The personalisation of social care – the idea that everyone who is offered support should have maximum choice and control over their service and their life – is beset with some real problems. The biggest one being that making personalisation happen requires changes in services and budgets, at a time when councils are also cutting services and budgets. There have been articles in the trade press recently alleging that, surprise, surprise, the cuts tend to win out over more positive reforms.
But personalisation is also beset with problems which aren’t real. Right from the start, people’s picture of what personalisation means has been as much about the myths as the reality. Of course, when even the people charged with carrying out the policy on the ground themselves have a fairly shaky understanding of what personalisation is really about, myth swiftly becomes reality for lots of people.
The ideas that people should have choices, control over their services and their lives and the opportunity to make a contribution to their community: all of these are real and important ideas. We can’t let them drown in the myths. So there’s a real need for some myth-busting. Here are my top myths in need of busting: I’d love to hear yours.
1, Personalisation is all about personal budgets or Direct Payments.
Personalisation is about people having more choices, more control, more opportunity to contribute. Changing the way the money moves around is only one part of making this happen. People who don’t want control of the money still want control of their lives. And having control of the money makes no difference if there’s no one ensuring that there is a growing choice of small support providers, not a diminishing group of cut-price care supermarkets.
2, Personal budgets and Direct Payments are the same thing.
People are still confused about the difference between personal budgets and Direct Payments. Not to mention individual budgets. A personal budget is an allocation of social care resources. There are different ways to take that allocation, the ‘purest’ being as a cash Direct Payment. But if you don’t want to be legally responsible for spending that cash, you can get the council to manage it for you (sometimes called a managed budget) or another organisation to both manage your budget and provide your service (sometimes called an Individual Service Fund). Individual (sometimes mis-quoted as ‘individualised) budgets were a pilot scheme, now ended, which involved budget-pooling.
3. Direct Payments are just for employing a personal assistant.
Some councils have tried to make this a rule or have told people they can only have a Direct Payment if their allocation is at least a minimum amount. Some allocate Direct Payments based on hourly rates for employing personal assistants. There are all kinds of other rules out there about what you can and can’t spend your payment on. None of these rules are lawful or good practice. The point of giving people a payment rather than the service it would traditionally have paid for is to enable them to widen their choices, not to find new ways of restricting them.
4. Independent living is about living on your own.
How many of us really aspire to this? It should be a choice available to everyone, but forced on no one. A group of young disabled adults who had been brought up together in care and had little contact with their families had to fight to stay in their shared accommodation, because the council’s new policy was everyone to live in their own place, in the name of personalisation. Furthermore, most care and support has always been, and will remain, delivered by unpaid family carers: their role and the importance of family relationships is central to genuine personalisation. One final frontier of personalisation is recognition that adults with learning disabilities are increasingly likely to be parents with children of their own. We all live inter-dependently, within complex webs of relationships and we all crave a sense of belonging. Those are hard things to achieve just through better service provision; they require much wider attitude changes and more accessible and inclusive communities.
5. Older people don’t want personalisation.
Older people’s take-up of personal budgets is lower than that of other groups, but that doesn’t mean that older people don’t want choices or control over their lives. The older person whose goal is to live with dignity within their family home, cared for mainly by their partner should feel that their choice is supported, as should the individual who doesn’t want to lose the relationships, support or sense of belonging they might feel they have at their ‘out-dated’ day centre.
6. Personalisation is a cover for cuts.
This is rapidly becoming the hardest myth to dispel. The pioneers of personalisation, including those in government, did not sit down and think, “How can we disguise budget cuts?” There are cases where introducing a more tailored package of care can mean that someone’s needs can be met more cheaply, particularly if someone is helped to live more independently or to access employment. But simply cutting budgets, as is happening at the moment for entirely financial reasons, is unlikely to lead to better outcomes. Even when personalised approaches were being introduced several years ago, at what we now know was the peak of a boom, people were suspicious that innovations were a cover for cuts. Especially in areas where professionals saw an opportunity for making savings rather than improvements. Now the focus really is upon savings, it is more important than ever for councils to be clear as to what they are doing genuinely to improve the system and what they are being forced into by financial pressures, even though they know it will be damaging, or leave more people without support.
In lots of posts you’ll find on this blog, I’ve written about instances of people using Shared Lives or other small-scale approaches to improve their lives. In most of these cases, the new solution was also cheaper than the old. But enabling those improvements to happen took courage, creativity and clarity. Now more than ever, cynicism and mythology will get us nowhere.
Escaping the invisible asylum 
I would add this to the list::
“people with profound disabilities cannot make choices”.
