VIEWPOINT: Personalisation - the questions adult services directors must answer
As social services leaders gather for their annual conference in Manchester this week, social care consultant Colin Slasberg urges directors of adult services to ask themselves if they are delivering on four key pledges to service users
13 November 2018
Think Local Act Personal (TLAP), the body funded by government to promote its personalisation agenda, has this month re-issued Making It Real. First published in 2012, it sets out service user expectations alongside commitments of those responsible for meeting them. It does so through a series ‘I statements’ matched by a series of ‘we statements’. They are bold and ambitious. If the ‘we statements’ are delivered, the ‘I statements’ will be realised.
The ‘I statements’ describe a vision of life expressed in terms that have become very familiar since the personalisation agenda was launched a decade ago. This is a world where service users are very well informed about the system and how it works, control the way their needs are assessed and support planned, and as a result feel valued, included and independent.
But this remains a distant prospect for the great majority of service users. The recent Joint Parliamentary Inquiry into social care reported that far from being well informed, people found the system "bewildering". TLAP’s survey in 2017 found that far from being in control, a large majority of service users said their views about their needs were "never", "rarely" or, at best only "sometimes" listened to. The Local Government Association acknowledges that far from being included and independent, the system can leave people isolated and institutionalised in their own homes.
Why should anyone believe Making it Real mark two will succeed?
All this raises a key question. Why, ten years after the launch of the personalisation strategy, and six years after the launch of Making It Real ‘mark one’ has there been so little, if any, progress? Why should Making it Real ‘mark two’ be any more effective than ‘mark one’ has been? If we are to have any confidence in the authenticity of sector leaders’ commitments made in ‘mark two’, they must first address why ‘mark one’ has failed.
The familiar refrain is to blame austerity for all failures. But this cannot be allowed to wash. Whatever the reality of the funding situation the ‘we statements’ focus on practice and behaviours that do not depend upon money for their delivery.
ADASS is the key
We should look to directors of adults social services for answers. They have the lead responsibility for how social care is delivered within the communities they serve. Their association, the Association of Directors of Adult Social Services (ADASS), is a TLAP partner and contributed to the development of Making It Real. Their president, Glen Garrod, commends it as an “indispensable resource” to ensure “personalisation becomes everyone’s experience”.
The ‘we statements’ cover a wide range of behaviours. Some are more critical than others to delivery of service user expectations. The following identifies four which are critical, and sets the questions ADASS need to answer in relation to each.
One – ‘We have conversations with people to discover what they want from life and the care, support and housing that will enable this’
Delivering this commitment requires the conversation to be open and centred on the person for the conversation to be fully informed. It cannot be constrained or biased by any consideration of the consequences, which must be addressed subsequently. But current policy requires the exact opposite. The consequences dominate the conversation. This is because it must be conducted on the premise that all assessed needs must be met, whether through family, friends and community or with public resource. Consequently, the conversation can only recognise ‘needs’ for which there is resource. Far from the open, person centred conversation the ‘we statement’ promises, it is a heavily constrained, resource-led, profession centric process. Councils have little idea of what people want from life.
QUESTION: What does ADASS think needs to happen to free up the assessment process so practitioners can really discover what people want from life?
Two – we provide accurate and up-to-date information
One of the most important areas of information individuals require is how their council decides what its responsibilities to them will be. Public information is invariably couched in terms of the national eligibility criteria. But the problem is that national eligibility criteria actually play no part in how councils make these decisions. This is made clear by the existence of gross inequity in levels of provision between councils when all councils ostensibly work to the same criteria, along with spend following budgets, however volatile, whilst leaving no trace of unmet need behind.
‘Eligibility’ decisions have to be made on a highly localised basis in order to deliver on the imperative to constrain demand to local budget. However, this has to be done in a highly covert way. Being open and truthful would undermine the council’s defence if judicially challenged. Local decisions are dressed up in the language of the national criteria. This gives an appearance of conformity and consistency.
Paradoxically the public information material therefore serves not to inform, but to mislead and misinform.
QUESTION: What does ADASS think needs to happen to escape this bind so it can be true to the commitment to provide accurate information about how decisions are made?
Three - the people service users live with, and the support they get, are important to their wellbeing and often interlinked. We have conversations with people to make sure we get all aspects right for them as individuals
Sometimes the right place to live is at home but the cost of the support required would be beyond what the council can afford. Councils offer residential care on the premise that this will meet all the person’s ‘eligible’ needs, with any other issue influencing the person’s thoughts and feelings about what is ‘right for them’ either ignored or reduced to being merely personal wishes for which the council has no responsibility. It is not known how many people are in residential care for whom it was never ‘right for them’.
QUESTION: What does ADASS think needs to change so councils always know where is the right place for each individual to live?
Four - We welcome ideas about using personal budgets flexibly and creatively
This commitment matches the ‘I statement’ ‘I know how much money is available to meet my care and support needs. I can decide how it’s used’. It derives from the model of personal budgets empowering the service user as a consumer through an ‘up front’ allocation. But the Care Act does not define a personal budget in this way. It defines it as merely the financial value of the services the council offers to meet the needs the council has decided to meet. It is an administrative costing exercise that takes place following support planning. Councils have retained power over all the key decisions. The concept of empowering service users as consumers as the route to personalisation is, as I have previously stated in a Department of Health and Social Care blog, moribund and beyond revival.
The focus on personal budgets has deflected attention from the reality that councils, far from welcoming ideas from service users are not even listening to them.
QUESTION: What changes to the policy context are required so the power to make the decisions that determine the quality of life of service users is shared with them through authentic partnership and meaningful involvement?
BASW’s possible contribution
The questions above are no different to the questions BASW has committed to addressing in the context of its Initial Position Statement in readiness for the social care Green Paper. That statement identified the conundrum that would be created by having an assessment process that identifies needs in a person-centred way with a resource allocation process that allocates resources fairly whilst keeping spend within budget. A working group is addressing the conundrum. If it can arrive at credible answers, it can only be of the greatest help to ADASS.
Failing to deliver well intentioned commitments can be regarded as professional failure. Repeating the same commitments without addressing the original failure changes the complexion. Professional failure becomes moral failure. That is much harder to accept.
The commitments sector leaders are making in Making It Real are entirely worthy. If they make good on them, the effect will be the long-awaited transformation to a person centred system. But the ‘if’ is a very big one. If they fail to learn the lessons from ‘mark one’, ‘mark two’ will amount to nothing more than shallow and cynical repetition of tired clichés that change nothing.
ADASS must face up to what the evidence says about the current state of affairs. It will then be able to see the challenges that must be overcome to be true to their promises. They are about professional behaviours. BASW, as the independent voice of social work, should be the body ADASS can and should turn to for advice and support.
* This article is published by Professional Social Work magazine which provides a platform for a range of perspectives across the social work sector. It does not necessarily reflect the views of the British Association of Social Workers