The Social Care Institute for Excellence updates guidance on delivering personalisation in adult social care
Scie has been at the forefront of supporting the adult social care sector to adapt to the fast-moving personalisation agenda. It has already revised its Rough Guide to Personalisation, has launched an e-learning programme on personalisation for social work education and training, a Social Care TV programme highlighting the positive impact of personalised services on people’s lives, and a series of briefings for providers and other stakeholders.
- Tailoring support to people’s individual needs and maximising choice and control over care and support.
- Ensuring that people have access to information, advocacy and advice to make informed decisions about their care and support.
- Finding collaborative ways of working that support people to actively engage in the design, delivery and evaluation of local services.
- More widely, local authorities are expected to:
- Develop local partnerships to co-produce a range of services and opportunities for social inclusion and community development.
- Embed early intervention, re-ablement and prevention in service planning and provision.
- Recognise and support carers.
- Ensure everyone has access to universal community services and resources as well as opportunities for meaningful occupation.
- Personalisation, therefore, requires change at every level, including its organisational culture.
Personal budgets are central to delivering individual choice and control. By 2011 all local authorities in England should have made arrangements for at least 30% of eligible adults to receive a personal budget to arrange and pay for their own social care, and to have access to the information and advice services they need to support this. Ultimately, all eligible people who need social care and support should have access to a personal budget.
Self-directed support – the mechanism and framework whereby personal budgets are delivered – is central to local authorities’ delivery of the personalisation agenda. It is based on the principle that the service user knows their own needs best. They can be supported by their practitioner, family and friends in planning how to spend their personal budget.
Unlike individual budgets, which draw on several funding sources, personal budgets draw only on local authority social care budgets. A personal budget may be in the form of a direct cash payment, held by the person or by a suitable person on their behalf; an account held and managed by the local authority; an account placed with a third party provider; or a mixture of these options.
The provision of personal budgets needs to be consistent with the principles and values of personalisation – that is, maximising choice and control for service users, their carers and families. The Department of Health is clear that local authorities should avoid strategies to “bolster personal budget numbers at the expense of the wider Putting People First agendaWithout changing internal processes and culture, establishing support services, developing markets and altering commissioning contracts it is highly unlikely that real choice and control will be provided”.
Most personal budgets are used to pay for personal assistance and home care support but they can be used creatively to produce unique support packages, such as short breaks, leisure activities, access to fitness or arts facilities and education courses, so long as they are legal and meet the outcomes set out in the care plan. Support plans are revised to make sure outcomes are being achieved.
The NHS is exploring how the personal budget model could be extended to include some healthcare services, in the form of personal health budgets for people with long-term conditions, including mental health problems.
Implications for social care
System-wide organisational and cultural change will need to take place in social care so that people, rather than systems and procedures, come first. This calls for co-production – new, collaborative ways of working that support people to engage in the design, delivery and evaluation of services.
Because people will be expecting to choose from a wider range of services in order to find support that will meet their particular needs, the market should develop to offer suitable services. Providers that do not offer good quality care are less likely to survive when people who use their services can choose to spend their money on alternative care.
As personalisation develops, there is potential for social work skills to be developed to include the wider personalisation remit. This might include contributing to early intervention and preventive services, re-ablement, social inclusion, and helping to build community capacity, social enterprise and social inclusion.
Importantly, as Department of Health guidance has made clear, personalisation applies not just to people receiving local authority services to support independent living in the community but also to people in care settings such as private residential care.
Good quality care homes are important for the successful implementation of Putting People First. At its simplest, personalisation, in the context of care homes, puts the service user first in order to ensure that they can exercise choice and control over the way that services are provided. This is not a new concept for the best care homes.
Third sector and user-led groups
Third sector organisations have a key role in providing accessible and acceptable peer support, information, advocacy and advice, and some service provision.
Community organisations and small-scale “micro-providers” will need to be supported by strategic local commissioning so that people from diverse backgrounds and communities have access to suitable support and genuine choice.
The development of infrastructures with independent brokerage, information and advocacy services for people using personal budgets are areas where third sector and user-led organisations can play a vital role.
Service users have argued that implementing highly individualised approaches may undermine collective approaches to support, such as independent user-led services and peer advocacy.
However, Putting People First requires local authorities to support at least one local user-led organisation and put in place mechanisms that ensure people using services and their families have a collective voice in influencing policy and provision.
Putting People First is the government’s agenda to transform adult social care. It places the person, not the service, at the centre. Personalisation means:
- New and strengthened roles for social workers and frontline staff in supporting, advocating and enabling individual client choice and control.
- All those eligible for local authority-funded adult social care to receive a personal budget to arrange and pay for services that meet their assessed care needs.
- Information and advice about services to be universally available in communities to meet care and support needs.
- Increased choice and improved quality of care for the service user, regardless of who funds their care or who provides it.
Case study: Life history can help to personalise services
The life history of a person can play a crucial role in tailoring services to suit their needs.
For instance, Bob used to walk his dog before his evening meal. But after he was admitted to a nursing home with dementia, he would became agitated because he was no longer able to take a walk before his dinner.
Only a detailed knowledge of Bob’s life history, daily routine and habits enabled the staff to understand his individual needs.
Bob’s previous personal evening routine was replicated in the nursing home and he became much less agitated at evening meal times.
SCIE Report 20: Personalisation: a rough guide (revised edition)
SCIE e-learning resources: Personalisation
Author Association of Directors of Adult Social Services; Local Government Association
Title Putting People First: measuring progress
Publisher Association of Directors of Adult Social Services, 2009
Abstract This report sets out a national overview of progress based on the results of a survey of directors of adult social services to measure and report on progress in the first year of Putting People First.
Author Association of Directors of Adult Social Services
Title Personalisation and the law: implementing Putting People First in the current legal framework
Publisher Association of Directors of Adult Social Services, 2009
Abstract This document provides advice to councils to show how the main elements of Putting People First can be delivered within the current legal framework.
Authors GLASBY Jon; LITTLECHILD Rosemary
Title Direct payments and personal budgets: putting personalisation into practice
Publisher Policy Press, 2009
Abstract This introductory text book on direct payments and personal budgets summarises the current evidence and the implications for policy and practice, including the take-up of direct payments in the UK. It is a revised edition of Social Work and Direct Payments.
This article is published in the 15 April 2010 edition of Community Care magazine under the headline The Changing Face of Personalisation