Improving outcomes for service users in adult placement - Commissioning and care management
Making good placements - Person-centred practice
William was assessed as ready to move from his long-stay learning disability residential home, and as a candidate for individual funding. William’s care manager referred him to the In Control project and to the Person-Centred Planning pilot. After considering options with the In Control 'broker’, William expressed an interested in adult placement. The adult placement scheme worked with William, his broker and the person-centred planning facilitator to produce an individual plan that set out how William’s assessed needs and aspirations could be met through adult placement, together with daytime (work and social) activities. Willilam’s circle of support includes the person-centred planning coordinator, scheme worker and an independent advocate.
The first-stage practice survey found that, although adult placement carers generally work in a person-centred way, good practice is not being achieved through formal person-centred planning systems. The survey did not establish, however, whether using formal person-centred planning tools might improve adult placement practice.
Project group discussions confirmed a continuing lack of understanding of person-centred approaches and formal person-centred planning (PCP) in SSDs (and in adult placement schemes). Scheme staff, social workers and others questioned their council’s commitment to person-centred working.
Participants agreed with the earlier project findings that formal PCP tools are not always right for adult placement. Care managers and scheme staff reported disconcertingly separate streams of funding and practice for care management, PCP pilots and In Control pilots: 'PCP is not part of the social work task’; 'the care programme approach takes precedence over PCP’; 'PCP is a learning disability thing’; 'PCP is entirely separate from care management’.
The service user plan can be the PCP plan. Gateshead Adult Placement Scheme worked with the coordinator of the council’s PCP pilot project and the In Control project to arrange the scheme’s first long-term placement (see William, above). Among other project participants, however, the In Control project and Government’s Individual Budget pilots were not well known, and only a few placements are funded through direct payments (see National agenda).
Elsewhere, care managers and scheme staff agreed that 'PCP aspirations can be disheartening for service users and for practitioners’, including adult placement service users and carers, if those aspirations cannot be met. One service user took part in a PCP initiative in his day centre, and was 'promised all the things he wanted [but] it all fell through’. Another service user was 'guaranteed’ shared supported housing but a year later nothing had happened. One adult placement carer reported that the social worker 'visited a few times and did a PCP plan’; another carer had prepared a 'life book’ for the person in the placement which the social worker 'copied for the PCP plan’; yet another said: 'PCP frightened the life out of my Polly’.
Isolated PCP pilots may be less effective than mainstream person-centred working. In one participating authority, the intensive work and time devoted to one adult placement service user and one scheme worker caused resentment in the team. In another, the local authority was 'doing PCP as part of the modernisation and closure of day centres’.
Participants were frustrated that PCP is limited to people with learning disabilities undergoing major life change, funded through Partnership Boards, to help empty learning disability homes and hospitals. Officers from one council called for local authorities to lobby the Government to include a measure of person-centred working in the performance rating system.
Senior managers should:
- Work to close the gap between service user aspirations as identified in person-centred planning, and assessed needs and eligibility criteria required by care management, to avoid misleading and disappointing service users.
- Cascade learning from local authority person-centred planning pilots into mainstream practice, including adult placement, and include adult placement scheme workers in person-centred planning training.
Line managers should:
- Ensure that care managers understand and practice person-centred working, as distinct from person-centred planning.
Adult placement schemes should:
- Explore the potential of formal person-centred planning tools to improve adult placement practice.