The strategy to deliver personalisation through Personal Budgets is not working. The claim that Personal Budgets are bringing about better outcomes is unfounded. The reality is that it is only people who have a Direct Payment who are experiencing better outcomes. People who have a 'Council managed' Personal Budget are not experiencing any change. The strategy is on the rocks. However, it will be possible to rescue it, and deliver personalisation for all to the greatest extent that available resources will allow. Doing so will require a change in direction, with a move away from the current ideological basis for the strategy to one that is much more pragmatic.
I have placed a short(ish) paper in the Resources section that explores these propositions if anyone has the time and inclination to read it. It would be great uf people shared thoughts about the issues
Colin Slasberg
Hi Colin,
I couldn't agree more with what you are saying, the concept of Personalisation has always been politically/financially motivated and never about the 'person' as it should be.
Just out of curiosity what is your perspective on Personalisation and the effect on Adult Safeguarding? Do you think there is an increased or decreased level of risk for Service Users?
I'd love to hear your opinions.
Kind Regards
Hope2baSocialWorkerSoon
The increased risks to vulnerable adults from personalisation has been well documented. I think the problem is that the whole strategy rests on creating a system that suits the most able, probably about 5-10% of service users. They are people with high social skills, experienced in living with their impairment and the social policy environment. They are the least at risk of abuse. The trouble is that when you say something like that, you are accused of being a non-believer who is puttiing people down. My view is that it is right to expect the very best of people, but it is neither kind nor bright to expect more of people than they are capable of delivering.
I can say from my involvement in IBs a couple of years ago that the risk side of it, and the fact that it would lead to more instances of safeguarding has always been well known, and inside LAs there has been no secret made of this at all.
What advocates of IB's and personalisation in general pointed to was the benefits in terms of choice and control which they said outweighed the risks.
What strikes me as odd though is the fact that on one hand you have formal care which is very, very, highly regulated in that all carers must be CRB checked and have the correct training in things like moving and handling
On the other hand you have IBs where. I had one instance where a service user on IB's asked how they could get a CRB for a potential carer. To my surprise I found out that this was no straightforward task - as CRBs are not available to individuals, only approved bodies, whatsmore the local independent living foundation did not CRB the people they kept on a list of carers - what I also found out in the course of my enquiries was that this is not against any rules, it is essentially up to the service user to make a judgement and though it isn't straightforward they could if they wanted get a CRB through an approved body, though they would not be able to view this themselves. - though I should point out that the rules may have changed here since that time - if they have anyone feel free to update me.
In part there was a political element to this in that people involved with IB's felt that their judgement should be respected - and this to an extent is a pertinent point as it is an issue among sections of the disabled community that they should be regarded as more 'vulnerable' than the rest of us simply because they happen to have a disability.
What does strike me as strange though is you have on the one hand an ever tighter regime - CRB, POVA etc, but on the other you are then totally undermining it altogether.
What seems to be the biggest area with IBs is when someone put's themselves at risk - either by choosing an inapropriate care package which doesn't meet their needs, or by simply wasting the money on something else.
In my experience this was a major, major issue for IBs. The scenario being - someone spends IBs inappropriately putting themselves at risk. They then contact the department telling them this. What does the department do? Does it knowingly leave someone at risk, or does it set up an emergency care package.
I'm not saying this scenario would happen through someone being willfuly negligent, in my experience it was usually a case of an IB user not budgeting for a carer being on holiday, quitting, or going off sick. Now all of these situations can be prepared for quite easily, and you would hope that a good care plan would cover these, but ultimately people are people.
Economically speaking though you have a situation where the LA always underwrites any deficiencies in the care plan, so there is no incentive to plan for all eventualities. Ok for most people perhaps, but the problem is striking a balance as people who have planned and spent their money wisely may well be angry that those who haven't are bailed out and that there is no incentive for being frugal.
As it stands, the view in the media and society is that the department is ultimately responsible (it could well be that with IBs this changes over time as Social Services Depts take a less active role in care planning), so any risks it knows about have to be dealt with. The scary thing for IBs to work for everyone is that there also has to be some kind of sanction system in place such as the suspension of IB's, but here you get into difficult territory particularly if you have a 100% IB system such as what was proposed when I was around.
You make good points Neil80.
In addition to the approach being designed around the most able SU's (a minority of them), I believe it makes another philosophical error in basing the approach on consumerism. It comes from the credo that 'the customer is always right' within retail. But the PB enthusiasts fail to see the humour and irony when the phrase is used in retail. All retailers know that actually, customers make dreadful decisions. They might even choose a green shirt to go with a blue jumper!! But, becuase the customer is paying, of course they are right, as the retailer sniggers all the way to bank the money. But, however much it is dressed up, a personal budget is public money. There cannot be the same philosophy. How can a Council stand by and watch someone choose services that will, say, make them more dependent or simply waste money.
Service user choice can of course work, but it surely has to be against agreed and transparentcriteria, along the lines of being a service that will promote policy objectives (around independence and well being) and in the most cost effective way.
The Personalisation Agenda is far too demand-led and ignores the supply side of the equation. I have attached the text of my blog from August into how personalisation in supported housing (for which the usual suspects are getting more and more on the agenda) serves only to REDUCE choice and INCREASE cost.
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The latest ‘great and good’ theory is called ‘Personalisation’ and as the name suggests it is intended to place more power and specifically choice in the hands of the person. Personalisation is lauded and actively promoted by this government as a good thing and it even accuses local government of hindering the increased choice it says it gives to vulnerable service users. It also has its own quango called ‘In-Control’ to advocate this great and good theory and again we see its name being synonymous with (the purported) increased choice.
The easiest way to explain the theory is that instead of social services finding and arranging suitable accommodation and care for those with assessed care needs, social services give money to the individual in the form of a personal budget or PB. The individual then chooses (with SSD help) what to spend this PB on and purchases the services he or she chooses and hence the ‘Personalisation’ and ‘In-Control’ tags of its advocates.
At this stage I should mention the discussion site on CommunityCare had an in-depth discussion on whether it was acceptable for a disabled service user to spend his PB on twice yearly visits to a prostitute in Amsterdam. They concluded it was acceptable.
However, while the theory of personal budgets and personal choice is hard to argue against, the reality of personal budgets in practice in supported housing reveals it will and must reduce the provision of supported accommodation and therefore reduce choice – the exact opposite of its aims as the scenario below explains:
Scenario
A 10 bedded house for residents with disabilities (Sometimes called the Supported Living Model);
1. The social landlords funding model is dependent on 10 lots of (a) rent and 10 lots of (b) SP funding. The care element is of no financial consequence as the landlord doesnt deliver care. This is the typical model across the UK since the advent of the Supported Living Model of care (SLM) became de rigeur after the Community Care Act.
