What's the difference between personalisation and self-directed support?
This week's blog is from Tim Gollins, TLAP's part-time lead for self-directed support. He also works to support councils in implementing self-directed support in his other role as regional coordinator for the Yorkshire and Humber Association of Directors of Adult Social Services (ADASS).
The question sounds like the start of a bad joke, but it is actually a serious question. I believe the answer lies at the heart of many of the issues facing people who use services and carers, providers and councils.
Personalisation has been around for some time now. It's a way of thinking about care and support services that puts people at the centre of the process of working out what their needs are, choosing the support they need and having control over their life. Since its inception, the way we think about personalisation has developed.
Over the past few years in particular, there has been a lot of focus on self-directed support as a central component of personalisation. Indeed, it was almost impossible to discuss the progress of personalisation without commenting on the numbers of personal budgets people had and how many of those were delivered as direct payments. This describes the process where money is allocated to people by their local councils to pay for care or support to meet their assessed needs. This was followed by a detailed support plan and a subsequent review of how the money was spent and whether it helped people meet improved outcomes for their lives.
But personalisation has always been a much broader concept. We absolutely know that elements of the SDS process need to improve. For example:
- Proportion of direct payments to managed budgets; as we know there is a nine-fold variation between councils and regions in the number of direct payments used for older people for example.
- Resource allocation systems.
- Support for councils, which despite lean process being the primary indicator of better outcomes, still tend to get mired in 'risk panels', whose job is all too often to pre-emptively control budgets rather than to proactively manage risk.
- Support planning which can otherwise sometimes become a way of controlling spend rather than being a positive experience for the person using services or carers.
However, resolving these issues alone will not be sufficient to deliver personalisation - that is that people, as individuals, have greater independence and enhanced wellbeing. To deliver the vision for personalisation, we need to address:
- Access to good information and advice - still the bane of many people, especially if they pay for care themselves
- Diverse money management options with a variety of providers, making the most of individual service funds (ISFs) for example
- A local market of alternative providers that is accessible by individuals
- New commissioning practices which focus on low level market development without abandoning necessary larger contracts
- The involvement of public health partners at community level
- Support to voluntary organisations, user-led organisations (ULOs) and community groups
- Personal Health budgets linked up to personal budgets in social care
- GPs prescribing social solutions as well as medical solutions
- Intermediate care and re-ablement working on social and psychological issues i.e. housing, loneliness and informal networks of support, not just physical (domiciliary care) problems
- Support to families to help their ageing children and vulnerable adults in the best possible ways
And that's far from an exhaustive list - more is set out in TLAP's new partnership agreement. And the new 2014 ADASS personalisation survey of all councils in England is far more comprehensive in the questions it is asking about progress. But I am optimistic, because despite the obviously challenging financial environment there are some real strategic positives:
- TLAP's new partnership agreement is now between 48 national 'umbrella' organisations. This means that personalisation is not considered a narrow council led self-directed support programme, it is recognition that personalisation can only be done in partnership with organisations and systems well beyond adult social care.
- Personalisation is planted centrally in the Care Act, which, apart from other important things, means there is a need to make changes in the work force focussing it on delivering wellbeing and greater choice and control for people who use services and carers.
- The integration agenda opens up possibilities with health especially if personal health budgets can be grappled with successfully by Clinical Commissioning Groups. And Health and Wellbeing Boards and public heath teams are well established in councils, providing much better links between health, housing, communities and social care.
So despite the financial challenges facing councils, personalisation, as something which goes well beyond self-directed support, is an exciting possibility. However, on a slightly different contextual note, I feel it is worth mentioning that in contrast to the possibilities of achieving personalisation, I remain totally unconvinced that England is ever going to win a world cup in my lifetime!