OK, here goes. I wanted to write a proper response on this issue because I have the opportunity to respond to it so often on training courses – and I think I know some of what to say that people find helpful. I've tried to do that here, and I hope people can appreciate that if I say things in a way that grates or irritates then that might be because I'm attempting to cover what I think are hugely complicated issues in a small enough number of words (and finding that hard to do).
I think that lots of people (incorrectly) think that person-centred planning, and person-centred care work as follows:
Firstly, we ask people what they want in their life. We might ask them what their dreams for their life are. Then we write this down, give it to those responsible for organising services, and we/they try to make a plan for how these services are going to respond. In doing so we/they try to balance budgets, staffing, the needs of other residents (etc) and so on.
I think that inevitably what we get when we do this are all sorts of things which are difficult to respond to. Person A might like playing loud music even through it upsets everyone else in the residential establishment. Person B wants a holiday to Florida, but we don't have the money or staff to provide this for them. Person C wants to spend 6 months of the year living in Spain – which is simply not within our power.
But when we do this kind of thing the issues aren't just about the budget and staffing. There's another huge issue about whether it is right to ask someone to spend time dreaming about something they will never get.
Sometimes, of course, a process like this is quite useful. For instance it leads us to get some headphones for Person A. Person B gets included on the weekend trip to the seaside, which they really enjoy. And a helpful member of staff brings in some old Spanish language tapes for Person C
But the real thing – real person-centred planning and support and care – aren't anything like this.
I've tried to work out different ways to say this. I could write more sensitively I suppose – something about how in my humble opinion there are some interesting differences between this and person-centred planning as I understand it was originally envisaged - but I tried that earlier today and it took me a whole side of A4 typing to say the same thing as takes one sentence here. The differences between person-centred planning as I understand it, and much of what I see being called person-centred planning, are so huge, and so fundamental, that I can't think of a better way to express myself than to call one 'real person-centred planning'. If someone can tell me how to say this more sensitively then I'm all ears.
With 'real' person-centred planning I think there are some really significant differences to the scenario I've given. The first difference is that the point of the exercise isn't to produce a written document. We all know that handing a service provider a document saying that Person B wants a holiday in Florida is pretty pointless.
Real person-centred centred planning starts from the assumption that there are some things that service-providers are always going to struggle with (given their existing design). Because of this it does its best to bring non-service-people into the equation. If person B is ever going to get a holiday in Florida, then it'll be through ordinary non-service people. Of course this raises a big question – who are these non-service-people?
Person-centred planning was created by people who believe that real inclusion is possible. They believe that people who need support – even people who need lots of support – can be connected in the world. They believe that it isn't inevitable that the only people who have strong personal (as opposed to friendly-professional) connections with them will be one or two close relatives, or the one real friend at the day centre. They believe that people can be connected in through ordinary relationships to ordinary people (not meaning 'volunteers' by the way).
But even if we can do this Florida still seems unrealistic doesn't it? After all, 'Joan' might not even survive a trip on an aeroplane, and Jack is simply too challenging?
Real person-centred planning does something very special. It sets up an environment of really deep trust, where people can talk about what's really genuinely of importance to them. When we do this very few people talk about a holiday in Florida or playing their music loudly. Person A is more likely to speak about how lonely he is, and how lovely it would be to get back to having a life like when he was in a rock band. Person B will say she just wants to be free from pain, and that she'd really like a man (like she's seen on pictures of Florida). Person C will talk about wanting to feel whole.
These things aren't in our power to deliver. BUT that misses the point. Clearly it will never be possible to 'provide' someone with friends and a rock band, or a man, or the feeling of 'being whole'. But it is possible that if we work out a way to provide very different kinds of support – support to become more connected - we will be able to help people (with some of their allies) to genuinely work towards these things.
Of course, to do this takes a good deal of time, imagination, people, and so on. Not least of the problems is that the kind of person-centred planning I'm talking about is a challenging and powerful beast – something that can't be delivered to a timetable (once a year for every service-user would be completely unattainable – and completely undesirable – for instance).
Where does this leave you, DonnyMan, as a manager? I think in some difficulty. Your role, one way or another, is going to be to run the establishment pretty much as you do already. Whether because of being part of a local authority, or through funding, that's what you are paid to do. As you've identified, it simply isn't possible for an establishment set up to house a group of people together to be 'person-centred'. That's not to say that you can't run an absolutely top-class service, in which those that use it are deeply respected by the staff, and in which a huge amount of imagination goes into juggling the needs of different people. But person-centred support simply doesn't start by bringing together a group of people because they are seen to share the same 'needs'.
At this point many people throw up their hands in horror and say: "Well in an ideal world maybe, but in the world as it is just now the best way we have found to plan services for groups of people like this is to do what we do just now."
They conclude that person-centred planning is simply too idealistic, and that the best we can do is to take what we can from it and discard the rest. The best we can do is to work out how to be a bit more respectful in delivering and organising our service-centred services.
I disagree. Instead I'd say: We know that for the moment we're stuck with the way things are. We know that society rejects and isolates certain people. We know that some of what we do for people is really good. We also know that for many people the way we organise to help them just isn't right, and is sometimes worse than that. We know that many isolated and excluded people aren't really helped much by us bringing them together and putting them with other people who are seen to "have the same needs".
I'd say: What would happen if from this group we took one person at a time, one by one over many years, and spent some extra time on working in a very different way with them? What would happen if we could work out a way to (re)connect each of these individual people with a whole load of ordinary people in their community? What would happen if each time we did that we found a really powerful way to help the person to ask their friends and community for some help?
That's what I see person-centred planning as enabling us to do. But it isn't a magical tool – it's a very human one. Getting it to work well isn't a matter of a good implementation plan, or some excellent staff training. It's going to take much more than that, and it will be difficult.