Personalisation and Professional Disillusionment

Yesterday, Community Care published the result of a survey they had undertaken about ‘personalisation’ among social care professionals.

The headline figures while wholly unsurprising, make for interesting reading where only 41% of respondents felt that service users would benefit from the implementation of personal budgets and 83% felt that cuts would impede the progress of the personalisation agenda.

To which my first thought was ‘only 83%’?

Anyone who has read some of my previous writing/ranting about personalisation will be pretty clear where I stand.

While the idea and the concept of introducing more person-centred support planning and opening up direct payments to a wider range of people is absolutely fantastic as a concept, the implementation has been dire.

There has been a complete side-lining of service user groups that don’t fit into the ‘easy’ mode – namely those with mental health problems, older adults and those who might not have capacity to involve themselves fully in the support planning process, the same figures and quotes that the government and her agencies roll out again and again about the man who pays for a PA to go with him to a football match instead of a day centre are so completely off the radar when the smaller pool of money available for care services exist that they are almost insulting to those for whom a) the thought of having enough money allocated to pay for two tickets to a football match would equal 7 showers a week – so it’s football or cleanliness and b) that group of people (because, yes, much as the government don’t want to accept it, they do exist) that actually WANT to go to day centres.

And so we plough on.

But even though I have had many criticisms of the way that personalisation and particularly personal budgets either managed centrally by the local authority (where the end effect is exactly the same for the service users in most situations) or delivered by direct payments (where someone has to have capacity and desire to take on the direct payment and employ assistants or have someone who is willing and able to do that for them) – there is more to the personalisation agenda and process which is in danger of being lost in the process.

Personalisation as a value base and an approach to work and social work in particular with people who need or who are eligible to receive services for care ties in perfectly with aims of re-addressing the power differential between provider and ‘receiver’ and the imbedded dichotomy between ‘giver’ and ‘taker’ in society.

That model of giver/taker which is bound within the welfare state system can create an imbalance and the potential to give back some of the ‘control’ and some of the decisions to the person who receives services may, in some way, redress elements of this balance. There is no way that my training and experience has taught me better than anyone else, what YOU as a recipient need. Yes, I learnt my theories and my models and understand that building social networks is important but if you prefer to do that at a coffee morning at the local museum instead of at a day centre that’s perfect. If you want your neighbour’s granddaughter to help with your personal care rather than an anonymous and frequently changing ‘carer’ from a local agency who is paid at mimimum wage and has a day full of appointments and who isn’t paid for travel time by her agency so she needs to cut short on some of the time – perfect.

But we already had that system with Direct Payments. Where is the difference?

Ideologically, the difference was that everyone would know how much money they were ‘getting’ – whether directly or managed and they would be able to be consumers. Our society tells us that money is power. Money creates consumers and the market will right itself.

Even, theoretically, when a personal budget is managed by a third party (and I include the local authority as a potential ‘manager’) you will know how much is ‘allocated’ to you so that you can ‘spend’ it in the way you want.

This doesn’t happen in practice though because local authorities need to save money and are still tied up into procurement contracts that make agencies unequal when ‘bidding’ for the funds that have been allotted via personal budgets.

I know this is getting a bit technical and complicated but it’s important to understand. I don’t think anyone can oppose ‘personalisation’ as an approach regarding empowerment and ideology.

The implementation, however, reeks of money-saving and penny pinching. It also has pushed the responsibility for services away from the local authorities and onto individuals and their carers.

You have £100 per week, find the care yourself – then we (the LA) aren’t responsible anymore.

I’m wholly in favour of contracting out assistance and advice on self-assessments and support planning to local voluntary sector organisations. My own LA tried that. We referred lots of people to them.  They withdrew because we were referring too  many people to them and the local organisations didn’t have the resources (or the contract) to undertake as many support plans as were being referred – but the idea is not one I have any problem with and in fact, I rather like it.

But this wasn’t offered to people who do not have the capacity to lead in their own self-assessment and support planning. The organisations couldn’t do that because they were not experienced in non-directed advocacy work – it takes longer.

It is hard to see through the budget cuts as well towards a future where, as Burstow as said he wants direct payments to be the ‘preferred method’ of delivery of personal budgets.  I don’t want to detract from the fact that this is and will be fantastic for some, perhaps most people, we move to a model where there is – again – a ‘one size fits all’ approach.

