Talk of personalisation, empowering individuals and person-centered practice started over 20 years ago with the introduction of Direct Payments. But I'm questioning if the fundamental changes have occurred to make these goals a reality?
Well, a raft of policies have been introduced - Personal Budgets in 2003, Individual Budgets 2005 – 2007 and Personal Health Budgets in 2010. The 2014 Care Act strengthened personalisation by placing in law the planning and support process and personal budgets. Then in 2015, the Integrated Personal Commissioning (IPC) programme brought together health and social care funding around the individual.
Despite the increased use of personal budgets, people’s experiences suggest however that the transformational change required to support personalisation is underdeveloped - i.e. we still don’t have a solution that:
- Focuses on their needs, choices and what they want to achieve
- Offers an easy, flexible and transparent means of accessing information advice and services
- Supports guided self-management, autonomous and informed decision making.
Therefore, my question remains, from a person’s perspective, what demonstrable evidence of personalisation exists today in health and social care? Well, there’s been a wave of:
- eMarketplace solutions, but these are reliant on knowing what you are looking for and without the necessary knowledge, control and ultimately choice are surely unattainable. They also tend to promote what can be significant spend rather than lower cost or free community alternatives.
- Help and Advice sites trying to drive people like you and I down one of the numerous pathways. Regardless of how many paths are available, they cannot cater for the unique individuals each of us are.
- Strategy documents, plans and projects usually containing the correct wording, sentiment and focus but are rarely realistic or deliverable, leading to change fatigue for everyone involved.
Of course, there are many other examples but overall do they really place the individual, you and I, at the centre? Do they have the capacity to be replicated across the country, the flexibility to support local organisational variances? Can they retain a person-centered focus and change demand? Are they sustainable and responsive to new requirements?
So what could a brighter future look like? Well, for me it involves placing the person at the centre, with choice and control to direct how our needs are met. Achieving this requires change, so here are five things for councils to think about:
1. Education – people have to be educated and made aware of what choices are available to meet their personal needs and given the tools and encouragement to be more proactive in directing and managing their care. The digital age offers councils real opportunities to a) rethink how it educates the public and their own staff about the choices b) tailor the deliver of that awareness, c) encourage a global approach to ‘knowledge’ whilst fostering local expertise to promote local support.
In parallel to this people must also be able to tap into the wisdom of crowds and talk with ‘expert by experience’ people to help inform their thinking and decisions. In doing so they contribute to the growing wealth of community knowledge.
2. Harness innovation – Services must be responsive and innovative in helping us accomplish what we want and in meeting our individual needs. To achieve this Councils’ and their staff need to become champions of innovation and together with providers and the public actively share the existence of good ideas and celebrate success.
3. Market capacity and development – Personalisation will only work if there is choice. As part of this councils need to become facilitators, rather than managers, of conversations, connections and relationships, with and between individuals, communities and providers. Such direct contact will increase demand for, and response to tailored support, which in turn will stimulate new market opportunities.
4. Financial flexibility – why do we expect personalization means the person also gets the burden of financial administration. A way of promoting flexibility is key, with some people receiving both direct payments, and also, the council or a third party managing too.
5. Consistency – Whilst personal, councils need to demonstrate a consistent experience for people regardless of who is paying (i.e. the individual, council, health, third party or a mixture), and how it is being paid for (i.e. pre-paid card schemes loaded with funds, virtual wallets, personal debit/credit cards, Individual Service Fund and third party payment schemes e.g. PayPal).
After all, to the individual, their care is all one to them and doesn’t come with a label attached.
I believe that by focusing on these five areas, councils can truly (and finally) make personalisation the reality in social care.