How is personalisation having an impact in your area?
CareSpace support
I work with supported housing organisations, the area of support and not care. Specifically I advise provider organisations - think of hostels, refuges and other support services in which some care may be funded but usually it is housing related support in the form of SP that funds.
It seems the support sector views the entire personalisation agenda as superficial nonsense and a direct threat to any accommodation-based service such as a hostel, refuge or group home situation - and I would suggest with good reason.
Yes of course funding should follow the person and the availability of support should not have to be tied in with accommodation. That theory is sound and should happen, but we all live in the real world. Now we see moves to make the receipt of support a condition of the accommodation (again with good reason) that just the mention of tends to see social care workers throw up their arms in horror. Unfortunately, that is the impact directly of the personalisation agenda.
Take the example of a 10-bedded womens refuge in which all ten residents receive accommodation and support from the refuge provider.
If under personalisation just one resident decides they want their support to be delivered from another and external source then the financial situation of the refuge becomes non viable. 10% of revenue income is simply too much for the refuge to lose. Two residents making 20% sees the inevitability of closure for financial reasons. The same principles hold for a 10-bed homeless hostel
The direction of travel of hostels has seen a massive trend towards smaller and smaller units to avoid institutionalisation and correctly so. A 10-bed direct access hostel is much more preferable provision to a 300-bed unit - again little contention. However such provision needs a minimum staffing lvel due to safety reasons (in both hostels and refuges) and if they are both direcct access this means 24/7 provision. So, the loss of 10% of their largest funding stream - the support element - represents a situation in which expenditure costs remain the same but income falls 10 or 20%. they no longer become viable.
The only protection against the significant risk personalisation holds for providers is tying in the provision of support as a condition of tenure.
Support providers fear the impact and mainfestation of the personalisation agenda and especially so in accommodation-based provision. They also fear that visiting support services are or can be at the whim of service users and can also mean such servicves are strongly threatened financially by it, with good reason. Why should and how can provideers commit to staffing levels and costs if those services can be taken from by service users? A fear of driving costs of often specialist support down to domicilary care levels - ie just on price alone will abound.
If, simply put, personalisation is about giving vulnerable service users more choice, then its funding regime in individual self-managed budgets will create the exact opposite as providers withdraw from the market leaving less available supply. Then it is projected those remaining providers will increasqe costs as is the case with lack of supply in all sectors of the economy. The budget levels given to individual service users will then buy less service from a lesser choice of providers.
It is important to note that funding for support (as opposed to 'care') has no statutory basis and individuals have nor legal right to 'support.' Hence, there are much fewer checks and balances to ensure that an IB given for support will end up being spent on support AND the individual vulnerable person receives such support.
At present IBs and the personalisation agenda is very embrionic in support services and so much of the impact has yet to happen. Though this is perhaps due more to the uncertainties of SP funding itself than design. Many providers expect a significant puch in the personalisation area very soon and hope their fears dont come home to roost
SPeye,
I work in Commissioning and was recently involved in setting up a service, which I think (and hope) will allow personalisation and individual funding to take place in such a way that it would not threaten providers. The provider is very interested in personalisation of services and was more than happy to be involved on this basis
I would be very interested in your views on this and if you think that such a setup would work in the situation that you describe.
The service involves supported accommodation for seven people. It is provided in an eight flatted property, with the eighth being a staff flat. It could equally have been provided in a single eight bed property, the fact that it is individual flats is not central to the funding.
We recognised that the support package for the people consisted of two elements, firstly having the support of someone in the building at all times, that they could call on. Secondly, individual therapeutic work with each client. To allow the clients to have choice and control we separated these elements.
With the provider we costed the provision of a staff member 24/7, management costs and property costs to be £70,000 per year (i.e £10,000 per person).
Each person has an individual budget, but a condition of having a place in this service is that they use the first £10,000 to buy the basic support service)
For example one client might have an individual budget of £20,000 per year. £10,000 is used to buy the basic support service and £10,000 is used to purchase a therapeutic service, either from the principal provider, or from someone else.
In this case, all seven clients are having the service provided by the same provider with a total budget of £190,000. (Average individual budget of £27,000) If however any client should in the future decide that they wanted to use a different provider, the principal provider would simply reduce their staffing to that client, but would still have a financially viable service. This would be the case, even if all of the clients decided to use different providers.
