Personalisation in social care: Webchat with David Behan and Martin Routledge

On Thursday 12 January David Behan and Martin Routledge co-hosted a webchat on personalisation in social care.

This presented a unique opportunity for you to ask questions to them both, and to join the conversation around personalisation.

At the recent Caring for our future engagement, personalisation formed an important topic for discussion, and David and Martin were particularly interested in hearing from people responsible for commissioning, running social care services or for embedding personalisation in service provision.

Below is a complete Transcript of the Conversation that took place.

1:51 Comment from DH Host - Good Afternoon. we will get started in a few minutes. You can start sending in your questions for David and Martin.

2:02 [Comment From Angela Broadbridge (GAIN): ]

Gateshead Advocacy Information Network is nearing the end of a 3 year DH funded project looking at the role and value of Independent Advocacy in personalisation. We see huge potential for the role of Independent Advocates to be promoted by Department of Health, but have found that this role is not readily being promoted by the Adult Social Care workforce, where people are not always offered the support of an Independent Advocate at the self-assessment stage, are experiencing cuts to care packages and require support to speak up and challenge decisions, and in some cases are being supported simply to access the assessment that they are entitled to. Question - Does Department of Health recognise the vital role Independent Advocacy plays in personalisation, in promoting service user rights, choice and control and increased independence?

2:02 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi there everyone, pleased to be here representing Think Local Act Personal. The Partnership has been set up to maintain and support personalisation and community-based to be here so we're really excited to be taking part.

2:04 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Angela, thanks for your question and I'm interested to hear of your project. From a Think Local Act Personal (TLAP) view, we have a workstream in this area. We've recently been reviewing issues and possible options for getting good expert local information advice and advocacy. Our next steps are likely to be to work through our partners to share good practice and develop advice for councils and provider organisations.

2:04 [Comment From joe gough:]

What are the key issues for ensuring the sustainability of personalisation (sorry massive question!)

2:06 [Comment From Martin @ TLAPMartin @ TLAP: ]

A really important question Joe. A few thoughts from me: first it's really important that the way personal budgets are delivered is streamlined with no unnecessary process or bureaucracy. We've recently produced advice on this (on TLAP website 2nd, people really need to be allowed to use their creativity to get the best value from personal budgets with as few restrictions as possible and in ways that help people put together their own personal and community resources with any cash from the council. Third, we need to make sure that support planning is done in a way that maximises people's opportunity to do this themselves or with support from user or carer led organisations.

2:07 David has been slightly delayed but will hopefully be joining us shortly. Meanwhile Martin will be happy to take your questions.

2:07 [Comment From KayKay: ]

what community development models (if any) are being used to support personalisation?

2:09 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Kay. Supporting building and maintainence of building and maintaining community capacity is a critical part of personalisation. TLAP has been working hard on this with councils, community partners and researchers. We've produced a range of practical materials, that everyone can use to review and increase social capital of their local areas.

2:11 [Comment From Martin @ TLAPMartin @ TLAP: ]

Kay, as well as that, we've been working with Professor Martin Knapp from London School of Economics to review the evidence supporting a number of practical approaches, like timebanks and community navigators. there are useful practical case studies on our website

2:11 [Comment From Stockport CouncilStockport Council: ]

Will the 100% target for personal budgets going to be achieved by 2013?

2:12 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Stockport Council. In the survey of ADASS members in October 2011 - they expressed confidence they achieved this target. For TLAP., outcomes and quality are at least as important as numbers. We believe that all councils should have a practical way of measuring the results of personal budgets with their local communities.

2:13 [Comment From RachelRachel: ]

As the parent of a disabled child, I know very little about personalisation and how it will affect us. It seems that the public sector and the third sector are gearing up but the recipients know very little. Its just all words on the television or on paper.

2:14 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Rachel, a very good point. We're really keen to make sure that people who use social care and their families are well informed about personalisation and we want to help councils and others to do better at this.

2:15 [Comment From Martin @ TLAPMartin @ TLAP: ]

Rachel, we recently published our markers of progress for personalisation called Making it Real. its development was led by people who use social care and their families and making sure that everyone who needs to be are well informed and this is a core part of those markers. Making it Real is on the website.

2:16 [Comment From Martin @ TLAPMartin @ TLAP: ]

You'll see that Making it Real starts from a number of I statements written by people and families that say, in plain language, what they would expect to see, feel and experience if personalisation is working well.

