Choice has to feel easy

From my perspective and that of a provider interested in delivering better outcomes for people, personalisation needs to mean far more than just giving people money. We need people to have a real choice of good and tailored services to spend that money on.

There's no point in outsourcing decision making to people if they find it's just a new responsibility with none of the choice. So we need that genuine choice and market building. That has to be for everyone, not just for people who can speak up for themselves or those who have people around them who can help them speak up. We need choice for those who are least able to get their voices heard and in some areas advocacy is becoming worryingly scarce; choice processes have to feel easy.

People will settle for second best if achieving the services of their choice feels like wading through treacle. I think that means that the challenge for us, as providers, is that we don't go into this sector to construct support which just maintains people at survival level. We need to be moving towards the kind of support approaches which feel like they've got a future focus. In other words which don't just help people survive or cope with the challenge or problem they have today, but helping people to plan ahead and to start to move towards a better life tomorrow.

Understanding outcomes in that context is then a real challenge. We don't, as a sector, have a good culture of measuring outcomes. There is evidence out there, but we don't have that consistency yet around some of those most important outcomes, which have traditionally been seen as hardest to measure, and therefore hardest to buy and commission for.

We need to move from cheap to good. Actually, if we do that, we still won't be there, because you can have a great service, you could have a brilliantly tailored, well funded service, and still be living a miserable life. We can all think of people for who that's true, because they're still isolated. It's the older person who says, 'I feel useless, I don't feel like I've got a role, a place where I can contribute'. The person with a learning disability who's got great support during the day, but can't get a job. So if we're going to move from a good service to a good life, that's got to broaden out, and this is a huge challenge for TLAP.

We hear constantly from providers who say, 'I'm expected to be excellent, but the price the procurement department is willing to pay won't even pay minimum wage.' We're seeing areas where people are experiencing cuts in their individual resources, which don't feel like they're an individually decided process. So there are some huge challenges there.

So what does TLAP do about that? It's got to get those stuck areas unstuck, it's got to get behind the areas which are taking the risks and which are achieving. It's got to do that by putting people, and what people want, and the lives that people want to live, at the centre of that.

There's got to feel like there's a space for the "traditional" as well as the innovative. In other words, we've got to take some pretty huge risks, and we've got to do that at a time of, probably, unprecedented fear, and that's quite a big ask. The route to doing that is to get serious about co-production with people who use services, providers, commissioners and government.

Comments

Posted on by Kim Roberts

We are a resource centre that runs activities for disabled people. Where are the people? We are trying to get more here but not a lot of success. Any ideas? We are losing more council funding next year and people do not want to pay for the services!
We are cheap compared to some other places, but still cannot get them to come!

Posted on by Kirk Wells

Commissioners have got to get out of the block contract mentality and stop imposing their “one size fits all” blanket rulings, usually around what they won’t fund! They should look at each individual on a case by case basis and do this rigorously to ensure that proper Best Value is in place, not just the cheapest option! There is a culture of trying to reduce costs while only meeting critical need, which leaves little scope for outcome-focussed support as invariably, it’s about crisis recovery before any real progress can be achieved. Even then, where’s the incentive when the stock reaction tends to be that progress=reduction in support? Moreover, there’s no acknowledgement that progress is made as a direct result of such personalised and focussed support or the risk of regression if the support is to be removed/reduced. It’s all so reactive. There is also a huge inequality within our locality as the default option is to commission the majority of services through the “Independent trading company wholly owned by county council”. It’s Block Contracting dressed up as Personalisation just because somebody uses their Personal Budget to pay for an otherwise Managed Service!

Posted on by Old Site User

Commissioners are responsible links in the chain between the assessment of need and the delivery of support to people. But without accountability that is all taken on board by providers who are forced to take short cuts and provide second rate or worse services because of the commissioning process - which is not subject to inspection. Asking CQC I am told that they are not mandated to inspect the commissioning process and the decision is one for MPs. I have lobbied mine and hope that others will do the same.

Posted on by Old Site User

Thanks for your comments, we will take all blog comments and use them to form the basis of TLAP's new partnership agreement.

Posted on by Trish O'Hara

I think providers across the board have focused on output which are SMART - but find it very difficult to truly measure outcomes - as they can be intangible and more difficult to enter into statistics. Individuals have very specific outcomes that need to continue to linked to their dreams and aspirations. Unfortunately, services are still only funding need - as is expected at this time of savage cuts to public services. If social workers still focus on need rather than aspiration, how do we really support outcome focused assessment. And the directives for early intervention become meaningless as a way of supporting someone who is yet to 'need' as it were. The ideology is there - but I am not so sure the long term funding is.

Posted on by David Steven Twist

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I found the values presentation for the UK National Health Service intriguing and a little troubling however I haven't seen their terms of reference

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Posted on by Melanie O'Neil

I am currently focused on communication. Having choices is a big must, but if you struggle to express what you want how can you have choice and control over what is meant to be a tailored package? I am at the end of a course to become a Regional Makaton Trainer and have developed a Person Centred planning template using life coaching tools. I have delivered training using my template and have had a huge response back from clients. Many of these individuals learned Makaton whilst at school and later it was pushed to one side.
Social Care and other professionals are aware of Valuing people and 'No conversation about us without us' .... well, make it so that meetings can be for the individual and enable progression !

http://www.melpersonalised.co.uk/

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