Of course if that were to happen, we would be beginning to question what the principal provider was doing wrong, and consider if they should continue with the contract. This however would be a decision based on competency, rather than because the service provision was no longer financially viable.
A few quick points:
1. The general basis is sound ie having a core support service that is signed up to by each tenant as part of the tenure document. This is in the best interests of all parties. - However:
2. I would revise costings of 24/7 staff asAlso it seems inadequate and unsustainable. Simply to provide single cover 24 hours each day 7 days a week is a minimum of 168 hours or at least 4 FTEs. £70k for 4 salaries with salary on-costs alone only equates to about £14.5k yearly salary per post. Then there is other direct and indirect service costs to add. There is much more necessary costs as well that need to be covered - staff will need handover periodd so its more than 168 weekly support hours. As is 24/7 the costs of cover for sickness, holidays, training etc - i could go on - Yes some income toward costs can be from HB eligible services but this is not likely to cover the actual costs that far exceed £70k
There are many more aspects just on the inadequacies
Ive contacted your profile with details if you need to get in touch
Apologies, I was slightly inaccurate in my initial post. The "additional support budget" ,if I can call it that includes a day support element, therfore the £70,000 is not 24/7, but is in fact for evening and overnight support. I can assure you that the provider has costed this in detail, and costs are being fully covered!
I apologise for having misled in my initial post. The point that I am trying to make still stands though, that with a little creative thinking it is possible to maximise the choice and control for clients without creating a situation where providers are destablised.
Just wondering if anyone is working with personalisation with domicillary care providers and how you feel it is going, how are you coping and how do you think it's changed the role of the social worker? What support or training (if any) are you getting?
Not much happening on this thread. Is that a reflection of little happening "out there"? Or are the people involved so busy that they don't have time to post? Or are there no great issues arising?
I don't have anything to add to what I have already said, but I keep checking here to see if anyone else is interested!
Just an update on the latest coming out of the supported housing / supported living sector on personalisation. The quotes below are from a report yesterday - the Goverments response to the CLG Select Committee report on Supporting People
Original Select Committee Recommendation: Recommendation 6. Personalisation of services is good for increasing service user choice, but sometimes too much choice is overwhelming or even inappropriate. Careful consideration must be given to how to balance personalisation with important commissioned services for people who need emergency support, or who are unable – or unwilling – to choose. Careful consideration is particularly needed of how personalisation will work in accommodation-based facilities. We recommend that the Government extend the Individual Budget pilots to learn more about how personalisation works in practice. (Paragraph 41) The Governments Response 21. The Department of Health took the lead on the Individual Budget (IB) pilots – these have now been concluded and the evaluation report published. 22. Supporting People was identified by the IBSEN evaluation as integral to the success of the Individual Budgets and the most successful funding stream in terms of integration and alignment with social care processes 23. The evaluation also recognised that if FACS (Fair Access to Care Services) had not been the gateway for people seeking an IB, then many more Supporting People service users may have benefited. 24. The Government recognises the value of personalisation, but also that Individual Budgets may not be the most appropriate way of delivering personalisation for all. A working group which includes representatives from umbrella organisations (e.g. National Housing Federation, Sitra), providers and local authoritiy representatives has been established by Communities and Local Government to consider how personalisation and choice can best work for recipients of Supporting People services. A report on the work of the group will be published in early 2010. 25. In addition, officials from across central government departments have established an interdepartmental group on personalisation, led by the Cabinet Office, and Communities and Local Government’s Supporting People policy team is contributing to the work of the group. The policy team is also working with the Office of Disability Issues to consider how Supporting People might be incorporated in the ‘Right to Control’ initiative. My views still havent changed in that whatever the above come up with Personalisation is flawed in theory as it will lead to less providers in the marlet, less choice of provider and incrases in costs from an overall finite budget and hence cannot work in practice.
Original Select Committee Recommendation:
Recommendation 6. Personalisation of services is good for increasing service user choice, but sometimes too much choice is overwhelming or even inappropriate. Careful consideration must be given to how to balance personalisation with important commissioned services for people who need emergency support, or who are unable – or unwilling – to choose. Careful consideration is particularly needed of how personalisation will work in accommodation-based facilities. We recommend that the Government extend the Individual Budget pilots to learn more about how personalisation works in practice. (Paragraph 41)
The Governments Response
21. The Department of Health took the lead on the Individual Budget (IB) pilots
– these have now been concluded and the evaluation report published.
