At NCODP (Norfolk Coalition of Disabled People), as service users, we're researching and reviewing Personal Health Plans for the NHS Norfolk (PCT) Personalisation agenda. NHS Norfolk came up with a solid draft version so each of us in the focus group took copies home with us to do either an imaginary test run or, being disabled, to complete the test plan for ourselves.

I decided to do the latter and initially found that in general someone with sensory problems would have difficulty with some of the text and that the boxes to write in information are too small - someone with even a mild tremor or arthritic hands couldn't enter information easily. And yes, I know:

"...you may want assistance from others such as your carer or your key worker."

I also know that if my carer, my wife Kathy, tried to fill it in with me it would develop into a verbal tornado before box three! Key Worker? Availability? Competence? Skilled? Choice? I'll expand on the skills bit later. But when you become disabled you lose what you've grown, evolved and developed since childhood. Many people will see completing their plan as a personal challenge, even if it's just to demonstrate they are still capable of something. Respect independence.

The most important aspect is that the Personal Health Plan is loaded bureaucracy; loaded with emotional ammunition and some of this bureaucracy, for many people, will have a hair trigger. I skipped the section which said: "What it might help others to know about me: ...details of personality, likes and dislikes to help inform health professionals." That would probably need repeated visits for some - with a great deal of introspection - and some of it demands a great deal of sensitivity - and high professional knowledge and skills in a key worker.

Now I have the benefit of over thirty years as a senior social work practitioner, mainly in mental health, but when I reached the section which says "These are the concerns I have about my current health and well being. Consider psychological, emotional and social as well as physical issues." I had to fight to stop myself breaking down (I know I shouldn't have but there are social circumstances in which it is difficult - we had visitors in the other room). Why, at this seemingly straightforward section? I had, a few hours back, been watching personal holiday videos showing Kathy and I striding out along coastal paths. When looking at that section it shot out and hit me that I WOULD NEVER EVER DO THAT AGAIN. Something of me had died and I was grieving.

The point of all this is: the person assisting someone to fill in these Personal Health Plans, and there are thirteen pages of similar slots, the "Key Worker," will need to be highly skilled in dynamic socio-psychology. Clumsiness could, feasibly, elicit a depressive episode carrying potential suicide. Insensitivity with someone who has obsessive, compulsive disorder could leave the person tormented. Ignorance towards someone with a tendency to paranoid delusions could be disastrous.

So what does this mean. In my book it means that, by extension, the Key Workers in adult social services Personalisation work will need to be as highly skiilled as above. I could have done it and I have known others who were capable but I also knew some who would be a debacle. It's good that there are proposals for better and more extensive training and education for social workers, along with carer grade practitioners. Specialists with honed special skills will be needed.

But I see elsewhere on this site a suggestion that fewer social workers will be needed for Personalisation. Dear me, I despair.

MIke.