2:17 [Comment From jeanette thompsonjeanette thompson: ]

hi all - have we (thats the royal we ie all of us ) started working out the implications of, and the contribution of personalisation to the carting for our future and dilnot stuff ......

2:18 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Jeanette. As you might know, there's been a personalisation reference group as part of the caring for our future engagement exercise. The main recommendations from that have been published on DH website. I've been a member of that reference group and we are going to carry on working with DH on the detail of those ideas and recommendations until the publication of the White Paper. We're really keen to hear any thoughts and ideas you might have for us to input.

2:19 [Comment From GuestGuest: ]

What are the key obstacles to making Personalisation work well for people with complex needs?

2:21 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Guest, you raise one of the most important topics here. The evidence and our experience clearly shows that some groups including for example frail elderly people, people with dementia, people with mental health problems are not currently benefitting equally from the personalisation agenda. As I'm sure you know there are a lot of challenges here but we all must act to address these. TLAP is making this a priority for our work this year including for example exploring practical ways of supporting people with dementia.

2:21 [Comment From Jean from East YorksJean from East Yorks: ]

Is the emphasis on people accessing their personal budget through direct payments likely to continue? This certainly offers potential for people being in control and having choices, but many people are put off by the bureacracy of being an employer, which with the best will in the world LAs cannot simplify. A non-cash PB if done properly could give the person almost as much choice and control as a direct payment and is preferred option for many. Is the 100% target about personal budgets per se or is t he target really about direct payments and are options for simplifying processes still being addressed?

2:23 [Comment From Rachel Rachel: ]

Problem is because we are nice and middle class and are not heavy users of the social care system at the minute because we are deemed to be "coping", we are out of the loop. Im sure we do have a social worker but I have no idea how to contact them or even who they are. I'm sure I'm not alone in this.

2:23 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Jean, I'll leave David to comment on the policy position of this (he'll be here shortly). It's clear that direct payments offer many people the highest level of choice and control. It's also true that some wont want to manage the direct payments themselves. It's really important that councils improve how they deliver managed personal budgets so they can offer similiar levels of choice and control.

2:23 [Comment From Sonia Sonia: ]

Continuing from Kays question-my organisation Nu Social health Organisation, provide opportunities to young and elderly people in the community using Timebanks-in our day to day work we are sometimes asked by clients to support them with personalisation and we are already seeing benefits with Timebanking on some mental health issues. How can our Timebank organisation strengthen the personalisation agenda?

2:24 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Sonia, great to hear about your organisation. Timebanking and other approaches to strengthen community capacity are central to personalisation. We;re interested in the potential, for example, of health and well being boards pulling together individual approaches to personalisation and broader community initiatives.

2:25 [Comment From Barbara DalbyBarbara Dalby: ]

I know examples of LA's not allowing users to pay staff for participating in training - surely a personal budget user as an Individual Employer has the same rights to train thier staff as any other social care employer - this is what driving up standards is all about, especially when it comes to individual isolated from the wider social care community - surley they should have the autonomy to know what would benefit thier staff and indeed in turn benefit them..

2:26 [Comment From GuestGuest: ]

Sorry, didn't put my name, it's Freya (complex needs Q)

2:26 [Comment From joe gough: ]

Is there an equivalent of think local act personal in Scotland?

2:27 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Joe, not aware of a direct equivalent, though policy is developing quickly now in Scotland so hopefully we'll see such a development

2:28 [Comment From GuestGuest: ]

Interesting to see David mention personal budgets. Is the DoH aware that people on the autism spectrum have difficulties in managing money and find organising their own personal budgets difficult. Wouldn't this be counterproductive and not cost effective? More redtape for people who can't cope with it?

2:29 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi there guest, understand the point you're making but it's important to remember that there are different ways that people can take a personal budget, that don't always involve managing the cash. we need to make sure personal budgets can work for everyone.

2:30 [Comment From MandyMandy: ]

Becoming an employer when having a personal budget is sometimes a step too far for some people. Have you any ways to help with this?

2:31 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Mandy, this is an increasingly important issues as the numbers increase. don't know if you've seen the TLAP paper on improving direct payment delivery on our website?

2:32 [Comment From DebiDebi: ]

I would like to take this opportunity of raising the AUTISM issue! As we all know personalisation is very important to people on the autism spectrum. What concerns me is that the Autism Strategy does not appear to cover children and therefore the message of tailored personalised care and support does not get a mention and may children are in my opinion being failed. Also whilst I am on that subject, I would like to hi light the generations of lost autistics currently invisible who do not have a diagnosis and therefore perhaps not the personalised care they require? Thank you.