22. Supporting People was identified by the IBSEN evaluation as integral to the success of the Individual Budgets and the most successful funding stream in terms of integration and alignment with social care processes
23. The evaluation also recognised that if FACS (Fair Access to Care Services) had not been the gateway for people seeking an IB, then many more Supporting People service users may have benefited.
24. The Government recognises the value of personalisation, but also that Individual Budgets may not be the most appropriate way of delivering personalisation for all. A working group which includes representatives from umbrella organisations (e.g. National Housing Federation, Sitra), providers and local authoritiy representatives has been established by Communities and Local Government to consider how personalisation and choice can best work for recipients of Supporting People services. A report on the work of the group will be published in early 2010.
25. In addition, officials from across central government departments have established an interdepartmental group on personalisation, led by the Cabinet Office, and Communities and Local Government’s Supporting People policy team is contributing to the work of the group. The policy team is also working with the Office of Disability Issues to consider how Supporting People might be incorporated in the ‘Right to Control’ initiative.
My views still havent changed in that whatever the above come up with Personalisation is flawed in theory as it will lead to less providers in the marlet, less choice of provider and incrases in costs from an overall finite budget and hence cannot work in practice.
SPeye: Personalisation is flawed in theory as it will lead to less providers in the marlet, less choice of provider and incrases in costs from an overall finite budget and hence cannot work in practice.
I think that this is a sweeping generalisation. Whether or not Personalisation is flawed depends on what you believe it to be.
I believe that personalisation is about.
I don't see what is so flawed with those ideas. If people have different ideas or are adopting different practices, then perhaps their may be difficulties, but that does not mean the the whole thing is flawed.
Also not sure how you can say that less providers will be in the market. As far as I can see the only providers who might leave the market are those who can not provide what a client wants. The inovative providers who move with the times and meet client expectations will flourish. I feel that it may take time to work through, but the market place will grow in my opinion
I tA provider has a hink its a very naive view to say the only providers that will leave the market are those that cant provide what a user needs.
Many providers may have accommodation as well as support or care and they are funded on that basis. Hence if the service user wants an external provider of support/care them the financial model on which it is based collapses.
Take any client group MH/ALD/Older Persons for example who reside at such a facility - lets say a 10-bed facility. If they choose (on a whim or with good reason) another provider of support or care then the financial model of the provider suddenly has a 10% shortfall - if two its 20%. Very quickly that facility becomes non-viable. Hence providers will flee the market despite 'satisfying' 80 or 90% of their customers - that is very different from not providing what a service user wants.
Given that there has been a massive move from residential care to supported living model over the past decade or so (mainly because it can be part-funded by HB rents as much as anything), what personalisation will do is actually reduce choice because providers cant make accommodation-based services sustainable if one or two users decides they want an alternative provider of support or care.
This reduced choice of suppliers or providers will lead to increases in costs of care and support as well as reduced choice - the exact opposite of what personalisation claims will happen in theory.
New entrants to the market will be discouraged as the risks of personalisation explained here will make new provision or new entry into the market too risky and far less sustainable.
Without an adeqaute supply of provision and an adequate alternate provision personalisation cannot work in practice - the rabid promotion and selling of 'personalisation' as increased service user choice is delusional and the 'sexy' theory is so incredibly superficial and in practice will lead to the opposite and deny real choice for vulnerable service users.
Speye,
It seems to me that you are allowing your defence of providers to obscure the rights of clients. Up to now, the system of commissioning services has been based around providers and the business proposition that they were able to offer. Personalisation changes this system and moves the choice and control to the client.
The fact that you suggest that a client’s choice might simply be a whim rather than a reasoned and thought out decision shows that like many people who work in social care, for all the words that you say, you actually don’t respect your client’s right to make choices.
In the example that you give above you suggest that a 10 bed facility should continue to exist even if people no longer want it, simply to protect the position of the provider. In any other field, if your business model does not suit the market and the demands of your client then you have to look at your model. Your view seems to be that the provider decides the model and councils should simply fund that model whether clients want it or not.
People who require support, need providers who are willing to respond to their needs. Those who think that that they can continue to provide “old hat” services and be blocked funded to do so will wither on the vine like they deserve to do.