Landlord charges £100 pppw in rent and £100 in support and so the entire service generates 10 lots of £200 each week which is £2ooopw and £104,ooo per annum. This £104k per year equates to the housing management cost, the intensive housing management cost (higher costs of supported accommodation such as staffing for security, furnishings, communal facilities etc) and support services and is a break even figure.
Under Personalisation residents could choose to stay in the accommodation but choose another external provider to deliver support services – after all Personalisation advocates state why should a vulnerable person only get the support if he or shes goes into specific accommodation. Another good argument that works well in theory but not in practice.
Two of the 10 residents decide they want another support provider. The existing provider still has the same staffing cost as it still provides housing management and intensive housing management to all 10 and support to remaining 8. Yet the income has reduced by £200 pw and £10,400 per annum, a 10% reduction on the ‘break-even’ income it needs. The service is thus non-financially viable and may need to close.
In that scenario 20% of residents get choice which negatively impacts on the other 80% and in fact on all whne the service closes. That is not real choice at all and it is reduced choice for all.
The point the advocates of Personalisation conveniently lose is that the provision of an accommodation-based supported housing service is sustainable at the whim of every service user. That is a risk too far.
I understand the points you make SPeye. The "personalisation" strategy has effectively emasculated the strategic function, and so issues like this are not thought through. The thinking has not gone beyond the ideological view that the market will adapt as markets do, and you dont need to plan it. It is clearly a wrong headed view. Social Care is not an efficient market place and cant be while its pricing levels do not get anywhere near to permitting the surpluses such a market requires.
I believe current strategy also greatly over-states the issue of choice of service as the route to personalisation. Reseach suggests its the way services are delivered that makes the difference to service users. I dont accept the assumption that large organisations cannot deliver flexible, personalised services. Its actually a nonsense - their size can offer the economy of scale that an organisation requires to be constantly adaptable to its service users. The issue is how they are commissioned.
I think by it's very nature personalisation presents a threat to any kind of collectively provided services.
The analogy I prefer is thinking about it like buses and cars. The car, like personalisation, offers more choice; its chief advantage over the bus is that it allows you to go exactly where you want when you want (of course as long as you can afford the petrol. Like personalisation it sounds good, but the problem is that the more people that drive the less viable the bus becomes, as it relies on a certain number of users, so anyone relying on the bus, or choosing the bus then has that choice taken away from them.
Some people see this as a good thing, like the bus, services like day care and assisted accomodation have a stigma about them and have received criticism. There is a sense that collective services are old fashioned, inflexible and most of all serve to segregate disabled people from mainstream society.
The logic of personalisation is that people with a disability should be empowered as consumers and through this will be able to integrate into mainstream society. So in the now age old example of a football season ticket as opposed to day care this means that the disabled person is able to participate fully in their community rather than being hidden away and as a result of their higher visibility wider attitudes will change. Another logic is that the market will respond to the stimulus offered by the money hitherto tied up in collective services and block-contracts and this will drive innovation and generally act to improve access.
I have to say that to an extent this logic is good, but I think the point that CS makes and that I agree with is that what it really comes down to is just how much faith you have in 'the market' to deliver results.
Personally I have concerns that the market will be rather disfunctional. A fundamental problem with the market is that services are allocated on ability to pay, not need so unless LAs are prepared to fund some people to the hilt then they will lose out on services they are perhaps more in need of, but less able to pay for. Knowing what LAs are like we know they are unlikely to do this.
I remember once being in a meeting and hearing about IBs success stories and hearing of one where instead of respite a group of parents of people with an LD clubbed together to pay for them to go to an adventure camp. I was told that they had topped up with some of their own cash to make up the shortfull. now this is great, but it shows how organised (presumably middle class) people will get the most out of personalisation and say as a result of their opting out the local respite centre had to close then.......
Another example is with expensive high-end 'retirement communities' full of people who wouldn't meet FACS at moderate level. It shows that the market loves well off clients with low needs. At the moment some of these people subsidise services like home care and day care - paying full, or near full rate whilst at the same time contributing to the viability of the service.
Without such people we will be left with residual services provided, or purchased by LAs for low income and/or complex needs clients. These will be the people who will have no choice at all in the system.
Now i'm not saying the current system is great. It needs to change, but too much time and energy has been spent on a personalisation agenda which despite its potential advantages also has a number of serious flaws.
Ultimately pushing for IBs to be the default seems wrong. Direct Payments seemed to me to be a successful policy and one which could and should have been promoted far more by LAs, but people should be given a choice - whether to have them or not, not just have them imposed on them.
I'm really happy people are discussing this somewhere. I've been working in local authority adult social care for the last 2 years and the personalisation orthodoxy makes me feel like I'm inhabiting some kind of alternate universe, where directors are so hell bent on proving their policy decisions to be correct that they are blind to the real experiences of service users under this system. For older adults at least, there is little choice, no change, and the self directed assessment system is both patronising and irrelevant. Most older people I see don't appear to give much of a hoot about "control and choice", they just want a decent service with regular carers. Unless they want to employ a PA (many frail older people are just not up to doing this, even with help) then they're getting essentially the same service as before, but with a different name slapped on it to make our Individual Budget statistics look good. If you point this out to anyone then you are viewed as an oppressor of the vulnerable who requires re-education (OK those last 4 words were a bit hyperbole but it's not too far off).
It's funny you say all that because 2-3 years ago when I worked for an LA quite a few of us were saying the same thing.
The wisdom of the front-line, gained from being in close contact with SUs, was that older people just didn't want the fuss. Granted some may have been interested in IBs, but as soon as they became aware of the admin side their interest nearly always evaporated.
The thing that really opened my eyes to the wrongness of the policy was when our MOWs coordinator told me about the results of their satisfaction survey which indicated that most MOWs users didn't want to have to make a choice.
By the same token lots of people loved going to day care.
Now, you, or I would probably hate having a set meal everyday, or the thought of a day centre, but many people actually value the services.
Whats wrong with IB's is that its a way of doing things which is very good for some people, or some groups even, but not so much for others.
If these sides could co-exist as in the case of DPs then it's fine, but as has been pointed out the viability of services some people value is being undermined so therefore their choice is taken away from them - not to mention all the other problems.
Unfortunatelt I think the people in charge of implimenting the policy don't hear the voices of SUs as well as frontline workers do and are just saying that anyone opposed to IBs is a naysayer.
I think its very important that front line staff find the courage and skill to speak up within their own organisations. I fully understand how risky that is when senior managers are following a route that has so little to support it beyond ideology, but we all have a responsibility to do whats right for service users. I believe that the facts and evidence I have used in the papers I have put in the Resources can be helpful when challenging collegues, but you will still need enormous good judgement and skill when doing so!
Can I check - are you saying that it is ok to ask ten people to share ten "beds" in a house?
Glasshalfull - my view is that is better than asking 50 people to share 50 places in a house, but not as good (in most cases) as being supported to live in your own, individual home. Its all relative, and, as the numbers come down, the costs go up (all other things being equal). Its simply more usually the case that working age adults live in smaller units than older people, and hence the unit costs are sginficantly higher but making it possible for a greater range of needs to be addressed by staff.
