling back institutional care.

Two news stories I spotted over the last twenty-four hours stirred up my emotions. One was a very personal story in the Mail Online, the other was on the BBC news about government policy.

So much press coverage of late has focussed on the failings of social workers to support those who are most vulnerable. What we need to remember is that for every negative story, there are hundreds, if not thousands of examples where social workers are using innovative, personalised approaches to improve the support people receive, and in some cases, actually save people's lives.

The work to make 'personalisation' real for people has got to be tackled on a number of different fronts.

Most commentators agree that personalisation is the greatest shake-up in service provision since the launch of the welfare state but it turns out it is fraught with dilemmas.

Prof John Glasby of Birmingham University went through some of the dilemmas, including whether direct care is, in effect, a privatised system and whether it overloads service users and their families. For social workers, the question is whether it undermines them or frees them up to do their jobs.

He pointed out that it allows social workers to mobilise the system while at the same time empowering service users to lead independent lives. Direct care workers speak passionately of the system, saying it allows professionals to feel they have made a difference, bringing job satisfaction.

He described it as putting the social back into social work and helping to reconnect professionals with the work they came in to do.

Glasby explored its use in health care and found personalisation could be used as a tool for joint working.

Mark Wardle, General Social Care Council chief executive, said personalisation could be viewed as the beginning of Every Adult Matters.

But for practitioners, codes of practice must be reviewed to ensure they can cope with this change. The challenge is to build a confident professional workforce to preserve its identity, he added.

Independent disability consultant Simon Stevens told audience that he has employed personal assistants since 1992 and expects the best. If he doesn't get it he complains. He pointed out that although he can sack a PA, a PA could walk out on him, leaving him in "a right mess".

For him the service user is the king/queen. It is important to distinguish between a personal assistant and a carer - the two were not the same. He identified other issues as standards versus personalisation, recruiting, funding and involvement of unions.

It was the last howl of those great beasts of social care's jungle, Dame Denise Platt and Paul Snell, respectively chair and chief inspector at the Commission for Social Care Inspection.  As co-authors of the last ever State of Social Care report from the CSCI, they might have sounded fiercer and more frightening than they actually did.  Lesser animals did not flee in terror as they were told in remarkably measured tones about the slow progress in the policy of personalisation, nor did they quake as CSCI's soon-to-be successor, the Care Quality Commission, was reminded that there's this thing called social care and that it had better pay attention to it.  Somehow, astonishingly, the earth remained in its orbit.

In fact, there was plenty in the report to be happy about.  When it came to the performance of councils in meeting the outcomes people want, the word "poor" had virtually, if not quite, disappeared from the CSCI's vocabulary.  Two councils found themselves in the naughty corner for doing too little to promote users' personal dignity and respect, but in terms of overall performance councils could boast of the sixth successive annual improvement with 18% judged as delivering excellent outcomes for people who use social care, 69% rated as good, and 13% adequate. 

But the drumbeat of personalisation runs through the report and you can sense some frustration that the CSCI will not be around to raise the tempo, for example in Dame Denise's launch statement: "If CSCI were continuing our work, we would be watching closely to see whether the 'personalisation' agenda really does make a difference for people.  I hope that our successor organisation will maintain this focus."  Quite.  Given that the CQC will be dominated by health, where personalisation still mostly means listening respectfully to the patient and then doing what you were going to do anyway, this is a moot point.

To judge by the report, personalisation is scarcely more advanced in some councils.  In 2008 councils received a new year letter from the Department of Health, Transforming Social Care, informing them that significant progress in the implementation of personalisation was expected by early 2011 and that every service user, includling those with the most complex needs, should be included.  So far the message has been less than transformative. The 13 individual budget pilot authorities may be well on the way to implementing the government's "Putting People First" policy, a few others may be ready to join them, but generally progress has been "patchy" with different levels of understanding of and commitment to personalisation among councils, their partners, users and carers, "as well as difficulties extending pilot schemes".

The statistics give an indication of how far there is to go.  The report states that 1.75 million adults used social care services in 2007-08 with total public and private expenditure likely to have been well over £20 billion.  Once again half of council spending has gone on care homes, representing such a slow shift from residential and nursing care to community services (about 1% over each of the last five years) that you need an acute eye to see it.  If you look at the actual numbers of people cared for, the numbers are slightly more encouraging.  Just over one million adults were supported at home as at March 2007 - 1.3% up on the previous year - compared with 231,000 supported in care homes, 3.7% fewer than the year before.  In a survey of 657 care homes for older people, over 40% of residents were identified as having dementia and over 84% of the homes had at least one resident with dementia, numbers that are bound to rise in the coming decades.  

As for personalisation itself, the numbers are still a pinprick.  The day when 2 million adults will be using social care cannot be far off, despite the investment in prevention/early intervention services intended to reduce the flow.  Yet a mere 2.5% of social care budgets were spent on direct payments in 2008, admittedly an improvement on the fairly static 1% of a few years ago but still hardly the explosive growth that might have been hoped for 12 years after the direct payments legislation came into effect.  In 2008, 55,900 people received them, compared with 40,600 about a year ago, while that new kid on the block, individual budgets, went to slightly shy of 4,800 people by last March.  Social care may one day be transformed - but not just yet.

The State of Social Care report rightly points out that good personalised care and support is highly dependent on suitably skilled and trained staff, including the many local authority social workers who wonder what the future holds.  At least up to last year social care appears to have had one of the few workforces left unscathed by the economic downturn, claiming an estimated 1.5 million workers, an overall increase of 8% from 2006-07.  JobCentres were doing a brisk business in care and support worker vacancies as council vacancy rates ran at 8.6%. More were employed by the independent sector and fewer by councils, and personal assistant roles predictably mushroomed from 113,000 to 152,000 over the year.   

Here, the report comments that "there is an urgency to engage people using services and support in the debate about the qualities they see as important in personal assistants and whether such roles should be regulated".  It might have mentioned the Skills for Care survey a few months ago which suggested that service users were rather less keen on regulation than personal assistants themselves, and that training of personal assistants wasn't especially high on users' agendas either. 

The report shows exactly why training and regulation will be needed - and why quality social work will stay in demand - in part two, a study of personalised support for people with multiple and complex needs commissioned from academics Melanie Henwood and Bob Hudson.  Referring ominously to the "marginalisation of human rights", they discover a frequent "lack of ambition and a prevailing negativity as to what people with multiple and complex needs might achieve".  Finding that these users all too often languish in out of area residential placements, they detect a "general suspicion that the personalisation model has, as yet, been insufficiently developed for people with complex needs and that the most widely showcased examples of success highlighted in the individual budget pilots and other schemes have addressed some rather 'easier wins'".  Ouch!  Here too, then, the personalisation revolution has barely begun.

When someone is leaving a job or indeed the job is being abolished, it is an opportune time to say what you really think and, to an extent, so it is with the Commission for Social Care Inspection's final report.

On personalisation, the commission's findings mirror Community Care's own from last year, revealing widespread variation in progress on the transformation agenda and the services provided by councils. The report calls for a culture change in all councils and states this would be an area that CSCI would monitor closely if it were not replaced by the Care Quality Commission in April.

Another area CSCI highlights is the future of adult social care in England. It condemns some councils for still assessing financial means before care needs and the fact that self-funders are often excluded from good advice and assessment. The report's introduction goes further with the statement: "Social care in the future should be delivered within a single system, regardless of who is paying, so that no-one is excluded from assistance in gaining access to the care and support they need."

These two statements run the risk of being interpreted as sour grapes by an outgoing team. But in reality they are important issues the government must consider in its ongoing reform of adult social care.