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.

Read the complete post at http://www.communitycare.co.uk/blogs/social-work-blog/2009/01/the-state-of-social-care-whate.html