Joe, whilst I agree with the general drift of what you say, I think you are being unfair to Speye, who raised the issue of a facility where one or two people wanted to change their service supplier, but the majority did not. The facility could thus become non-viable, over-riding the rights/choices of the majority, who would lose their supplier of choice.
Joe90 – I take your point, but I would argue its the opposite, and is a rejoinder to the naive primacy of client need and not client need itself.
Personalisation is great in theory for the client and even for market principles, yet we have a very skewed and far from perfect market. It’s a market like any other that has to face up to practicalities even if they (annoyingly) appear as constraints.
The commissioners in that market - like any market – need to understand the issues providers have (and many don’t) not for the sake of the providers themselves, but for the impact however unintended that may be on vulnerable service users. If you re-read my concerns about providers they are genuine concerns about vulnerable service users because of the impact it will have – less suppliers and increased cost will damage vulnerable peoples needs.
I’m not advocating ‘old hat’ or the “we have always done it this way” at all for providers – they have to change and adapt, or flee the market. They are already fleeing the market at the prospect of Personalisation and some need to go too. Yet even the best ones are considering the risk of Personalisation as too risky and that is my deep concern.
In supported housing for example, that is my area of (alleged) expertise, we have seen the primacy of “funding must follow the person” over any practicalities. Personalisation is similar in many ways to this – great theory but very troublesome in practice and it prioritises clients wants. Yet we have seen a 43% reduction in funding for homeless hostels and a 22% one for DV refuges – both accommodation-based services that have and need support to be tied in with tenure. The replacement in visiting support is far less in quality terms, less in responsiveness and proactive terms and costs more - sometimes double the cost from official figures - all from a finite budget. The principle of “funding follows the person” is a very superficial one as has been demonstrated in 200,000 less vulnerable people being supported largely due to blind adherence to this theoretical good.
The upshot of this is that vulnerable service users have less choice and have a higher cost – and commissioners in social and health care are now moaning that there is not enough supply and its harming their budgets (a fourfold increase in NHS cases of caring for rough sleepers and homeless being the latest example this week.)
Over many years and decades we have seen many great theoretical policy initiatives become the antithesis in practice. My deep concern is that Personalisation is the same and those it set out to help will be the ones that bear the brunt of fewer services and less chance and choice of being helped -
Ok, hands up folks, I admit I was a little hard on SPeye and I apologise. I was probably placing him/her in the position of all the poor providers that I have come across and dealing the blame on that basis! Sorry!
I have certainly come across many providers who do wish to keep trotting out the same old services in return for their block funding, when the service could be provided at a higher quality for a lower price if they listened to clients and responded to what they really wanted.
SPeye: Personalisation is great in theory for the client and even for market principles, yet we have a very skewed and far from perfect market. It’s a market like any other that has to face up to practicalities even if they (annoyingly) appear as constraints.
As you say, personalisation is great in theory for the client and the market. With that in mind, we need to try to make the theory work in practice rather than rejecting it completely. I would go further and say not simply that it is great in theory, but that it is therfore the right thing to do.
I also apprecaite that a provider who has set up a service on the basis that it is for 10 people will face problems if their are only eight using the service. But the response simply has to be a reconfiguration of the model so that it works with 8. We can't simply say that 2 people must go on accessing a service that they do not want.
Introducing personalisation is not without it's challanges and it is not the universal cure all that some people claim. However the alternative to going down this route, is going doen the route where we say that clients shouldn't have the right to make fundamental choices about their own lives. That is a situation that I couldn't possibly support.
Personalisation even with all it's difficulties has to be the right way to do things. I am aware that some local authorities are doing it badly and are using it as an excuse to cut costs. That is not something I can support. However there are many in which people are designing and receiving high quality services that are personalised to them and fully meet all that they would desire in their support. This is what we should be striving for.
Joe90: "I also apprecaite that a provider who has set up a service on the basis that it is for 10 people will face problems if their are only eight using the service. But the response simply has to be a reconfiguration of the model so that it works with 8."
Easily said, but often not feasible when buildings and other capital items are involved. So the provider may have no choice other than to close, and the 8 lose their preferred choice, for the benefit of the 2. Is that the way we want to go? The funders are hardly likely to agree to paying a higher unit price, just to keep the 8 happy.
Joe90 – Thank you for being gracious enough to apologise, it is genuinely appreciated.
