Myths, cynicism and personalisation

[Alex Fox]

The personalisation of social care – the idea that everyone who is offered support should have maximum choice and control over their service and their life – is beset with some real problems. The biggest one being that making personalisation happen requires changes in services and budgets, at a time when councils are also cutting services and budgets. There have been articles in the trade press recently alleging that, surprise, surprise, the cuts tend to win out over more positive reforms.

But personalisation is also beset with problems which aren’t real. Right from the start, people’s picture of what personalisation means has been as much about the myths as the reality. Of course, when even the people charged with carrying out the policy on the ground themselves have a fairly shaky understanding of what personalisation is really about, myth swiftly becomes reality for lots of people.

The ideas that people should have choices, control over their services and their lives and the opportunity to make a contribution to their community: all of these are real and important ideas. We can’t let them drown in the myths. So there’s a real need for some myth-busting. Here are my top myths in need of busting: I’d love to hear yours.

1, Personalisation is all about personal budgets or Direct Payments.

Personalisation is about people having more choices, more control, more opportunity to contribute. Changing the way the money moves around is only one part of making this happen. People who don’t want control of the money still want control of their lives. And having control of the money makes no difference if there’s no one ensuring that there is a growing choice of small support providers, not a diminishing group of cut-price care supermarkets.

2, Personal budgets and Direct Payments are the same thing.

People are still confused about the difference between personal budgets and Direct Payments. Not to mention individual budgets. A personal budget is an allocation of social care resources. There are different ways to take that allocation, the ‘purest’ being as a cash Direct Payment. But if you don’t want to be legally responsible for spending that cash, you can get the council to manage it for you (sometimes called a managed budget) or another organisation to both manage your budget and provide your service (sometimes called an Individual Service Fund). Individual (sometimes mis-quoted as ‘individualised) budgets were a pilot scheme, now ended, which involved budget-pooling.

3. Direct Payments are just for employing a personal assistant.

Some councils have tried to make this a rule or have told people they can only have a Direct Payment if their allocation is at least a minimum amount. Some allocate Direct Payments based on hourly rates for employing personal assistants. There are all kinds of other rules out there about what you can and can’t spend your payment on. None of these rules are lawful or good practice. The point of giving people a payment rather than the service it would traditionally have paid for is to enable them to widen their choices, not to find new ways of restricting them.

4. Independent living is about living on your own.

How many of us really aspire to this? It should be a choice available to everyone, but forced on no one. A group of young disabled adults who had been brought up together in care and had little contact with their families had to fight to stay in their shared accommodation, because the council’s new policy was everyone to live in their own place, in the name of personalisation. Furthermore, most care and support has always been, and will remain, delivered by unpaid family carers: their role and the importance of family relationships is central to genuine personalisation. One final frontier of personalisation is recognition that adults with learning disabilities are increasingly likely to be parents with children of their own. We all live inter-dependently, within complex webs of relationships and we all crave a sense of belonging. Those are hard things to achieve just through better service provision; they require much wider attitude changes and more accessible and inclusive communities.

5. Older people don’t want personalisation.

Older people’s take-up of personal budgets is lower than that of other groups, but that doesn’t mean that older people don’t want choices or control over their lives. The older person whose goal is to live with dignity within their family home, cared for mainly by their partner should feel that their choice is supported, as should the individual who doesn’t want to lose the relationships, support or sense of belonging they might feel they have at their ‘out-dated’ day centre.

6. Personalisation is a cover for cuts.

This is rapidly becoming the hardest myth to dispel. The pioneers of personalisation, including those in government, did not sit down and think, “How can we disguise budget cuts?” There are cases where introducing a more tailored package of care can mean that someone’s needs can be met more cheaply, particularly if someone is helped to live more independently or to access employment. But simply cutting budgets, as is happening at the moment for entirely financial reasons, is unlikely to lead to better outcomes. Even when personalised approaches were being introduced several years ago, at what we now know was the peak of a boom, people were suspicious that innovations were a cover for cuts. Especially in areas where professionals saw an opportunity for making savings rather than improvements. Now the focus really is upon savings, it is more important than ever for councils to be clear as to what they are doing genuinely to improve the system and what they are being forced into by financial pressures, even though they know it will be damaging, or leave more people without support.

 

In lots of posts you’ll find on my blog (http://alexfoxblog.wordpress.com), I’ve written about instances of people using Shared Lives or other small-scale approaches to improve their lives. In most of these cases, the new solution was also cheaper than the old. But enabling those improvements to happen took courage, creativity and clarity. Now more than ever, cynicism and mythology will get us nowhere. I'd be grateful for any comments here or on my regular blog.