The language used here implies us and them, professional and "service user", units and beds. People don't live in units and beds they live in houses and homes. People are not "service users" they are people who sometimes need support to overcome the barriers society places in the way of their inclusion and contribution. This support should be personal to them, designed and controlled by people themselves and those who care about them with other support if needed - not placements in services or beds in units
Are you saying there is robust research demonstrating increased risk? Could you provide references?
I think that's some quite pertinent points there and it's a good argument for personalisation that it will ultimately break down the dichotomy between professional and service user.
But, I think many front line workers in social care departments know how there is a big difference between rhetoric such as things like 'social work values' and the reality of limited resources and buracratic structures. After all if you look at what the Care Planning methodology was supposed to achieve it was pretty similar to IBs in terms of placing the person at the centre of the process yet for the reasons I've mentioned it fell short.
The concerns I'd have is that a move to 100% personalisation will result in those with the most complex needs and the least resources being disadvantaged.
I also feel that the loss of communally provided services like day care does present a connundrum, as has been said such services need a certain number of people for them to be viable, yet by a number of people opting out then the choice is reduced for the people who want that service. It's a hard balance I think, but I do also feel there is an element of anti-collectivisation rhetoric in some of the personalisation arguments which have been made.
Like I say I think of it as cars and buses. Yes cars are great, they give us freedom and choice, but they cost more to run and when most of us drive that leaves those that rely on the bus having to deal with a patchy run down service.
Anyway I'd like to hear your thoughts on this
I'm going to advocate for Personalisation.
I think the old regime of we have 'this service' so 'like it or lump it' was totally and utterly useless. Give a service user a drop in with potentially damaging/unnessisary support with other service users who may or may not be in the same demographic as them. This was the 'only choice' service users had.
With personalisation this changed, so let me spell it out for you so you can all understand... PERSON CENTRED APPROACH.
Where does this become political? Where does this become policy driven?
PERSON CENTRED APPROACH, I say it again as this is supposed to be the under pinning value in all social work/care.
Bed spaces.. I can see some of the points raised but is everyone annoyed that if your work or company is just not delivering the right support but doing the right housing surely the Service user has the right to get the right support as they see fit.
I've posted on these threads several times before so I will reiterate the 'problem' as I have seen it in practice. Those Social workers who should know about personal budgets seem to have had no training! Bosses of said Social workers are keeping a beady eye on the budgets and not allowing those who are in need of them to have them or even access them. Some Care Coordinators have no concept of what they are and what they are for.
So YES Personal Budgets should be working fine and from the ground level (I am one of those PA's both for a Charity for Mental Health and for a Brokarage delivering support for Learning Disabilities) they are.
THE ONLY PLACE IT FALLS DOWN IS WITH THE HIGHER SO CALLED PROFFESSIONALS... Who are usually the ones moaning that it is not working, Making it not work.
So to those who are not allowing the budgets or those who are not even trying them with your clients shame on you! You wouldn't like it if you were told that you could only buy Tuna to eat for the next 6 months, so why should a sevice user have to only recieve support from one provider. So let me say it one last time just to let it sink in for you all. PERSON CENTRED APPROACH.
Personalisation can and does work.
PJ REPLY:
Absolutely right. The whole ethos of Personalisation is about giving people choice BUT........ it seems, giving people *choice* also de-regulates the provision. It's not easy for a 'service user/potential client' to get a CRB check done. It is a mixed bag where some LA's and Charities are offering the service but NOT the costs involved. Some LA's don't provide the service at all.
However, all of this is masking a real safeguarding issue. The role of the PA.
I had a rather heated discussion with a disabled champion a week or so back who felt it unnecessary to re-visit all the regulation issues as he (..and by that he meant the general disabled group at large) had been through it around 20 years ago. I explained that what was now happening was the older vulnerable groups were being 'forced' into PB's and DP's and that very few had any experience of it (let alone 20 years!) and, worse, as a general group were far more *at risk* then the disabled groups. And, it's true. We see 80 somethings with short term memory loss and/or dementia onset who cannot manage their own affairs whatsoever.
Anyway, there is no regulation for a PA who provides care & support to a single client. None. It's a private arrangement between client and care provider and falls outside of CQC regulations, HMRC regulations, CRB & Pova legislation etc. However, the client DOES become an employer and as such, must run his/her care provision as an employer, complying with employment laws, redundancies, holiday, sickness and much more.....not easily done by many older vulnerable adults.
However, if a PA provides care & support to more than ONE client, they must register with CQC, inform HMRC, pay tax and NI etc., etc.,
A de-regulated PA system such as this is troublesome and very dangerous as those with such intent, move into this market place for ulterior motives... unseen and unhindered.
I think what is quietly happening for the older vulnerable group is that more managed budgets are being introduced and along with that, the potential service user is gently *steered* into regulated care provision. I read that many LA's are imposing conditions on where the PB money is spent also.
In addition, the way that cuts are taking hold, most DP's and PB's are not sufficient in monetary terms to provide the necessary personal care let alone doing anything 'creative' with the budget. Wasting money is a pipe dream for the immediate future, at least.
Clearly, PB's and DP's *might* suit children, disability and learning difficulty groups but...the older vulnerable section of our society are struggling with this. Most just do not want to be involved in anything to do with the management of their care. Thet just seem to want what they need when it is arranged....no more, no less. It is, in my view, the most inapproapriate system and ethos for this group of people.
PJ
dede: As a personal budget user who employs own staff, is highly motivated experienced within disability movement and my own impairments. I totally agree with your remarks, it is only service users who know what they want , where to get info, how to understand the vagaries within social care, ETC ETC Are people who are unlikely to suffer from any form of abuse. These are the people who really CAN get the best out of personal budgets/direct payments. But I do not neccessarily agree this will always be so, with a great deal of support I think many others will also gain more choice and control. We are seeing this already but there is a long way to go. One of the best ways of implementing the support that service users want and need is more true co-production with DISABLED USER LED ORGANISATION who work with disabled people all the time, give real peer support and with specific impairment led service users who know and understand and also with SU's who have the experience of using Direct payments/ Personal budgets. We know what the pitfalls are the negatives and positives.
You may well do for disabled people. However, what gives you cause to think that older vulnerable people have anything like the same capabilities, the same ambitions, the same needs & wants and the same risks as disabled people...?
I would say that some of the problems we face is to get it clearly understood that there are vastly differing requirements through the social care sector groups. Enormous chasms almost. That disabled poeple have many years experience of PA's, PB's & DP's says nothing about how older vulnerable adults are able to cope, what their aspirations are and what they require in terms of care & support.
For the most part, as another poster has already stated in this thread, older vulnerable adults (in general) are not interested in choices about their care, not interested in what they might do with their budget money and they almost certainly do not want the responsibility of the admin of such budgets... all they require (in general) is to have the needed care & support arrive at the agreed time, day in, day out and preferably with the same care worker.