Yet I have problems with a couple of your points. Just because something is great in theory doesn’t mean we should go ahead. I’m minded of the policy of introducing random drug tests for prisoners – surely unobjectionable and great in theory. Yet as Cannabis stays detectable in the body’s system for up to 28 days and heroin about 72 hours the unintended consequence was to move prisoners en masse from cannabis onto heroin!!
The second issue is with “...the response simply has to be a reconfiguration of the model so that it works with 8.” The 10 bedded units cost of delivery is based on 10 paying an equal share. To ‘simply’ make it viable on 8 involves the ‘simple’ choice of increasing the cost by 25%! That is not a ‘simple’ or likely solution at all. In practical terms the same staffing compliment is needed for 8 or 10 service users and staffing costs account for anything between 60 and 80% of all provider costs.
"Dear SSD, as you have advised 2 of your clients to source alternate support and care I trust you will be paying a 25% increase in funding for the other 8 charges of which you are responsible. Yours etc”
Personalisation has many challenges not yet considered. Recent legal cases and legal precedence can mean that in the scenario above, the decision of the 2 could be legally challenged by the other 8 under DDA duties of councils. I am awaiting legal advice on this and will explain in detail as soon as I receive this.
I may have mised how the issue of individual payments to service users has finally been decided upon but anyway I am not clear, perhaps other people have a view.
I understand that DLA will still be paid to people on personalised budgets. I suspect that in the medium term however all the finance streams will be thrown into the pot. If I was a politicain with control of budgets this would certainly be a question I would ask.
With limited budgets/ cutbacks for social care would it not be a possible plan for all the current finance streams to be Needs Tested. So ILF, DLA, Supporting people monies would all be in the pot to meet assessed need.
This prospect concerns me as somebody who may have to do these assessments.
Also whilst we may be keeping to the principles of choice in the spending of the payment the amount of income would be so finessed around the definition of their "needs" that it leaves little choice in the way that it can be spent.
I would expect most people to spend the funds sensibly in their own best interest but realistically we know that some people won't. There is evidence of this from current direct payments.
Will we be saying that people with capacity who do not spend their funds on what the local authority has defined as their needs are solely responsible if their choices leave them in possibly critical difficulties?
It would be a dangerous folly to include SP funding into the mix of personal budgets as described above for a few reasons.
SP is not an entitlement to a service user whereas DLA, ILF and care (depending on level of assessed need and availability) are service user entitlements. SP is only an 'entitlement' to a provider under contract. So to rely in part on SP funding to formulate any part of funding is dangerous.
SP can be withdrawn at any time and especially so now that it becomes unringfenced from April forming part of LAA / ABG funding. Hence councils can decide to spend this on roads or libraries or anything - it is NOT restricted to any form of social care spending at all.
That is another reason why providers are fleeing the market to add to my comments on the 'personalisation agenda' above.
If and when SP funding is withdrawn or no providers are funded in the expertise needed for the IB holder what do they then do?
Exactly the sort of thing that concerns me. In our authority all care plans were looked at and if some of the care package could be deemed as being supporting people this was changed to supporting people. Usually with no consultation with the care manager or they may not have had a care manager. This in a substantial number of cases had an impact on ILF that caused so much time and effort to sort out.
I wasn't advocating that all the monies should go into the pot but I suspect that will end up being the fairest way of doing it. It will cause problems, I think, if the funds that individuals are getting - based on need assessment - are different from funds that other people are getting that are not so strictly needs or means tested.
If say supporting people funds are not ring fenced how can an assessment and allocation of resources be realistically made?
The sound bite part of individualised budgets is of course to be applauded but the thing is that the personalisation agenda is as much about resource allocation as it is about individuals choices.
Social care can be part of the benefit system is this a good thing or a bad thing?
SP was intended to be a prevention funding stream, provide support by a resident warden in sheltered housing as this prevents or at worst delays an older person needing to go into residential care. Thats a fundamental difference to care funding which by comparison is reactive after needs have got to a certain level, and the same goes with benefits such as ILF or DLA. Hence to incorporate this anomaly into other stable funding streams just to pay for reactive meeting of needs is bizarre.
Apart from anything else moving part of the SP budgets (£1.6bn that save public purse 3 times this according to official figures) is a false economy. Its just taking money out of prevention into reactive funding and thus stores up more need and cost for a later date - anyone for an ultra uber critical eligibility banding in care?
