Personalisation must deliver for those who have least

By Mithran Samuel, adults' editor, on July 4, 2012 12:01 AM| No Comments

 

Councils have delivered complexity, rather than choice and control, for users in the way they have implemented personalisation, to the particular detriment of those with the greatest needs and the least family support, says one older people's mental health social worker.

[Read full coverage of our coverage of the 2012 personalisation survey with daily updates on our special report page]

 

The personalisation agenda, launched in 2007, was about changing the mould of adult social care delivery in England. We had seen direct payments increasing both options and delivery methods for care and the idea was that these benefits could be extended to all users of adult social care services.

So has it 'gone wrong'? Some of the more worrying elements of Community Care's latest personalisation survey revolve around the discrepancy between the way the policy was envisaged and the reality. While I remember being fed stories about the positive impact that external agencies could have in support planning, 68% of survey respondents said planning was mainly led by council employees, with 3% saying it was led by users and family members and a worrying 0% saying it was led by user-led organisations.

There was a lack of appropriate structures to support personal budgets and support planning across adult social care when the ambitious policy was rolled out. The targets given to local authorities were about take-up rates for personal budgets. These could be met by ticking boxes to make a 'care plan' a 'managed personal budget' overnight without evidencing any differing outcomes in terms of service delivery or choice, so an opportunity was missed. Few lessons were learnt from the implementation of direct payments because the process seemed to be 'more of the same' with a few tweaks. However, what was needed was a more wholesale systemic change in structures - not just of assessment and review but of commissioning and management.

As the survey makes clear, local authority managed budgets remain the most prevalent delivery method for personal budgets. Managed budgets have allowed local authorities to meet the targets by providing personal budgets on paper while using the same block contract agencies, with the same time-limited visits by the same people. I hope that policy makers heed this and pay much more attention to the need for flexibility and choice in managed budgets, and move some of the focus away from direct payments, which are often working better, in my experience anyway.

 

It's important to remember the positive objectives of personalisation - although it's easy to forget sometimes in the face of increasingly complex paperwork that is tailored more to the organisation than the end user, ironically. As social workers we owe it to those who rely on us to advocate for them and push out the message that personalisation is about better outcomes, not processes.

Social workers need to push for greater transparency in the operation of resource allocation systems that currently seem to be loaded or just plain over-complicated. Improving support planning by using advocates, particularly for those who may lack the capacity to make decisions about support needs or lack family who are able to support them in this way, is crucial too, and if this cost needs to be built into the RAS so be it. Currently there is no additional provision for this group of people and the time and consideration needed isn't built into the funding systems, making it 'easier' for the social worker to default to less ambitious and less meticulous support planning as there is no additional time.

The difficulty is that much of the implementation of personalisation has come during a period of cuts. The irony is that good service delivery doesn't have to be more expensive but it definitely has to be less complicated and more transparent. We need to focus on co-producing support plans with people, especially those who rely on managed budgets, rather than embedding bureaucratic systems that alienate everyone, including social workers, who would prefer to be delivering a better system for all, rather than one which discriminates in favour of those who have more family support and louder voices.

http://www.communitycare.co.uk/blogs/adult-care-blog/2012/07/personalisation-has-delivered-complexity-not-choice.html