It's really very simple ...yet we have disabled groups championing this system which is great and efficient for them (..and other social groups) but what it isn't is a great system for the older vulnerable groups. And that's just the overall system without getting into how they are not receiving enough money to buy the care they need. I have experience of small hundreds of PB's & DP's to service users who when receiving direct provision from the LA could not replace it in anything like the same way when they were awarded a PB. It is a system that broadcasts choice when in fact, there is little or no choice and it is a cycnical ploy to reduce further the costs of social care. It isn't working for the older vulnerable people in our society and we are seeing an upsurge in managed budgets under DP's.... managed by the LA!
Cut....then cut again..... it's actually a disgrace in my view.....
JBD WROTE:
Yes...that's the thing: As always it's disabled, learning difficulty and child care that * might* find some benefits in PB's. Why, oh why, is it ALWAYS that the people who champion this system come from one of those sectors?
When are we going to get it clear that older vulnerable people do not want (generally) PB's & DP's. They just do not want it, they do not want the responsibilty and they have no wish, aspiration or desire to manage their care & support.
All the really require is the care & support they need to be delivered each day, at the same time by, preferably, the same person. I am growing more angry and tired of other social groups thinking they can speak for this older vulnerable group. They cannot, they do not and they should not.
On top of all this, the system is being used to re-assess and downgrade monetary budget awards - worse since the latest cuts - and the whole ethos of the drive to force people into this system is disgraced and identified for what it really is.....a cost cutting exercise lauded under the false guise of personal choices. Ha, what a shameful joke.
Blimey PJ what a lot of generalisations and simplifications. Older people don't want choice and control - what all of them? Do they not want any? What about all those older people and their families using direct payments and registering higher levels of satisfaction and improved outcomes (see PSSRU research). What about those carers of older people in the IBSEN study clearly benefiting? What about the people with dementia in the report two weeks ago from the Alzheimers Society? Sure there are challenges but were things ok before? Shall we also ignore the person centred approaches for older people using residential and nursing care (as its not all about Dp type PBs. Are you really comfortable talking about "social care sector groups"
glasshalfull: Blimey PJ what a lot of generalisations and simplifications. Older people don't want choice and control - what all of them? Do they not want any? What about all those older people and their families using direct payments and registering higher levels of satisfaction and improved outcomes (see PSSRU research). What about those carers of older people in the IBSEN study clearly benefiting? What about the people with dementia in the report two weeks ago from the Alzheimers Society? Sure there are challenges but were things ok before? Shall we also ignore the person centred approaches for older people using residential and nursing care (as its not all about Dp type PBs. Are you really comfortable talking about "social care sector groups"
If we are to resort to seeking out exceptions as a method of overturning the understanding of the *rule* then we are lost. Of course ALL anything cannot be true. Not ALL older vulnerable people want this, that or the other. We are necessarily talking about *generally* since the whole process of grouping (for stats, reports and general reference) wants to lump ALL over 65's together. Thus we are constrained by that definition. Someone just retired at, say, 66 years of age with full capacity *might* well be interested in having the money and sorting out their care...or whatever they wish to do with their money. Get to 70, 75 and up, into 80 and 85 year olds, many with increasing levels of short term memory loss and dementia onset CANNOT manage and don't want the responsibility or all of this system.
So, which specific report are we talking about? The 2004 one..? Direct Payments...funded by the DoH, the ESRC and the MASCI ? (independently funded research might offer *better* understanding!) If so, it's out of date. If not be happy to look at it.
Glad you mention Dementia and the Alzheimers Society....for the largest group of people suffering these conditions come from the over 65's (older vulnerable group) and absolutely are not equipped for DP's or PB's whatsoever.
Further, let's be clear, I'm not talking about residential care at all. I'm talking about the largest group in the domcare sector.
And yes, I'm absolutely comfortable defining social group types....particulary in the context of DP's where clearly it can, and does, benefit certain groups but is most inapt for the older vulnerable groups. This was brought home to me last week when a heated discussion with a disabled person who is part of a ULO demonstrated that DP's are great for those groups, are driving through with this to the detriment of those that are unable to manage their own affairs and/or have no desire to manage their affairs. If you doubt this, I suggest you get some experience of specifically working with and/or talking to large numbers of over 65's.
As an aside, we (my experience) are in a market of around 2,000 older vulnerable service users living in their own homes. We have spoken to about 600 (so, one third) of those service users about DP's and PB's and without exception...EVERY single person we spoke to and interviewed about taking up a PB/DP, once informed of the management responsibility (..and before that for many) and employment legislation complinace, said they preferred NOT to have a DP or PB.
That's not only damning of the system but it is indicative of the social sector group of older vulnerable people.
So, it about the change from direct provision of social care & support by the LA for the older vulnerable group living at home and the move into (dubious) assessments, financial award and a almost complete deferring of responsibility by the LA, encumbering those that do not want to be part of this system to actually have no choice! Great isn't it? The whole ethos and thrust of implementing personal choice is taken away by not allowing the choice of NOT having a PB.....
The whole thing stinks from start to finish. It's a below the line financial cut hidden from view of the Public and championed by nonsensical dogma such as personal choice, outcomes and 'person centered' approach.
We are seeing the thrust take older service users into DP's but they are being managed almost entirely by care management at the LA ....not a great difference in this brave new world from the LA providing direct support EXCEPT, of course, each and every one that I know of (which runs to small hundreds) have been denied the same amount of care they received under direct LA provision and the care & and support they can buy with their DP.
It's not working for the vast majority of older vulnerable and frail adults, especially those with short term memory loss and dementia....
Ok from the length and vehemence of your reply I guess you and I are not going to agree or get into some of the ways forward to reduce the age discrimination in how personalisation is being delivered in practice. For those of you wanting to explore how to help older people get the best out of personalisation I would recommend the Alzheimer's report. The AS would generally not be seen as part of any kind of ideological push for personalisation and so their ideas and research are interesting. The research they use is of two typical types - you ask people who have not got a personal budget if they think they wld be helpful and people express scepticism and sometimes fear. Ask people who have got one and (as in the AS report) you see improved outcomes and satisfaction alongside continuing concern about process etc. A number of the research reports in this area report how older people are not introduced well to personal budgets or introduced to the range of options for use or supported well to use them.
glasshalfull: Ok from the length and vehemence of your reply I guess you and I are not going to agree or get into some of the ways forward to reduce the age discrimination in how personalisation is being delivered in practice. For those of you wanting to explore how to help older people get the best out of personalisation I would recommend the Alzheimer's report. The AS would generally not be seen as part of any kind of ideological push for personalisation and so their ideas and research are interesting. The research they use is of two typical types - you ask people who have not got a personal budget if they think they wld be helpful and people express scepticism and sometimes fear. Ask people who have got one and (as in the AS report) you see improved outcomes and satisfaction alongside continuing concern about process etc. A number of the research reports in this area report how older people are not introduced well to personal budgets or introduced to the range of options for use or supported well to use them.
