Report 55: People not processes: the future of personalisation and independent living
Barriers and obstacles
There are local authorities, services and practitioners who do understand personalisation and get it right, but this tends to be dependent on the individuals involved and there is no cohesive approach.
While participants described many positive experiences and outcomes from personalisation, there is a clear view that for many people, in many areas, there are still barriers and obstacles to personalisation. Participants thought the number of people who had truly personalised services remained very low and some said that the numbers had started to go down in their areas (one person said the number of people using direct payments in their area had gone down by a quarter).
There was a concern in the workshop discussions that current approaches to personalisation in most areas have become too bureaucratic. The principles and values of independent living, co-production and choice and control which underpin personalisation are not properly understood. As a result personalisation is not delivering the choice and control as intended.
Participants said that there are local authorities, services and practitioners who do understand personalisation and get it right, but this tends to be dependent on the individuals involved and there is no cohesive approach. People described particular difficulties where they had good workers who moved on.
There was also a view that areas that are not doing well are not always prepared to learn from those that are delivering successful personalised services.
The way that the medical model continues to underpin the approaches of many service providers is seen as a fundamental obstacle to the future development of personalisation. Independent living is based on the social model of disability which was developed by the disability movement and focuses on people being disabled by society’s responses or lack of responses to impairment. The medical model focuses on people’s impairments as the problem and personalisation’s focus on this approach undermines the outcomes that it can deliever.
One workshop group said the medical model approach is also frequently accompanied by what they called the ‘professional gift model’, with users and carers having to feel grateful for what they are given rather than it being based on rights and empowerment.
Staffing and workforce issues were another important area of concern. People primarily see a need for the social care workforce to be more focused on delivering person centred support and for better training to enable them to do this. At the same time, some people suggested that training and qualifications can be unhelpful and that common sense, being practical and kindness can be more important than training. They also thought social care workers need greater empathy with service users and carers.
Another difficulty identified was around high staff turnover. In particular, this caused the difficulty of having to deal with duty social workers who do not know their details.
Odi Oquosa said many of the barriers that exist with traditional services continue with personalisation, so users and carers from BME communities continue to experience difficulty accessing services, do not have choice and control over their support (particularly where mental health service users receive involuntary and coercive care), and language and lack of cultural understanding are not addressed in the assessment system or staff training.
He also believes that there is not enough understanding of what personalisation and person centred/self directed support are in BME communities. While mainstream services continue to be inaccessible and inappropriate he thinks BME communities will continue to develop their self sufficiency and establish their own care and support services.
Other barriers identified
- lack of market to purchase services with personal budgets
- funding cuts are leading to the closure of some services and organisations and this is reducing the choice people have over the services they can use
- funding cuts to support services – this includes those that relate directly to the personalisation of social care services and cuts to broader services such as Citizens’ Advice Bureaux and Legal Aid
- local authorities not listening to what people want
- inflexibility around use of personal budgets and direct payments – an example was given of someone who had saved some of their money for a holiday but the council clawed it back
- risk assessment panels blocking some people’s choices
- dividing people/fragmentation – personalisation strategies only supporting people to do things on their own, not with other service users, which works against collective approaches like pooling budgets
- lack of support for people who are isolated and do not have independent support
- personalisation is only on the agenda in health and social care services and there is little awareness of personalised approaches in other local authority services.
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