One of our main areas of work over the last couple of years has been the Personalisation of social care.

Personalisation, in summary, is about making services more person-centred.  In a social care context it is associated most closely (but not exclusively) with the idea of Personal Budgets – also known as Self Directed Support, Individual Budgets or Individual Accounts.

The idea behind a Personal Budget is this:  you decide how any money which is allocated to you for your care is spent.  Previously, you would be assessed, and if you were eligible for support from social care, they would tell you what you could have, in order to meet your desired outcomes.  Now, in theory at least, you get to decide how that money is spent.

I say “in theory” because our experience over the last twelve months is that there is a significant gap between the aspirations of personalisation and the reality for a lot of people.

Let’s not underestimate how much of a culture shift this is for the social care system.  We’re talking about power – spending power – being passed down to the people who should have that power.  Traditionally power has been in the hands of people who, as professionals, have been given the responsibility of choosing what care other people should have.  It’s natural that such a shift will take time.

Logistically, this is a massive shift too.  It’s much easier to run systems where those running the system choose what the system will offer, in bulk form.  So it’s easier to run a meals-on-wheels service which will offer meals (which you’ve chosen) to be delivered at some time between 1115am and 130pm, Monday to Friday.  Or to offer a homecare service which puts someone to bed at some time between 830pm and 11pm.

But what if that person wants to watch the 10 O’Clock News, and doesn’t want to go to bed at 830pm?  Or what if they reckon that meals-on-wheels, for all their official nutritional balance, taste like you might expect a meal to taste if it was cooked 200 miles away, frozen, reheated and then carried around in a van for two hours?

This is why I believe in Personalisation.  I believe all too often people get the support that system is able to offer, rather than what people actually want and need.  And, rather than being efficient, routinely giving people services that don’t particularly meet their needs is a terrible waste of resources.  All of this in a system which, I’m sure we’d all agree, needs a lot more resources.

Let me focus on what we’ve witnessed.  Our experience is primarily in two councils where we’ve done some detailed work on Personalisation – and is backed up by anecdotal evidence from elsewhere.  I really don’t think the cities we’ve worked in are much better or worse than anywhere else when it comes to making Personalisation work.

Over the next few days I want to look at some of the issues that we’ve come up against. I’m highlighting these issues not to point the finger of blame – but to acknowledge that there are practical problems which are making it difficult to develop person-centred services in the way that many of us would like. What’s interesting, I think, is that when you consider each issue, it makes you realise two things.  One – there’s a lot to sort out.  Two – you can break down seemingly intractable problems in “the system” into chunks – each of which could be sorted out – if there’s willingness to sort things out.

I’ll look at each stage of a person’s journey through the system – and highlight some of the issues that we’ve come up against.  I’d very much welcome your thoughts – and experiences.

The first problem to overcome is getting an assessment.  The social care system is under immense pressure and it can take far too long to get an assessment.  When you get that assessment, it may be undertaken over the phone – which I’m sure you’d agree, isn’t the best way to assess someone’s complex needs.  One thing’s for sure – this initial stage doesn’t make it easy for someone to consider doing something different – like getting a personal budget.

A complicated process for the assessment of needs:  at the heart of Personalisation is an assessment process (usually called something like a Self-Assessment Questionnaire) which aims to work out what people need.  We’re aware of a Questionnaire (which, in theory, can be completed by the person themselves) which is 60 pages long.  I say “aware” – again it’s only anecdotal evidence – because the council in question won’t actually send us a copy of the questionnaire.

Problems at the next stage – the Resource Allocation System (RAS).  This is the points make prizes bit. Somehow (again, we haven’t been allowed to see the detail) the responses to the questionnaire are fed into a system which allocates points to each answer – which then translate into £££’s – which form what is called an Indicative Budget.

We’re told anecdotally that there is little faith in the RAS – and anecdotal evidence suggests that when the actual Personal Budget is allocated, it tends to be lower than the Indicative Budget (even though guidance suggests that you could actually allocate more than the Indicative Budget, if such spending was deemed necessary to achieve the outcomes in the person’s support plan).  Is this because there is little faith in the RAS?  Or because there is pressure to ensure that Personal Budgets don’t cost more than traditional services?  I imagine it’s a bit of both.

Next time I’ll look at the support planning and brokerage stages of the process.  As I say, I’d welcome your thoughts on this – in particular your experiences – and any examples of where the system is working better than I’ve suggested above.

This entry was posted on Monday, June 6th, 2011 at 6:54 pm and is filed under Public services, Social Care, Social change. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.