Well...if it was vehement (which I didn't think so myself...) it certainly wasn't directed at you, or anyone, in particular. The system.....well, that's another matter!
My comments about the AS reporting..or any for that matter insofar as older vulnerable groups are concerned, is that they are late to the table. We would expect to have positive comments from those who have chosen to take a PB/DP. Chosen because *they* felt it well within their capabilitiies OR..and here's another aspect, they had a support system from family/loved ones etc already.
We are now not very long into the idealogical push for DP's for older vulnerable adults. 12 - 18 months best. Hitherto the uptake was in other social care sectors and it is no surprise to me whatsoever that this over 65 group have been the last to take up on the new system. To the point where it is now being *forced* onto them, to meet with central governement targets. However you mess around with this, whatever statistics one wants to draw upon, whichever report one adopts the reality is that most older, vulnerable and frail adults, many without family or close support living alone, just cannot cope with this new system.
It's as though there is a mantra. Let's look carefully at the reality of its adoption. How it doesn't fit older groups generally for a myriad of reasons...not least that they really don't have massive aspirations or inclinations to do anything much more with a budget than to secure good quality, dependable care to help them get through their days and weeks...
For what it's worth, I'm also involved in a NFP organisation where people, mostly those with mobility issues (though not disabled) and being over 80, are part of a club that decides for themselves what (usually meaning 'where') they wish to go on a social outing trip.
It could not be run (otherwise) from PB or DP adherents alone ...not enough income but is a most valuable vehicle for those involved in the *club*...
...and here is the rub. Not one of the many hundreds of PB and DP holders I mentioned in another post has ANY money left over to *buy* into this sort of activity....not one!
That's because the financial award is insufficient to buy sufficient personal care and support ..let alone anything else. Hobsons choice.
So, under this great, person centered, satisfactory outcomes dogma we actually, in reality, on the ground at this very moment, find no choices that DP's are supposed to deliver, no social support that PB's are supposed to offer and no real difference....other than there is less money coming out of the coffers of LA's via this system ...which in turn is denying people the appropriate care and support they need.
It's an illusion... it's a trick and there is such incredible sleight of hand going on that it is invisible to those not involved in the trick....
Of course, we may just as well be arguing the most disgraceful attack on older vulnerable people by a whole swathe of changes, including raising the thhreshold criteria, cutting services, reducing direct care, not managing the provision market (or is it to be Adam Smith.... leave the market to its own regulation?), cutting front line staff whilst we appear to support bankers and banking, foreign wars and overseas aid at the very same moment we are disenfranchising a whole sector of our society ...many of whom contributed to the efforts that allowed us to prevail in 1940 and thereabouts...many that spent a lifetime contributing into a state system that then got changed without recourse to them.
I won't go on but if you have access to UKHCA stuff you might find an entirely different attitude to the system you are supporting.. for what its worth...!
best
Just scanned the exec summary of the AS report and something sticks out..
"There are currently barriers that prevent people with dementia and carers accessing therange of personal budget options. These include a system that has not yet adapted to theneeds of people with dementia and carers, and a lack of understanding and information onpersonal budgets for people with dementia, carers and professionals. In addition, there arewider barriers such as a lack of funding in the social care system and strict eligibility criteria.There is a risk that personal budgets are seen as a cure-all for the social care system butsocial care reform is necessary to address these wider barriers."
For me, as always my position is that I like the idea of IB's, one or two misgivings over risk and equality maybe, but by and large I'd call myself cautiously-pro.
BUT....The issue for me, having spent a few years working in social care is that it's always about the realpolitik- the lack of funding, the wrangling with managers, the eligibility criteria and so on.
The point about it not being a 'cure-all' is especially pertinent.
We only need to look at the failiure of the current system which was in it's day heralded as a great way of putting the person at the centre of the process. In many ways it is theoretically possible to do a lot within the current system, you could get someone support to do anything, say for example a support worker to take someone to the gym, even to go to a pub or club, but the problem is then getting that by a manager to fund it.
That's the real crux of the issue.
I think what brings 'professionals' and advocates of IBs into conflict is actually professionals concerns with what an underfunded IB system will look like, pessamistic maybe, but these are the people who day-in day-out struggle against the system on behalf of the people they work for.
Advocates for their part mis-understand the issue as being about control, but having worked behind the scenes I know that you couldn't find a group of people more committed to the ethos of giving control back to the people they work for and who more often than not are frustrated that a lack of funds or appropriate structures.
Yes I think cautiously pro is about right. Personal budgets can't possibly solve the problems of a social care system that is clearly underfunded and where that underfunding is getting worse (though neither should they be blamed for cuts which would be happening at this time whatever service approach is taken). Neither could personal budgets of themselves, even with resources at a reasonable level achieve a transformation to choice and control - many other things are and would always be needed. I'm a registered social worker and former lead of a care management team myself and I know the frustrations. I would say that the values of social work and personalisation are very similar and the smart move for social work would be to proclaim that it stands for true personalisation. We are not talking silver bullets and revolutionary departures here - rather building on decades of learning and societal shifts. Older people for a whole bunch of reasons are mostly not experiencing personalised support and they should. Personal budgets are and will definitely benefit many, they should not be denied this by blanket categorizations of who will and will not benefit. This doesn't have to mean taking on employer responsibilities etc. At the same time we do indeed need to make sure that where people use in house or agency home care (PJ I know UKHCA well) or residential care that this is increasingly personal and responsive.using approaches developed over the last decade and a half but often not used. Why don't we try not to polarise this debate? People don't need us scrapping amongst ourselves they need us helping them find solutions to very real challenges with a good will
glasshalfull: Yes I think cautiously pro is about right. Personal budgets can't possibly solve the problems of a social care system that is clearly underfunded and where that underfunding is getting worse (though neither should they be blamed for cuts which would be happening at this time whatever service approach is taken). Neither could personal budgets of themselves, even with resources at a reasonable level achieve a transformation to choice and control - many other things are and would always be needed. I'm a registered social worker and former lead of a care management team myself and I know the frustrations. I would say that the values of social work and personalisation are very similar and the smart move for social work would be to proclaim that it stands for true personalisation. We are not talking silver bullets and revolutionary departures here - rather building on decades of learning and societal shifts. Older people for a whole bunch of reasons are mostly not experiencing personalised support and they should. Personal budgets are and will definitely benefit many, they should not be denied this by blanket categorizations of who will and will not benefit. This doesn't have to mean taking on employer responsibilities etc. At the same time we do indeed need to make sure that where people use in house or agency home care (PJ I know UKHCA well) or residential care that this is increasingly personal and responsive.using approaches developed over the last decade and a half but often not used. Why don't we try not to polarise this debate? People don't need us scrapping amongst ourselves they need us helping them find solutions to very real challenges with a good will
It does seem to divide...this personalisation issue doesn't it? It feels that one is either for it...or against it with very little middle ground.