2:34 [Comment From David @ DHDavid @ DH: ]

Hi everyone. Sorry to join this late. I will start to answer your questions now.

2:34 [Comment From David @ DHDavid @ DH: ]

Debi thank you. The Autism Strategy raised the important issue of recognition and diagnosis. When we spoke to people with autism, they all told their individual and personal stories about how if affected them. All these stories were different, and what became clear through these conversations was the role that personalisation could play in ensuring people received bespoke services.

2:35 [Comment From Barbara DalbyBarbara Dalby: ]

With regard to anyone with any ability managing a Direct Payment can be facilitated by anyone - if they have the correct level of support - the problem is some LA's are cutting the contracts for support providers. Investing in peer support to tutor users/carers and provide an individual level of support for an unlimited timescale, or as and when needed (without having to jump through referral process) to gain that support would be very welcome.

2:35 [Comment From Barbara DalbyBarbara Dalby: ]

Knowing there are others out there for whom the DP system is making such a life changing difference is crutial to the uptake of DP's.

2:36 [Comment From Helen Gibson, AgenciaHelen Gibson, Agencia: ]

We have developed a training guide that assists implementation of objective 6 of the National Dementia Strategy as community and personal support services are developed. Designed for frontline professional staff working with people with dementia, this online, interactive and innovative training guide introduces community and personal support services in a simple and user-friendly way.

2:36 [Comment From David @ DHDavid @ DH: ]

I think this is great now - you're all chatting amongst yourselves!

2:36 [Comment From Gavin CroftGavin Croft: ]

When will we have some sort of national framework to turn policy into legislation and force local authorities to take the personilasion agenda seriously?

2:39 [Comment From David @ DHDavid @ DH: ]

Hi Gavin. The Law Commission in their report made a number of very important recommendations to the Government about changes to the legal framework to support personalisation. The Government is committed to responding to these recommendations in its forthcoming White Paper. Think Local Act Personal's Making It Real: Markers of Progress for Personalisation offers a framework now to support the delivery of personalisation.

2:39 [Comment From RichardRichard: ]

Hi Martin. How is the DoH supporting local health staff to help drive the use of personal health budgets and understand the benefits and savings that this initiative can bring?

2:41 [Comment From David @ DHDavid @ DH: ]

The Department is supporting the pilots delivering personal health budgets. As part of the piloting work, good practice is being shared by our dedicated PHB web pages on the DH website. The academic evaluation of these pilots will be published in October 2012, there are interim reports already available on the website.

2:44 [Comment From RachaelRachael: ]

Hi, have you found there is anything specific that needs to be done to support people with PMLD and their carers to go through the personalisation process? Thanks

2:47 [Comment From GuestGuest: ]

Martin, I would add people with learning disabilities to that, we know of some service users who have personal budgets, but are completely unaware as family/friends manage the budget, or they have a council managed budget, and therefore have no real choice or control.

2:47 [Comment From David @ DHDavid @ DH: ]

Hi Rachael, thank you. The key issue is - is there a dialogue between the individual and their family which focuses on what a person is able to do as well as where they might require some help and support. This approach is common, whatever the needs of an individual. For those people who are able to communicate, it is important care is taken to find the most appropriate means for communication, and for those people who do not have the capacity to consent it is important that an advocate engages on their behalf. There is a good tradition in services to people with learning disability of staff working to promote personalisation.

2:48 [Comment From Martin @ TLAPMartin @ TLAP: ]

Thanks Barbara. Going to back what I have said about allowing people to have the maximum amount of flexibility in using their personal budgets as long as they are achieving the person's agreed outcomes is surely the way to go here.

2:48 [Comment From NickNick: ]

How do you see IT software/the internet aiding Personalisation

2:49 [Comment From jeanette thompsonjeanette thompson: ]

we need to make sure the law commission work interfaces with caring for our future, dilnot and the benefit reform activity currently underway or we will end up in a complicated scenario that is even more difficult to navigate -

2:49 [Comment From jeanette thompsonjeanette thompson: ]

yorkshire and humber joint improvement partenrship funded some work on personal health budgets last year - information can be found on the local tlap website and it included a paper on efficiencies by the centre for welfare reform - that is also on their website

2:49 [Comment From Barbara DalbyBarbara Dalby: ]

My father already has a Personal Health Budget and although not a huge capital amount, the benefits it brings, just knowing you have the control of your own health needs has made such a difference to him both physically and mentally.