The true tragedy of the personalisation agenda is that is has and is coming to fruition during a period of cuts – the government (and the previous Labour government too) want to pull back the responsibilities of local authorities and with the criteria for accessing any support is rising rapidly it may well be that more and more personal budgets are delivered directly from peoples’ own savings or disability benefits (while they still exist).

I am fearful of the future for adult social care but I’m not necessarily unhopeful.

I think there is potential for change and development but unfortunately the ways I see of improving systems come at higher cost.  There has to be some major research and debate about the delivery of personal budgets and the way that personalisation encompasses people who lack capacity and lack advocates (family and friends) and how they can best benefit from this process – perhaps access to additional funds to pay for the trust fund type system of management we were assured would happen but in practice is not feasible for a relatively small sum of money as it costs more than it might deliver.

We need to see more about how support planning can work in the voluntary sector as, speaking personally, I genuinely don’t have time to do the process of support planning any justice as a part of my day to day job. It ends up being rushed because I can’t devote a couple of visits of a couple of hours to talk through and develop a truly person centred support plan.

The process of self-assessment needs to be reconsidered because while the idea is fantastic for some people – our self-assessment forms are biased towards physical disabilities and look scarily similar to a DLA form where people are asked to explain how they are on ‘their worst day’. That doesn’t really help with confident-building when you are working with someone who has very low self-esteem and depression/anxiety. The process of self-assessment in itself can and has been traumatic – let alone the person who is not able to engage with the assessment process due to a lack of mental capacity where questions about ‘dreams, hopes and wishes for the future’ while well-intentioned, can be hurtful and hard for families to listen to when they are asked to their parent who has advanced dementia.

I fear we have allowed a great conceit to be steamrollered into simply another ‘one size fits all’ approach to developing social care. It doesn’t have to be like this but that seems to be the government perception about what ‘personalisation and personal budgets’ are.

Choice is fantastic of course, but sometimes people want quality as well. It shouldn’t ever need to be an either/or. It does feel like it at the moment with the promotion of choice above all things.

So where are we going? Personalisation isn’t going away and nor should it. Personal budgets aren’t going away and nor should they.  Local authorities, however, might be going away – further and further away from social care and the responsibilities that they hold towards it.

We keep up with the advocacy and with the systems that are failing because we owe it to those who are reliant on these systems to make them work as best they can but we keep trying to pinpoint and pin down the flaws in the implementation with the hope that sometime, some day, someone will listen.

As professionals we don’t oppose personalisation. We have always been trying to use person-centred approaches. We just dislike injustice and inequity and that seems to be painted all over the current implementation and the frustration is that so few people (if any) in government seem to be aware.  Am I disillusioned? Yes, definitely. We were promised new ways of working in a more person centred way.

Desperate, no, not yet though as long as there’s some fight left in the belly to keep banging on and on and on about what personalisation SHOULD be and why it isn’t working yet. Not for everyone.

13 thoughts on “Personalisation and Professional Disillusionment

  1. This is all about cost cutting combined with reforms(sic) in the Welfare budget; god help us all I feel a Tiny Tim moment coming on and I dont mean the the wacky 60s singer, but a return to the poor law and workhouses or eugenic I fear

    • Thanks Annie. I saw that report but it was after I’d already written this post. A couple of things to note, this is only the first stage of reports from the CQC so we should expect much more – and those reports were written following unannounced inspections which are very rare in care homes now.

