Practice implications

Enabling role for staff

The emergence of personal budgets is a challenge to current arrangements. Should the future model incorporate SP as well as social care (and other) monies, then personal budget holders might wish to purchase new forms of support. Fyson et al found that SP staff who had previously worked in residential care found it difficult to “stand back” and take a more enabling role, and new roles could require a very different attitude and range of skills and knowledge.

Different style of assessment

Assessment could be taking a very different form. The white paper Our Health Our Care Our Say announced the development of a common assessment framework to ensure less duplication across different agencies. This would certainly fit in with a multi-income streamed personal budget agenda and the need to address poor joint working across social care, housing and health. More fundamentally, the personal budget model implies some shift from professional determination of need to self-assessment and self-determination.

Predictive risk

Measures have been taken to reduce hospital admissions rather than maintaining people in valued housing and social settings. The new strategy on housing and ageing makes a commitment to piloting a predictive risk approach that identifies individuals who are at risk of both health and care crises a year before these crises arise. This is an ambitious concept and, if feasible, will have workforce and practice implications.