2:50 [Comment From DebiDebi: ]

Thank you for that reply David. I am relieved to hear that Autism is high on the agenda. One more thing. People with 'high function' autism are often expected to 'speak for themselves'. Many need their parents (even if they are 32!) to help them communicate. Please could we ensure that the views of the family are taken into consideration. So many families we speak to feel shut out and invisible. Thank you.

2:51 [Comment From GuestGuest: ]

Thank you, sorry my name is Debi, even so autism is a one off stand alone subject and very special consideration will have to be made as to the choices that autistics are offered. Advocacy is vital.

2:52 [Comment From David @ DHDavid @ DH: ]

Nick, thanks. Technology offers some new and different ways of ensuring people's needs can be met. I know some individuals trade personal assistant time using social networking software. I also know that telecare and telehealth can make a real difference to supporting people to live independently in the community. There is some fascinating work being undertaken under the heading of Slivers of Time, timebanking, and e-marketplaces. My sense is that technology will continue to make a contribution in this area, but will never replace the one-to-one contact between people.

2:53 Comment from DH Host: We have about 5 minutes left. We will post answers to any questions that didn't get answered today on this site in the next few days.

2:53 [Comment From British Red CrossBritish Red Cross: ]

Hi David, Really pleased to see the focus on prevention in the caring for our future engagement exercise. With this in mind, would be keen to hear your thoughts on the long term implications of personalisation on any existing (or future) universal social care provision, e.g for those with 'lower level' needs. Thank you

2:55 [Comment From David @ DHDavid @ DH: ]

To British Red Cross. I think we need to be careful not to see personalisation as only applying to selective services. I would argue that universal services are just as appropriate for personalisation. Essentially, personalisation provides people with choice and control, enabling people to make decisions about their own lives.

2:56 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi British Red Cross - adding to David's comments... it's important for the services that all people access to be available to those people particularly at risk of exclusion. people need to use toilets in city centres. people need to access libraries on equal terms...

2:56 [Comment From Helen Gibson, AgenciaHelen Gibson, Agencia: ]

Noting the enthusiasm and shared learning that is coming out of this webinar, I wonder whether there'd be an appetite to do something similar again or on a more regular basis? Any thoughts?

2:57 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Helen, definitely. Think Local Act Personal very keen to keep offering web chats. Watch our website for details of the next one... now that we've done it once, we're getting the hang of it!

2:57 [Comment From David @ DHDavid @ DH: ]

Helen, thanks for the feedback. this is, I think, the fourth of these that we've done, covering a range of subjects. We will continue to do these webchats on a regular basis.

2:58 [Comment From SamSam: ]

My experience of ' managed personal budgets' is they usually equal no change because councils end up buying the same old services. Why not get rid of internally managed budgets and encourage all councils to create external support for people to manage their personal budgets so there is no hassle?

2:59 [Comment From Martin @ TLAPMartin @ TLAP: ]

Hi Sam, the personal budget outcomes survey (POET one) did show that there were some challenges for councils in making sure that managed personal budgets offer real choice and control. one very interesting approach starting to be tried in some provider organisations are individual service funds. we can let people know about it if they contact us. we're also aware of work being done in the North West with councils to explore how they can maximise choice and control within managed personal budget options.

2:59 [Comment From Helen Gibson, AgenciaHelen Gibson, Agencia: ]

Fabulous! Thanks Martin and David! Keep them coming! Impressed by hi-tec ness...!

3:01 [Comment From David @ DHDavid @ DH: ]

Thanks everyone for contributing today. This is the fourth time we have undertaken a webchat. From my point of view, it is a really good way of getting a feel for the questions that you have, as well as listening to your views about progress.

3:02 [Comment From Martin @ TLAPMartin @ TLAP: ]

Just a reminder too that although the Caring for our Future exercise has formally closed, the debate continues and further ideas and suggestions are still welcome.

3:02 [Comment From Martin @ TLAPMartin @ TLAP: ]

Thanks very much for your questions. I've enjoyed co-hosting this session on behalf of Think Local Act Personal. As I mentioned earlier, TLAP really keen to continue drive towards personalisation. We'd encourage everyone to check out our new Making it Real markers of progress. You can download them from our website