Support workers and carers can be quick to make this claim – even about people they know well . However, with time and creative thinking, it is possible for most people to indicate preferences over some aspect of their life. Personalisation does not have to be about the BIG things. Being supported to make a choice over a tiny area of their life may be a huge step forward for some people.
I think that the change from the-council-choosing-for-you to the service user choosing for themselves is the right way to go. But it is bound to be very painful. Services that the council chose to fund will lose funding which will be distributed to users. If not enough users choose to fund that service themselves, then it will close. Some services which need lots of users to be economic may close even though lots (but not enough) of their users want them to continue. Smaller providers will have to open, advertise their services and attract users. All that will be very painful. Worth it in the end possibly. But painful in between.
i agree – there really is this no mans land at present where people who choose to uncouple their service needs from the council are left looking for the smaller service providers who either arent there yet or are overwhelmed by the sudden influx of requests for support – we do need a sort of small service provider season of spring – where the buds and blossoms of a new growth in places that provide an alternative to entrenched council services arrive and are ready to be used; yes it will take time but hopefully it will provide a fresh new landscape for the service user in the near future. Do please check out my new blog for support planners as we navigate this new territory http://www.afteralice.wordpress.com
A really interesting post – thanks Alex. It is attracting a lot of comments within our LinkedIn group “The personalisation group to revolutionise social care” which I co-manage with Philippa Codd.
I think you have identified some very real tensions and misunderstandings within the way personalisation is being interpreted and implemented. I partiicularly liked the examples around independent living. No, independent living does not automatically equal living on your own!
I wonder if councils are able to make the change culturally as the architects and managers of the current system. That’s not to say there aren’t individuals within councils who understand what the possibilities are and what needs to be done but the notion of micro working within a macro bureaucratic organisation does not sit well. Good pilots and good practice are usually down to good people runnning them and not the overall organisation responsible. Councils probably need to relieve the detailed control of personalised support to user led organisations and social enterprise.
Interesting point Jerry – i think achieving the balance between councils showing leadership and councils letting go of power is one of the conundrums of personalisation. I’m just writing something about that as it happens – and watch out for Community Care’s piece on a Unison personalisation survey next week which I think will give a lot of food for thought on this.
Great blog. Thanks.
Another myth is that personalisation is a social care “thing” and does not apply to other people living in supported housing. This is linked to the myth that personalisation is just about personal budgets.
That’s a really important point Ceri – many thanks!
A very helpful perspective – thank you. I would add a myth of my own to the list, which is that personalisation depends upon “up front” allocations of money. This is, of course, a central tenet of the Government strategy, but is, at best a hypothesis but is propounded as a certainty. I believe it is not actually true and is, at best, a red herring and at worst actually gets in the way of personalisation. Its a red herring because a). choice of service – which up front allocations is desigend to shift power to service users – is only one part of the decision making process that determines whether support is personalised. Just as important are the way needs and outcomes are defined (and PPF/TLAP are clear that outcomes have to be agreed with the LA), and also the way providers deliver their service b). there is no confidence in the RAS systems coming up with a remotely reliable formula for predicting how much people need before their assessment. They are quietly being dropped by Councils in favour of the quite cynical “ready reckoners” which simply place a monetary value on existing packages. Personal budgets through up front allocations get in the way of personalisation for those people (the great majority) who will use services that are also used by several others. The best of those providers will know they need the greatest degree of flexibility in how they use their resource base to respond flexibly to individuals as their needs change – having a range of silos in the form on each service user’s budget will not help in that complex process.
Alex,
A thought provoking blog. I’d add add one thats been bugging me.
“personalisation” and self-directed services are the same thing. Surely personalisation is a process of transforming the administration of social care funding and is by definition a process rather than an outcome.
I’m a big fan of transforming culture towards empowerment but hang on, there have been loads of brilliant projects and work going on for years including what people have been doing with their ILF.
Its always worrying when finance directors in local authorities are very excited by a social care initiative!
Hi Michael -thanks for your comment. The vision for personalisation (not always the same as what actually happens of course!) was that it would be a culture change, which include four ‘quadrants’:
1 choice and control, through self directed support and personal budgets
2 building community capacity (ie inclusive communities, use of volunteers – the previous government’s take on what is now (in)famous as the Big Society)
3 Universal access to information and advice, so that people could make informed choices
4 prevention and early intervention
Only the first one really made it through into public consciousness, and arguably, as you say, it is only the introduction of the new financial mechanisms which many areas have engaged with, rather than genuinely delivering self-directed support and a greater choice of services.