We need to start with people, not organisations

Featured article - 04 July 2017
By Ewan King, SCIE’s director of business development and delivery

Head-shot of the author, Ewan King, SCIE’s director of business development and delivery

"I regard the person I care for as my employer, whilst the organisation I work helps provide an environment in which I can provide good care."

These were the words of a care worker at the Kent Autistic Trust, a provider of care to people with learning disabilities; recently they’ve been rated outstanding. These words were shown in an excellent video at a session I chaired on personalisation in practice: part of a much bigger event run by the King’s Fund and SCIE on the future of social care.

Speakers and participants in the audience all agreed that personalisation is at the heart of good social care. Christine Edwards-Daem, Chief Executive of the Kent Autism Trust, argued that personalisation recognises people as individuals who have preferences and puts them at the centre of their own care and support. She said: "We must start with the person, not the organisation."

But what is personalisation?

From this debate it was clear that personalisation does not just refer to personal budgets - although these are important- but also encompasses a broad range of approaches: community capacity building, self-directed support, co-production, self-management, empowering information and asset based approaches. To make it happen, it requires committed and skilled leaders at all levels and also system-wide change.

Research shows that personal budgets and person-centred care enhances user experiences, as well as dignity and wellbeing. Good person-centred care, as Shared Lives and SCIE argue in a recent paper, can also save money.

But where are we on the journey towards person-centred care?

On the one hand, much progress has been made. More people are using personal budgets and the care act has enshrined personalisation in law. We have integrated personal commissioning, a hugely ambitious programme which seeks to build services around individuals.

On the other hand, there is a danger, as finances tighten, that traditional, service-led rather than person-led care is commissioned; and that our need to sort the crisis in hospitals and with our workforce makes personalisation less of a priority. Caroline Speirs, Director of Think Local, Act Personal writes that: “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.'

There is also a danger of the best practice remaining small scale - for the few and not always for the many. This was the challenge posed by one person in the audience who decried the poor quality of services received by those who do not meet the eligibility criteria for a personal budget.

The speakers at the event were clear, however, that whilst money is important- and there is not enough around - it is not the most critical factor in making excellent practice happen. Just as important are having committed leaders and having a brilliant workforce; as is drawing on the networks that reside in most places. One person said: “We need a Facebook network for people who use personal budgets.”

And change must be driven by the people that receive care - commissioners, providers and people working hand in hand to design care and support that meets their needs and aspirations.

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