To put it into IBs is even worse. When and not 'if' the provider of support becomes not available because of the incredible superficiality of personalisation (see above) then choice and its lack of is imposed upon the vulnerable service user an d furthe inhibits their choice (as well as increasing need through anxiety and instability caused!)
IBs and direct payments - isnt this when vulnerable service user is given £x and told find the best you can for that amount? Yes it is but its not being viewed that way. Service is not need led it becomes de facto resource led. That is very dangerous not only to the vulnerble service user but to cost and resource. It is in fact resource dumping on vulnerable service users passing the buck to vulnerable service users, yet the great and good say it is choice and the theroy is right but thats nonsense as it ignores the obvious and inevitable practical elements..
SP has had a similar theoretical panacea to 'personalisation' calledd floating support. The great and the good advocate two theoretical goods for this - (a) funding should follow the person, and (b) support should be separate from accommodation - eg older persons shouldnt only be supported by a resident warden, all oder persons should receive support wherver they live. Both in isolation and theory are to be applauded.
Yet in practice official in payment figures nationally show resident warden model cost £11.36 for each hour of support, and floating support costs £23.02 - more than twice the cost. All of this comes out of the same finite budget of £1.6bn. Hence FS model might make theoretical sense but practically it costs are prohibitive. The upshot is demonstrated by the fact that the UK SP budget supported 200,000 FEWER vulnerable persons after the first 3 years, of which 110,000 FEWER older persons were supported.
So great theory but a nightmare in practice that will result in greater cost to public purse and a greater demand on care budgets. And note well that the panacea that is the FS model has to be less qualitative support as it is far less reactive and far less proactive - support delivery goes from a resident and available support to 2pm every second tuesday.- but hey thats just another aspect that the great and good 'resource allocators' convenintly ignore!
With SP unringfenced totally from April and available to offset social care budget deficits then this will happen - but again this is resource shifting from preventative to reactive storing up even greater demands at a later date. Cynical? No! Thats the audit commissions official view and stated as such back in 2006 - and for once they are right and have it spot on, yet it reflects what I and many others publicly have said since 2003.
The realm of theory is great if it stays there, the practical is far more important and the relentless promotion of the personalisation agenda needs to be considered for what it is and will do - imposed less choice on vulnerable people and the exact opposite of its stated aims. Who is goign to wake up and smell the coffee?
For me, Personalisation is one of the best responses to the decades old 'crisis' in Social Work.
The crisis itself is that as society has moved progressively towards a postmodern way of working, Social Work as a structure is fundamentally modernist. I think Social Work has to have some basis in the way society fundamentally functions, and 'block contracts' simply do not cut the mustard anymore. Social Work and Social Care has nearly always favoured the larger organisations and service providers, forgetting the wishes and feelings of those that they have been designed to work with, the people on the ground who require the support and services.
Personalisation means Social Workers will have to begin to think again, to be creative, and willing to come up with ingenious ideas. This is a positive way of flushing out old, tired elements that allow us to stagnate and reinforce the image that the public have of Social Work.
There is still so much to iron out in all this and it is by no means the 'savior' when it comes to services, but it's quite possibly one of the most positive moves to have been made in the last two decades. I have moved from an authority that was piloting personal budgets for disabled children over 2 years ago, to one that is only just beginning to start piloting, as disappointed with that as I am I can't wait to be out there really pushing the positives of Personalisation and the power that this really does give to the people.
Just two quick points. First is that my comments above refer to adult services not childrens services and im ready to accept that the situation re providers and negation of choice may not apply there.
The second is a simple question. Can anyone provide any evidence that personalisation does increase choice and does work? Even the personalisation tsar has stated the evidence is not conclusive - a euphemism for we dont know if ever I saw one - so where is te evidence that is works?
Hmm. So theory of personalisation = good. Prospect of it working out in practise = doubtfull? Pilot projects seem to have had some positive results but hard to determine exactly what.
Crisis in social work decades old; well yes SW has been attacked from all sides not surprising given the role that SW plays in society. Extremely unlikely that anything will solve the issues that arise as the result of Social works position between the individual/family and the state.
I may be cynical, but although couched in language of choice what this is about is resource allocation. The conservatives and New Labour have consistently talked about choice in education and health. What actually appears to have happened is that the more wealthy or well connected or articulate you are eg can bus your child to a different school, can advocate with health services, the more likely you are to benefit from the advantages that the welfare state provides. This is not a surprise, this is not new. I cannot see personalisation making any difference to this. I cannot see the govn't wanting it to make a big difference - it would mean redistributing wealth.
