Personal experiences of transformation: South East

Ian lives in Kent. He employs Maureen as a personal assistant using his personal budget.

Ian's story

In April 2007 I married Denise. It was a fantastic weekend, the weather was beautiful, a big family wedding, a big celebration; the start of our future together. While we were organising the wedding, I felt fairly rough and pretty run down, but put that down to everything that was going on. A week after that I was in hospital and wouldn't be walking again.

I remember being taken straight into A&E and I remember a doctor giving me a shot of morphine, putting a catheter in and that's it. The next thing I vaguely remember is that on May 6th there was a string of cards above my bed and I had been in a coma. The illness had left me wheelchair bound, quadriplegic, unable to feed or even hold my head up in the early days. It took nearly six months just to be able to sit in a chair. The worst part was the unknown prognosis in terms of how much of a recovery I could make.

In mid November I was discharged and about a week later my case manager visited me. He realised very quickly that we had major problems. The biggest problem was for my wife - how was she going to cope with someone in my condition?

The social care team looked at the whole family and the whole support package we required. That was when we started talking about Self Directed Support and it became apparent early on that the 'Kent Card' was the way to go. The Kent Card is a Visa card from Kent County Council. The flexibility of the Kent Card makes it easier for me to pay for services in a secure manner and I use it to spend my Direct Payment.

I use my Personal Budget to pay for the services of a self employed personal assistant. I call her in as and when I need her and I pay for her time and any expenses direct, using the Kent card. I also use one of the local care agencies. They have people that come in on a regular schedule to get me up and to help me if I need them during the day. It's having access to very simple things that can make a huge amount of difference to the way you live your life.

The beauty of personalisation is that you've got a family life back, so you are getting back to some kind of normal routine, or as normal as you can make it.

Ian's TOP TIP

"Don't be afraid to be different. We don't all fit into the same boxes. I am not a "Service User" I'm an individual. The 'Professionals' have to stop ticking boxes and get to know the person and find new ways to give us opportunities. With the right support and effort you can get your life back."

Teresa's Story: Ian's Social Care Team Manager

I am Ian's Social Care Team Manager and have worked for Kent County Council for almost 18 years.

To meet the new challenges of Self Directed Support, Kent County Council restructured its Adult Social Services Directorate in October 2009. It was the first major restructure of Adult Social Services since the introduction of the NHS and Community Care Act in 1993. In the intervening years "care management" became the norm, which moved the focus of social work towards arranging standard block purchased services and away from the more traditional social work values.

The new system is aimed at giving people requiring care and support increased choice and control. It is the start of what, I anticipate, will be an ongoing and evolving transformation to meet the public's expectation of how they would like their social care needs to be met, both now and in the future. It is, in effect, a return to the more traditional social work values of listening to individuals and respecting their aspirations of how they wish their needs to be met in a safe, flexible and innovative way.

The restructure in Kent has not been without its stresses and challenges. The whole of Adult Services went through a restructure to form new teams to reflect how we intended to implement Self Directed Support. Some management posts were lost and some staff went through a preference exercise to identify the team they preferred to work in. Care Managers and Occupational Therapists are now known as Case Managers. The new teams are called Assessment & Enablement Teams and Coordination Teams. The Assessment & Enablement Teams complete the initial assessment of service users and enable people to reach their potential, before passing the cases onto the Coordination Teams to complete Support Planning and long term work, if required. It is in the Coordination Team that the personal budget is agreed, after the individual has completed a support plan. A Case Manager or Independent Broker can help to complete the support plan if necessary. Brokerage services are, at the moment, still in the pilot stage within Kent.

I was appointed Coordination Manager of Ian's Social Care team last year. I met Ian at a staff training day on Support Planning. Ian and other clients contribute to these training days to make the training "real", and I must say he was excellent at helping staff to understand that support planning can take time and may need a few visits to really make sure the outcomes are appropriate, individual, and meet the identified need.

In the five months since the introduction of Self Directed Support there has been a mixed reaction. On the whole, younger clients have embraced the choices and are generally very good at identifying how they would like to spend their personal budget to meet their needs. For example, I recently agreed the purchase of a camera for a disabled gentleman who wished to do a photographic course instead of the more traditional day care services that he felt did not offer him what he needed. However, some of the older people who are used to more traditional services want a Case Manager to arrange the care package for them, and are not always keen on completing the support plan.

The new structure is very much in its infant stages and is evolving all the time. We are looking at how we can best meet the needs of all our clients so that everyone, like Ian, will feel positive about utilising their personal budget.

Teresa's TOP TIP

"Changing staff culture and mindsets does not happen overnight, however by challenging, supporting, being a positive role model and open to trying new ways of working, we will eventually succeed"

Maureen's story: Ian's Personal Assistant

I have been Ian's Personal Assistant (PA) for over a year. Being a self-employed PA is very different to when I used to work in a care agency. In an agency there is a higher turnover of clients, so there is less interest in each individual, getting to know them and their particular needs. As a dedicated PA I see Ian regularly, and more often I am with him for a longer period of time, so there is more time to build a relationship. This is important, as I can watch out for highs and lows in his mood and know how to respond.

There is also a difference between a "Personal Assistant" and a "Carer". First of all, the individual is looking at you as a PA, and the perception of a PA is different to that of a carer - it is similar to a friend; someone you can trust to let off steam with. Secondly, you are more likely to be providing different types of services. A PA is there to enable individuals to do whatever they want. For example, Ian enjoys trips to the swimming pool and the gym. This has been worthwhile physiotherapy for Ian, as he is working to improve his mobility.

An individual may have lost confidence to do some things, sometimes either because of their physical or mental limitations, or because of how they feel other people perceive them - or both. A PA may accompany a client anywhere where some support is required. This might be a whole day out or a short bus journey.

I can see a number of benefits to the individual of having a personal budget. Individuals have some choice in what the money is spent on and they are in control of the services they buy. They are also able to have a much more flexible service - and flexibility is one of the key aspects to a successful service. I may be needed for just an hour or two, or for a whole day. Ian books my time weekly in advance as he needs it and this enables me to plan my time with different clients productively. Finally I can see that personal budgets give people a degree of independence that is important to their dignity and well being.

Ian is part of a Council project which works with individuals who are using various services to create training programmes for social workers. This has been a great success and Ian has enjoyed being part of a working team.

One challenge in delivering a service is that it is hard for individuals to find details of Personal Assistants. There is no directory as such, I have gained my clients through word of mouth. It would be much better if PAs were able to put their profiles on a local web site where individuals could browse and choose.

Maureen's TOP TIP

"Make sure you establish a clear understanding about payment methods and cycles at the outset. The individual has a personal budget to manage, and some people are better at it than others. They need to ensure they keep aside enough money to pay for their desired and required level of support from their Personal Assistant. Without any guidance on budget management, some people find this difficult. But the main thing is - treat everyone like an individual!"

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