A few comments (to a perfectly reasonable post, by the way)..... In reality, the proponents of personalisation (..and even here we might digress a bit - I believe from the outset it was seen as a measure to cut costs, which it has done, and was not some socialistic or moralistic dogma about giving 'power', so to speak, back to the people...) appear to always steer the discussions away from "polarising" it. It seems that way, we can talk overview, draw upon the vast experiences of the disabled groups who have been using this system for well over 10 years and prevent the highlighting of obvious, real and serious factors that impact and affect certain people. In this case, the over 65's. I think it is right that the serious pitfalls and downsides of the system for older vulnerable groups IS aired. This is not a system that works well for them. It is being forced onto most of them without recourse and at the same time, it appears, de-regulation is occurring.
I think I share your comments about care management team visions and I wouldn't disagree they mirror those of personalisation for the service user...after all, why wouldn't they? Why would care management teams want anything other than the best outcome of care & support for their service users? I'm glad that you also acknowledge that this transformation requires more than just PB's and a reasonable level of resources (whatever they may be....). And that, perhaps, is the defining criteria in which we disucss this matter. There is no cohesive, market shaping plan, no funding - just lack of it... further aggravated by swingeing cuts - and no real support system other than safeguarding when it all goes wrong. It seems to me as a a general observation that we are beginning to see increased safeguarding issues - we ourselves are already, this year, involved in 300% more cases than any previous year - and I see no reason for a reversal. Behind this, of course, are real stories of human 'misery', so to speak.
Now, my experiences are a whole lot different to yours insofar as older people are concerned. We find no desire for the system, in general, there is a general apathy towards outcomes and when the reality of the system is clearly explained - that includes all the personal choices they *might* have balanced up with the admin responsibilities - it is rejected. Yet the proponents keep re-addressing this by suggesting that the system "hasn't been explained" well enough!
In this respect, what are you suggesting is the position with regard to employment legislation...? Are you suggesting that a PB holder is NOT an employer? Or are you suggesting that a managed budget is the way forward?
Insofar as being an employer is concerned I can tell you (though I'm sure you know this..) any PB holder who 'buys' care & support becomes an employer (this is confirmed by HMRC, explained by most, I hope all, LA's to potential clients and remains so under whatever scheme of payment is introduced) that there is no alternative to becoming employer and it brings substantial obligations and admin by the service user. Those obligations for the most part do not fit well with the older groups of service users. The only way (well, even this is problematic from HMRC perspectives) is to buy regulated care - and that includes PA's who work for other PB holders. If the PA works for the one client, the client MUST employ them. Otherwise, the PA is 'self employed' (they must produce a tax form to the client to prove that) and must register with CQC , HMRC etc., etc.
Can you explain what system you are referring to when you say it .."doesn't mean taking on employer responsibilities"...?
Finally, I do think debating the issues is useful...it needn't be an emotional argument or personal attack - I am personally trying to elevate the issues concerned with personalisation in regard to older people and interested in examining those issues specifically with regard to older people. I see nothing wrong in that, indeed, as I have come to experience and understand, disabled groups, for example, do just that. They polarise the issues into how they affect disabled people specifically and not the communtiy as a whole. I'm taking a leaf from their book and polarising the issues for the over 65's....!
Obviously PJ you have issues with PB's to do with older people.
I can understand this as this is your point of view (and possibly those you work for).
Maybe PB's for older people should be kept within the LA's control and the older service users asked how they are doing on a regular basis.
We the 'disabled' work force seem to find it working and I would say that 99% of clients that I work with, who have been through the old system enjoy and have seen a marked difference in their quality of life through PB's.
Just one small point though try not to pidgeon hole mental health, children and learning disabilities under the 'disabled' monica. A lot of my service users do not recognise themselves as such.
There obviously are problems with all systems when in their infancy and maybe these will get ironed out eventually. The last system for social care has been about for how long? and how many glaring problems where/are there?
I feel that the moment that we spot these dificiences we should not be moaning about them but pointing them out to those in charge and beating our heads against the brick wall untill someone changes them. God knows the last system let so many people slip through the net, and didn't help many of the service users with in services anyway.
I agree about PA's should have CRB's and yes the system is open to abuse but no more than the old system (I have heard trully sickening stories from service users about the dark old days). I chose to work through PB's through companies and Brokarages so that I can be scrutinised (as well as my collegues). I feel this should be mandatory.
Sorry if I'm getting on your nerves. Yes I do see some of your points and do understand you come from the elderly clients point of view but don't rubbish PB's for other groups.
JBD: Obviously PJ you have issues with PB's to do with older people. I can understand this as this is your point of view (and possibly those you work for). Maybe PB's for older people should be kept within the LA's control and the older service users asked how they are doing on a regular basis. We the 'disabled' work force seem to find it working and I would say that 99% of clients that I work with, who have been through the old system enjoy and have seen a marked difference in their quality of life through PB's. Just one small point though try not to pidgeon hole mental health, children and learning disabilities under the 'disabled' monica. A lot of my service users do not recognise themselves as such. There obviously are problems with all systems when in their infancy and maybe these will get ironed out eventually. The last system for social care has been about for how long? and how many glaring problems where/are there? I feel that the moment that we spot these dificiences we should not be moaning about them but pointing them out to those in charge and beating our heads against the brick wall untill someone changes them. God knows the last system let so many people slip through the net, and didn't help many of the service users with in services anyway. I agree about PA's should have CRB's and yes the system is open to abuse but no more than the old system (I have heard trully sickening stories from service users about the dark old days). I chose to work through PB's through companies and Brokarages so that I can be scrutinised (as well as my collegues). I feel this should be mandatory. Sorry if I'm getting on your nerves. Yes I do see some of your points and do understand you come from the elderly clients point of view but don't rubbish PB's for other groups.
Hi JBD,
Yes.... I am trying to be specific in addressing these issues solely for the older vulnerable groups.
I can see, have a little experience of and generally support the notion of PB's for *other* groups. I hope I expressed that in earlier posts but, if not, then I'm happy to say I can see great benefits to other social groups. Also, for brevity, I did not distinguish every time between those groups and/or disabled groups. I'm happy to say that I understand disabled groups are not necessarily allied to learning difficulties and/or children and also, that many/much/all of those groups including particularly disabled groups do nto view themselves in the way those without disability might. I'm perfectly happy with all of that and can see how PB's and/or DP's can, and does work for them.
My issue, as you rightly say, is expressly with the older vulnerable groups that are being swept along in this dogmatic ethos which is, generally and for the most part, unsuitable. I'm not even measuring things against past systems and shortcomings that no doubt most, if not all here, have experienced. I'm not even saying change isn't required in some way. I'm merely saying there is an agenda driven ethos from government via LA's into this system because, and no doubt we could debate this as well, it is a money saving exercise that is being paraded out as personal choice and person centered outcomes. It is wholly inappropriate for most of the over 65 group, many who have no inclination, desire or ability to manage their affairs at the level required.