  2. I can fully relate to everything you say, except for me the disillusion started a couple of years ago when it became obvious what was happening.
    You are “lucky” still to have self assessments, we were told that because of the ccact right to assessment, self assessment was not valid/legal, so have moved to a very complicated ever changing assessment.These assesments would go to panel and would then be sent back, perhaps for a spelling mistake, or something in the wrong box. Conveniently any blame for delay could then be put at the social workers door, and was…
    Support plannng is being farmed out, people will have to pay for it out of their budgets, I think if they demand a social worker who would be free of course, they have to be given one but its likely they will have to wait.
    Contributions have of course gone up, a clever way of hiding cuts. Meanwhile assessments continue to get harder to get through panel with the blame passed down to the SW.
    Think everyone underestimated the cost of putting all this in place. Especially the time needed for support planning. Especially when a small number of families will take the bit between the teeth and get with it, others, cant/wont/expect it all to be done for them/dont understand what is expected.
    Social Workers are back to 80% of time spent on computers, filling in forms to feed the hungry computer process, which are complicated, time consuming and drain energy/creativity.
    I suspect the then Labour Government would never have supported personalisation if theyd realised it was not a money saving idea. They never had any intention of looking at tax injustice or challenging the bankers so hey an easy option to save money !
    I still think that if the “process” were different personalisation is still a move forward, but currently its slid back to really being case managment by another name. Some still benefit, and have more options, but with less money, affording to pay for things will be harder and harder. Good P/A support is not and should not be cheap, but we all know thats the drive.
    Way forward? More and more people campaigning for the sort of society they need and want. Unless everyone gets involved we are all doomed thats for sure. Unless we are rich enough to not care anyway.

    • Our ‘self assessments’ aren’t really self-assessments in the true sense of the word for exactly the reason you stated above. I just wasn’t sure if our experiences were that same all over. I agree about the time for support planning – we went to training about all these creative ways of planning but there is no time and more work on top of what we were doing before. It might be that voluntary sector can pick this up but the LAs need to factor this in and they haven’t.
      I agree about the purpose always being about saving money and putting in some great words – but the ideology shouldn’t be lost with the processes that are so poorly implemented. It doesn’t mean the idea of self-directed support or direct payments is bad – it isn’t, it is just very narrowly implemented.

  3. Thoughtful article. When Direct payments came in in one authority in Scotland a senior social worker was furious ans said at a meeting “We can’t just GIVE these people money!” (That’s not a story passed on via many people and embellished, it DID happen.) Our authority pays about £46 a day for a Day care placement but pays out much much less for socialisation in DP so that the recipient can only really go out about once a month in reality…

    • Yes, this is a problem. Of course, i have no problem at all with DPs and think they are wonderful when they work but they don’t work for everyone.

  4. This is a brilliant analysis of personalisation! A service user described to me recently that ‘they send you forms to fill in yourself now, because social workers are too busy to come and see you any more’. I was horrified at this complete misunderstanding of why self-assessment was introduced and how, yet again, it just backfires on social workers.

    • Thanks Elaine. It sounds like very similar experiences to mine. The frustrating thing is that we are so rarely asked to contribute to analysis and research about personal budgets. It’s right that the focus is on service users and carers but I also think that front line social workers could contribute as well.

  5. Promoting Independence in the direction of Self Directed Support is excellent but after £512m investment by the government reform grant they clearly now have lost their appetite for it and all that money (half a billion!)will be thrown away. What about those users who have had to undergo a massive change in coming to terms with managing their own support. Now they have to deal with cuts in services and managing their staff’s expectations down. Meanwhile in another department Essex, which pioneered DPs, are now selling off their Childrens Care Homes. Will someone in government please stop messing with people’s lives – in many cases these are vulnerable people who need ..remember the word…SUPPORT!! For goodness sake get a grip and lets have some commonality in the solutions.

  6. I love your rants! As you say personalisation in principle, cannot be disagreed with. But the reality (and this is just another rant) is that it is just as inflexible, controlled and prescribed as careplanning has always been. Creative support planning can and is being achieved but the squeeze on budgets and our time are forcing us to be tempted to be short sighted and reactive rather than thoughful and person centred (risk, risk, risk!)
    I don’t like the idea that being independent and ‘self directing’ means ‘get on with it’yourself and good luck. There is nothing wrong with depending, for a short time, on professional, well paid workers to advocate, support, facilitate and do the job we were trained to do. ‘Independence’ is much more than filling in paperwork youself and stressing out about budgets as we know ourselves!
    We should also be mindful as you point out not to wholley shift responsibility to services users and carers which promotes the notion of ‘obligation’. This only serves to perpetuate the guilt and indeed the poor health of many informal carers who, as we know prop up the care system.
    I suppose our daily challenge is to continue to work in a way that is personal (that is to listen to, to show concern for, take time with… )despite time constraints, paperwork etc, at a time where the term ‘personalisation’ has already become far bigger than the person.

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