I know it is not a scientific sample and is anecdotal ( not much difference from the surveys I have seen in fact) but theolder people I talk to about personalisation have not wanted personalisation per se they have wanted easily accesable services that meet their needs. There will always be conflict about what needs or wants the state will provide for. Its not neccesarily wrong to say "here's your slice of the pie, do with it what you want. it's your responsibility now" but we have to have our eyes open. If or when this whole project goes wrong central Govn't has already tried to ensure that it will look as if it is the responsibility of local government.
Does anybody think that it is impossible for Social workers to be proactive, preventative, imaginative and so on ? Certainly there will be some, maybe me, however these qualities seem to be not vital elements in progression through management do they? If these qualities were consistently part of the culture of our organisations perhaps it might be easier to resist constant tinkerings with structure to try and achieve budgetry and political ends. However what managers say is that they are constantly directed by central government about what they should be doing and having to provide statistics and worry about their rankings. Seems to leave little time to show much leadership about practise.
gchdevon: "I may be cynical, but although couched in language of choice what this is about is resource allocation. The conservatives and New Labour have consistently talked about choice in education and health. What actually appears to have happened is that the more wealthy or well connected or articulate you are eg can bus your child to a different school, can advocate with health services, the more likely you are to benefit from the advantages that the welfare state provides. This is not a surprise, this is not new. I cannot see personalisation making any difference to this. I cannot see the govn't wanting it to make a big difference - it would mean redistributing wealth."
I think this sums it up. Those who are articulate and "know their rights" will make personalisation work - for them. Those who are not will get a worse service, or none at all.
I agree with Surfer with regard to articulation and knowing ones rights and entitlements though that applies to all 'initiatives' and not just personalisation - more of a general valid principle.
As for resource allaocation or choice Im linking the lead story today of Audit Commissiion telling (pontificatingto ?) councils to get spending on older persons registered care down to less than 40% of all older persons spending. That is resource allocation in context whether its spending on IBs or direct payments or whatever and must mean direction is given to councils on increasing the preventative spending thereby spending less on reactive registered care.
Given that SP funding (the preventative agenda that prevents the need for care or at least delays it) was spent on 110,000 fewer older persons in its first 3 years than at the outset of SP, then a clear direct link is established.
Yet I note the AC choose to attack local government for this and dont attack central government for reducing in actual and in real terms the money they provide local councils with for this preventative SP spend! How convenient!!
The Personalisation agenda is similarly just another political resource allocation that is as much a misnomer in increasing "Personal" choice as SP is in actually 'supporting' people - and for completeness the 110,000 fewer older persons supported were part of almost 200,000 fewr vulnerable people supported by SP after its first 3 years. The danger is that 'personalisation' will go down the same route and replace existing care with a floating / visiting care delivery mechanism that costs more and so will lead to greater need for registered care with all its institutionalisation matters for vulnerable peole and greater cost matters on budgets.
Personalisation is being embraced enthusiastically in my area - as a justification for cutting costs and services of existing clients with 'expensive' and very neey clients with complex care needs. I speak as father of a young adult with very complex care needs as well as Trustee of x2 provider organisations and many years experience in social housing sector. This Soc Serv/Health Auth has identified most expensive 'cases' and put them to a consultant for review - they are to be paid on cost savings results - not appropriateness of care. Like Care in the Community Personalisation is a perfectly good concept in theory but has been hijacked to cut costs by such things as using the indicative resource allocation matrices of In Control to set cost cielings regardless of need.
This debate obviously raises emotions. Can I just say for purposes of clarity that if any authority is using the In Control RAS to "set cost celings regardless of need" then they are using it wrongly!
In Control would clearly say that the RAS will only work for around 90% of clients and some will require an allocation of funding beyond it's scope.
I'd agree they're using it wrongly. But they are doing it. It isn't being driven by well meaning professionals with a committment to getting the right package for the person. It's being implemented onto social service front line staff by commissioning sections separated off specifically for the purpose, who in turn are driven directly by the budgetary constraints of the Local Authority. When Personalisation reviews are initiated it seems never to be for person centred reasons but rather for resource driven reasons. This is why Personalisation for the client with an existing package feels more like personalised targeted service cuts than person centered package design.