On top of this, we are seeing that the system is also being used to under fund care provision via very dubious assessment practices. This is the reality rather than the theory of the system and I am at a loss to understand how a service user receiving a care package from direct LA (or LA procured) provision cannot get the same level after a PB assessment. We have, thus far, 100% rate of reduced care packages for service users transferring to PB's and DP's... all through funding cuts rather than personal choice after the PB award. Indeed, we are seeing minimum financial awards under this system and from which the whole notion of choice, that is being lauded, is utterly and hopelessly irrelevant. PB's and DP's that cannot fund the minimum personal care & support needed to maintain independence at home are no choice...they are no improvement, they are not able to affect outcomes and are meaningless in terms of measurement. When each and every social care service user has to add personal money into a PB award to get to the previously held levels of care provision it is difficult to see the pertinence and suitability of the system being imposed.
Now, DP's via care mangement ARE moving forward and we see more and more of this as the LA pushed into the older vulnerable groups to meet their targets. Indeed, it is through this we begin to see just how this type of system does, and does not, work for older people. It is almost certain that this type of provision (although, my previous comments about re-assement and underfunding still apply) can work for the older people.
However, we would then need to discuss how much of this system, provided in this way, is a *real* change. In reality, in my view, for the older vulnerable groups, it isn't. All that changes is the LA pay the client (I heard a Director of Social Services refer to those service users as 'customers' week before last), the same care manager organises the regulated care, almost entirely through agencies and the company bill the client instead of the LA. There's certainly no choices about care provision and no choices about social support. Choose to pay for a trip out from your budget and you choose to, say, forego a bath/shower or even a put to bed.... it's nonsensical.
You know, maybe the issue here is that the older vulnerable groups, generally, require more personal care to support independence than some other PB/DP users. Maybe.... I'm not sure about this but I can only recount my current experiences which show that every PB/DP user we support cannot make any choice (ok, if not any then very, very little) about what to spend their money on as it doesn't cover, already, the bare minimum to survive and prosper at home, alone (which is another great issue with this group).
How can one offer support for such a system that fails in its delivery in this way...?
I can only say from the my service users point of veiw that PB's for them do work. So to rubbish the system entirely is (sorry) presumtious.
I am interested in what ideas you have about how it could work for the elderly?
Could a change of policy which was more flexible for older users be beneficial?
Lets not kill the idea for the sake of one group. Why not embelish on what could work?
JBD: I can only say from the my service users point of veiw that PB's for them do work. So to rubbish the system entirely is (sorry) presumtious. I am interested in what ideas you have about how it could work for the elderly? Could a change of policy which was more flexible for older users be beneficial? Lets not kill the idea for the sake of one group. Why not embelish on what could work?
JBD, I know that *your* service users find PB's workable and of benefit. My whole point is that it is working for the disabled (..and other groups) but that BECAUSE it is working for those groups is not the reason to suggest it will work for the older vulnerable group. I am not rubbishing the whole system (though I have deep cynical thoughts about why all of this has been done and it isn't about the 'person' ....) I am saying that we can, and should, define those (reasonably) seperate groups, understand that the over 65's are different to children, to learning difficulty and to disabled service users and be able to discuss the refinement of the system on that basis.
In my view, the whole issue is about funding.....the shortcomings in the *old* ways were brought about by not enough money, the failings (if indeed one considers the old system to be a failure...) exasperated by lck of funding and LA's charged with managing overall social care budgets resorting to impossible regulations and demands from providers that are impossible to sustain. I am more than wary of this approach that seems to say the old system is failing, it's failing because of the system, lets change the system .....and nowhere is anyone calcul;ating and accepting that the whole thing is suffering and underperforming because there is not enough money. The ever extrapolating downwood spiral of trying to get more 'value for money' seems to know no bounds. You cannot keep driving down costs indefinitely..there are cut off points below which services become inoperable. We have more or less reached this point (some while ago actually - witness the collapse of the large residential care group..), bumped along the bottom and discovered the system isn't working! Well, it isn't working because we've reached ground zero in funding.
So, now what we have is a system that appears to serve certain social groups well just rolled out into a social group that really has no need, no want and desire to change things around. And, as I keep repeating, the new system is actually disenfranchising older people as they are re-assessed for the personal budget and the LA''s leap onto the opportunity of reducing their care provision costs. This is not some ideology on my part...this is what is ACTUALLy happening. How can we be expected to accept a system that takes away care & support from a level *enjoyed* under a direct provision system? You do understand this, don't you?
I would be very happy to use the overall ethos of PB's by asking (not convincing or steering or persuading) older vulnerable adults if they want to be involved in the management of their care provision. Simply that. And if the answer is no....which I know from our survey is going to be the majority... then let's have the *personal choice* ideology and extend that to those who just want to receive their care and support, in the way they have done for years and years, without change. Personal choice..after all. Desired outcomes as well.....
In reality, because LA's see, and have experienced, the money they can save via PB's and DP's, we are going to get much more of them in the over 65's group. However, as we are also seeing, the majority go for a managed budget under DP.. the care package being managed by social management teams. Not a whole lot different from how it works now, in fact. Welcome to the brave new world!
dede - I dont know if you had your Direct Payment before Personal Budgets came in, but if so, it would be helpful to know what difference the Personal Budget made to what you already had.
I am encouraged by the range of views and genuine debate expressed here and if any of you are based in the Bradford, West Yorkshire, we are organising a round table discussion between service users (old and young!), carers, assessors, service providers and planners. We are interested in looking at how we can make personalisation really work for all sections of the community and how together we can unblock the current barriers. The event is free, and will be held 15th February 2012, 9.30am to 12.30pm followed by lunch at Holme Christian Community, Madison Avenue, Holmewood, Bradford . For more information, email conference@hccbradford.org.uk explaining what your interest is. We want to invite a balanced group of people who represent the whole gamet of interests so if we are oversubscribed we may not be able to accommodate everyone who applies. For more information about Holme Christian Community go to www.hccbradford.org.uk
This is a good debate, but has become skewed. The issue is not whether Direct Payments/Personal Budgets work for older people compared to working age people. It is whether they can work for all, or only a minority, and, more than that, why they work.
The Alzheimers Society report is being falsely used to show that Pesronal Budgets can work for older people. In fact, as with all the studies used to support this contention, all the successes they found are for people with a Direct Payment. They represented just 10% of their total sample. We have known since the 1990's that Direct Payments work, there is nothing new in this finding. We have also known that Direct Payments can work for anyone who has the energy and skills to manage their own support system. We havealso known that can be the case for older people, although almost always it is family member who carries out the role.
