Tackling the 'rhetoric vs reality' gap.

The TLAP Partnership exists to support transformation through personalisation and community centred approaches. Several times a year we meet to identify sector-wide priorities and develop solutions to tackling and overcoming barriers. Our partnership model is fundamental to our success; it is demonstrably sector led and representative of the health and care sector, comprising members from central government, local government, Department of Health, Public Health England, NHS England, Allied Health Professionals, social enterprises, provider organisations and people with lived experience.

At our most recent Partnership meeting, members shared their concern about the growing gap between the high level vision of health and social care policy and the practice on the ground, or what we are calling the rhetoric - reality gap. More importantly, we discussed what we, as a national partnership, propose to do about it.

Rhetoric vs reality: Is personalisation losing momentum?

It was good to see social care receive some long overdue political attention during the run up to the general election.  However, unprecedented and ongoing financial constraints have arguably encouraged a shift in focus away from the continued strengthening of personalised approaches to an emphasis on the role of social care in reducing unplanned admissions and supporting timely and safe delayed transfers of care.  Whilst understandable – and of course critical -  this shift is, in our opinion,  short sighted:  good personalised care transforms lives and it is this transformation that will support a longer term and more sustainable approach to reducing demand at the acute end of services.

Results from TLAP’s Care Act survey and In-control’s POET illustrate that while there’s been progress in implementing the Care Act  there  is a marked difference between council perception of what is happening, and the experiences of people and carers themselves;  the former perspective offering a more positive view of care act implementation than the latter.  

Partners recounted similar experiences from their work with localities and people with direct experiences of care, where a comparable mixed picture of progress is emerging. Their findings also point to variations in Care Act implementation, whether that be across regions, demographics or with particular population groups

Some partners expressed concern that the enactment of the Care Act has created the impression that ‘personalisation is now done’ and we can take our finger off the pulse. Others felt that in such an austere climate, taking a personalised approach is viewed by some organisations as a luxury, not a legal requirement. The recent ADASS report ‘It’s still personal’ (opens new window)recognises this risk stating that “local budget pressures and poorly paid staff may make it extremely difficult to offer anything other than the most basic assistance to people in need of social care.”

Given partner feedback and the outcome of surveys it seems reasonable to draw the conclusion that personalisation is losing energy, creating a growing gap between the rhetoric of policy and vision and the reality of practice.

So what is TLAP doing to close the rhetoric - reality gap in social care?

We believe there is an urgent need to reset personalisation and endorse its centrality as a key contributor to supporting health and wellbeing.   The TLAP Partnership recognises that the sector currently lacks a strong objective evidence base and this lack of evidence hinders personalisation being routinely embedded.   Following the National Audit Office report on Personalised Commissioning in Adult Social Care (opens new window), TLAP and partners have made significant inroads in this area with a report and recommendations to be published this summer.  Together, with our partner organisation NICE, we are committed to making sure these recommendations are acted upon and that a plurality of evidence is available to support personalisation and its place in wider system transformation.

As well as supporting the development of the evidence base we will, at a national level, continue to influence key bodies by offering solutions to challenges.  We look forward to  utilising the collective influence, expertise and insights of the TLAP Partnership to contribute to and participate in the recently announced consultation to improve social care.

On a regional level, we will bridge the rhetoric - reality gap by aligning our national priorities with regional priorities where it makes sense to do so.   In this way we will provide additional resource to regional programmes and work is already underway with a number of   ADASS regions to support  greater amplification and acceleration of local priorities.

Finally, the recent appointment of Clenton Farquharson MBE to Chair of the TLAP programme board will ensure that personalisation remains the highest of priorities and that the outcomes gained from supporting  “a life, not a service” are reflected in the evidence base and  never subject to the vagaries of funding levels.

If you are a national organisation and would like to join the TLAP Partnership, please contact me at Caroline.Speirs@tlap.org.uk




Posted on by Karen Robinson

I completely agree with your comments Caroline, this is a continual challenge to those of us in learning and development. To keeping staff engaged with the practical application of personalisation and ensure that an individual's experience of accessing services feels like a personal journey.

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