Making it Real for everyone - Leeds event

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The national learning events for the Making it Real for everyone - a personalised response to Winterbourne View have allowed for honest debates on what is and isn't working in person-centred social care provision.

At the third event in Leeds, Real Life Options - a learning disability provider - and Leeds City Council shared examples and opened the floor for providers, commissioners and family members, carers and people who use services to get involved and discuss both milestones and challenges.

The following is a summary of the day's learning.

Personalisation

Personalisation only works when it is about person centred action, not just ideology or words.

Stories about examples of successful personalisation could be summed up by "it is at its best when it is about what my son wants, and not about what someone else wants".

Features of successful personalisation in practice

  • Where people had individual choice and control;
  • Where risk was seen as an opportunity and managed positively;
  • When it was aspirational, innovative and provided positive opportunities beyond traditional services, especially day services;
  • When it is done in a person's bests interests, with good approaches to person centred planning, using plenty of common sense;
  • When the local micro market is developed;
  • When innovative and flexible use of Direct Payments and individual budgets are positively encouraged.

Features of poor personalisation

  • When it is used inconsistently by different people;
  • When what happens is ultimately defined by services and prescriptive professionals;
  • When commissioning is not person centred and informed by peoples experience;
  • When block contracts dominate the market;
  • When the use of Direct payments and individual budgets is constrained, inflexible and over managed by services;
  • When there is poor access to good information, effective brokerage, and strong advocacy;
  • When other legislative changes and funding streams interfere with a personalised approach.

For some people returning to the community of their origin was not always the best thing; they have made better links in their new area.

Collaboration

There were a number of examples of good collaboration - in Partnership Boards, different types of leadership groups and Winterbourne View specific steering groups.

Features of good collaboration included: trusting relationships, a "can do" attitude and active involvement of families and self-advocates.

Some areas ran provider forums or developed relationship with preferred providers, which allowed closer working relationships and increased choice for individuals, although some preferred provider lists had the effect of restricting rather than promoting choice.

Break down of collaboration

Poor joined-up working was evident in children and families services especially at times of transition; with some providers, assessment and treatment units around discharge arrangements and where there were poor links with housing providers and with specialist commissioning from NHS England. It was also noted that poor collaboration showed up particularly at times of crisis.

One of the key reasons for a breakdown in collaborative working was the lack of strong leadership and commitment characterised by a culture of lip service and box ticking.

Co-production

Co-production works when there is a shared vision of the future,

there are shared values, and there are shared approaches to risk taking.

Good communication is at the heart of co-production and this occurs when it is underpinned by strong leadership and commitment, and characterised by honesty and integrity.

Up to date information about the current situation is regularly shared with all parties.

Good co-productive practice

There were examples of good co production that positively engaged families and self-advocates i.e some Partnership Boards, Good Life Leaders in Leeds. Self-advocates in some areas have been involved in writing service specifications, selecting providers, and selecting staff.

Co-production is also supported when procurement services are on side, where contracts are person centred and individualised.

Breakdown in co-productive practice

Problems occur when information is not collected and/or shared, where professional attitudes are paternalistic or poor, and when the idea of co-production is not understood (a common complaint), and not resourced.

Challenges to co-production

  • Tensions between what support is paid and what is provided through natural unpaid people and networks;
  • Engaging with local communities and networks as part of the co-production process;
  • Interference from organisational change, new legislation that seems to go in the opposite direction, and bureaucracy;
  • When it is important to work across organisational and geographical boundaries.

Conclusion.

The main theme that emerged from discussions was the importance of meeting the challenge to stay personalised when budgets are cut. This is making it very difficult to stay person centred, and to use Direct Payments and individual budgets in the way they were intended - to give people choice and control over what their lives are like, and how and by whom they are supported to do what.