At a time of serious threat to social care, we cannot afford to be driven by ill informed views. The Personal Budget strategy - from the moment the Government made the up front allocation "indicative" only - has added nothing positive to what is possible for service users. All it has done is given a new name to somthing old. It has, however, added hugely to the risks to social care and to the majoirty who do not have the energy and skills to manage their own support system. That is becuase politicians have been given the gift of being able to say that they are giving all service users the benefits they want of "choice and control", which costs them nothing, whilst slashing their funding.
It is, actually even worse than that. The second reason why Direct Payments service users have had better outcomes than the majority is they have had significantly higher levels of funding than the rest. That has been sustainable financially while the numbers were so small. With Councils now forcing Direct Payments on to as many with a bank account as they can, not only will there be no discernible benefit for them, they will not have the same levels of resource as those who can really use Direct Payments as they were intended.
It is fraudulent policy making to say this is what serivce users want, and this is what will deliver personalisation for all. The evidence is clear that neither of these things are or will be the case for any other than a small minority of serviceu users. The majority need something completely different if they too are to achieve pesronalisation of their support systems.
....or why they don't work!
Personally, as a result of seeing disabled groups completely and utterly disregard the issues that confront older vulnerable adults I have decided to actually *polarise* these matters so that it is clear that there are different issues that apply to the over 65 group (not my classification, but there you are) that do not impact disabled or, to a great extent learning difficulty and children.
So when you try to configure the question before answering it I would insist that we specify which socila groups we believe we are talking about when we find supporters of the PB system.
CS:
Good point (s).... DP's are being forced onto service users in our LA..... they are LA managed (care managers) and, in the broad sense, they appear to work for the most part.... HOWEVER.... and it's a big however, the system is being used to re-assess, to re-assess down in EVERY case we have experience of (over 600...) and to use artificially forced LA commissioned prices to calculate the financial award. In every single case, bar none, the DP client has not been able to buy the same personal care they received as a direct provision from the LA. It's a *below the line* cut that is not being seen by anybody other than those individuals involved.
Absolutely right!
It is all an illusion. There IS no money left after the barest of personal care provision is bought and paid for to make ANY choice. The reality is, also, for the most part, the older, frail service users don't want control...they don't even really want a choice over who actually provides the personal care (heaven knows how they make a choice anyway....from a list of 10 -15+ named providers...who knows how to choose under such circumstances).
All they really want is to have personal care provided at the same time each day, every day, preferably from the same (set of) care workers and to draw up a 'friendship' type relationship with their care worker. It's not rocket science and it's being de-railed by other social care groups who DO want choice and control and who CAN manage their own affairs. This is a clear example of not one size fits all.....
Good point also...
I just couldn't agree more.
I wonder if we could explore possible common ground? Its clear that many older people, especially people in some kinds of circumstances (such as isolation) are not benefiting well from attempts to introduce more personalised support into social care and especially as budget cuts have started to impact. You say that from your point of view you feel older people mostly want some consistency of support and people supporting them - important elements of personalisation. If we put direct payments to one side. Have you come across approaches or methods that you think show promise?
glasshalfful - yes, there is an approach that has been shown change of provider organisations, who have to develop their workforce at both front line and supervisory levels to deliver these new responsibilities. It requires Councils to learn how to identify providers with whom they can work in partnership and to treat them as adults. It requires practitioners to ensure their Support Plans focus on outcomes, not tasks. It also requires Councils to understand that providers cannot deliver flexible, responsive and perto offer personalised support to the majority who do not want to become their own commissioners but want mainstream, regulated services to work in flexible, responsive, personalised ways. It iof s through a shift from commissiong outputs from providers to outcome based commissioning . It has to operate at both the strategic (contracting) levels and operational (indivdual) level. It results in transformational sonalised services without paying them a fair price.
glasshalfful - sorry, the previous post seemed to develop gremlins and got jumbled. But yes, there is an approach that has been shown to offer personalised support to the majority who do not want to become their own commissioners but want mainstream, regulated services to work in flexible, responsive, personalised ways. It is through a shift from commissiong outputs from providers to outcome based commissioning. It has to operate at both the strategic (contracting) levels and operational (indivdual) level. It requires transformational change of provider organisations, who have to develop their workforce at both front line and supervisory levels to deliver these new responsibilities. It requires Councils to learn how to identify providers with whom they can work in partnership and to treat them as responsible and creative adults. It requires practitioners to ensure their Support Plans focus on outcomes, not tasks and to trust provider colleagues. It also requires Councils to understand that providers cannot deliver flexible, responsive and personalised services without paying them a fair price
glasshalfull: I wonder if we could explore possible common ground? Its clear that many older people, especially people in some kinds of circumstances (such as isolation) are not benefiting well from attempts to introduce more personalised support into social care and especially as budget cuts have started to impact. You say that from your point of view you feel older people mostly want some consistency of support and people supporting them - important elements of personalisation. If we put direct payments to one side. Have you come across approaches or methods that you think show promise?
No!!!
Sadly, the only model that appears to work... is for a managed budget by a social care professional.
I make that distinction because professionals, as opposed to PA's, appear to *know* how to place personal care provision more efficiently than non professionals, know who does what in their areas and generally knows who can, and cannot, provide the required support.
(in any event, I have grave concerns about the lack of controls over PA's....)
However, I would also temper your comments by saying that the regular personal care visits by regular care workers also is a very good good example of how, and why, subject to sufficient funding (that, in my view, is THE reason we see the cracks in the present system of care provision) simple direct care provision is all that is required. It is about *understanding* what the majority of older vulnerable and frail people actually 'want' for themselves to remain independent and at home. That 'want' is very simple. It is often specific and is usually quite clear. They really, for the most part, do not want to be able to access budget choice activities, they are often restricted by degraded mobility (as opposed to disability), are affected by tiredness and changes in temperature and can be completely bewildered by modern life. Often, short term memory loss and/or dementia onset prevents a lifestyle that allows choice to be made...safety and survival being the order of the day. Aspiration and expectation in this social group is very, very minimal and therein, I suspect, lies the problem of personalisation that has any real individual meaning for a service user.
Without endlessly repeating myself, the reality at the moment is that budgets are leaving nothing - indeed, in most cases are depriving people of fundamental basic personal care - whatsoever to make choices...! That is the problem of addressing this issue. There is NO personal choice to make from the funding and therefore the whole system in this respect is an absolute sham.
One might suggest that until funding is made that is cohesive and complimentary to the introduction of a PB there is little point introducing it....
I'm afraid, at this moment in time, the swing into DP's and PB's is being used to cut the social care cost. That is the reality and the argument is being deflected into finding where it does work, use that as examples of how and why it can work for everyone (...it can't!), create the mantra of personal choice as the nirvanic goal and then quietly watch the fireworks..... meanwhile, the real problem, cuts to funding are being ignored and 'backburnered' in just the way that those forcing through these changes might hope...
I suspect though that we are not far away from each other on this.....