Personalisation is a social care approach described by the Department for Health as meaning that every person who receives support whether provided by the statutory services or funded by themselves, will have choice and control over the care they receive in all care settings. Care is built around the specific needs of each individual rather than a one size fits all system. Briefly, it is interpreted as self-directed support through direct payments and personal budgets and used by Local Authorities to describe packages of services for people to enable them to live as independently as possible, preferably in their own communities. Over the time since personalisation first entered the care arena in the form of the 1997 Community Care Direct Payments Act of 1996 for disabled people, it has developed from a power to a statutory duty for Local Authorities to deliver, encompassing elderly as well as disabled people and their carers.
The political agenda revolves around keeping people at home for longer; enabling people to take responsibility for their care, to improve personal wellbeing and by doing so reduce and delay dependency and admissions to hospital. It can be argued that unfortunately the political style over recent years has shadowed the good work taking place in residential care settings that prevent acute episodes for people and improve their wellbeing.
The use of personal budgets across both health and social care for people with multiple needs and long term conditions is still in its early stages of development and needs concerted efforts, locally and nationally to obtain the best out of them. The Care Bill currently going through Parliament presents a strong opportunity to build on the personalisation agenda and ensure that this extends successfully to the NHS. The critical challenge for Local authorities and the NHS is to provide improved information, advice and guidance to support people in making their choices and to put effective preventative measures in place coincidentally to reduce admissions to hospital and finally, to be able to measure the extent to which the whole programme improves the lives of people and their carers. Local Authorities have £32m in funding to help them develop online information services with substantial information about available and accredited services.
Although Local Authorities are rising to these challenges they involve fundamental changes to the roles of social care professionals away from assessing people, drawing up a care plan and purchasing services on their behalf, towards deeper administrative tasks, developing a broader commissioned range of services for people to select from and ensuring choices are put into practice through properly approved service providers, many of whom will not be regulated.
Service providers themselves need to respond to the changing market. Local Authority block contract arrangements will be phased out over time leaving providers the task of developing responsive, outcome based services to meet the widening choices being demanded by budget holders. The difficulty for them is to be able to design sustainable businesses based in a variable demand led market place. To help them design services, Authorities now have to publish a market position statement, which can be found here, detailing the changing market profile as the personalisation agenda expands. The trick in terms of persuading the private sector to respond adequately is to develop a strong, transparent and trustful dialogue between all the parties. It is in the best interest of Authorities to do this in order to meet their statutory duty to provide care and to balance the take up of personal budgets with private sector development of services.
The national target is in the order of reaching 70% roll out of personal budgets by 2015. To put a local Somerset perspective on this, about 35% roll out has been achieved although this must be qualified by saying that these are largely managed budgets (by the Local Authority) rather than fully self-directed. This rather low figure should not really be seen a criticism but rather recognition that Somerset has chosen not to rush at the gate, preferring to consider each aspect of the task carefully and to engage well with the community (service users as well as private sector providers) to ensure a balanced and robust delivery of personalisation can be achieved without destabilising the market along the way.
The message that follows from this for private sector providers is that there is a way yet to go and plenty of opportunity to reshape their businesses to meet the changing market. This is a good time to discuss their ideas with the Local Authority, their bank managers and accountants.