Personalisation does not always require personal budgets. Person-centred care can be achieved in a number of ways, including in a residential setting
Today Demos published research looking at the future of personalisation, particularly for those with multiple and complex needs. Supported by Sue Ryder, we explored what people with the most complex needs – often in residential care and hospices – want and value from their support.
Our findings pose some potentially difficult trade-offs for the government’s personalisation agenda, which is driven by a 100% take up of personal budgets by 2013. The fact is, personal budgets can pose practical difficulties in collective care settings, based as they are on individual purchasing decisions. The take up of personal budgets for those with complex needs and older people in end of life and residential settings remains very low.
How can the government hope to achieve universal personalisation when personal budgets may be unpopular – or simply difficult to use – with certain groups and in certain care settings?
The answer seems to be a backlash against residential care, which is viewed as inherently incompatible with the modern personalised and empowering care system. No doubt residential care of the future will look very different, and serve fewer people, than today’s sector. But we cannot pretend there won’t always be a need and a demand for residential care – in the sense of collective care services combined with accommodation. We can’t simply do away with residential care, but that doesn’t mean the personalisation agenda should ignore it.
The solution is extremely simple. Stop using ‘personal budget’ and ‘personalisation’ as interchangeable terms. Recognise that personal budgets are not the only method of achieving person-centred care, and for some people, alternatives to personal budgets may be more effective.
This may not seem a particularly revolutionary insight, but it is potentially controversial . It goes against the tide of government policy narrative. In addition to the target set for 100% take up of personal budgets in social care, the government now wants to see a right to ask for a personal budget in health services by 2014. Having financial control over one’s health and social care is seen as a vital component in achieving person-centred services.
But these targets may make it tempting for care providers and local authorities to confuse the process (personal budget) with the outcome (personalisation). The fact is, personal budgets do not guarantee person-centred care and there are many examples of person-centred care in settings where personal budgets are not used.
Now, I am an advocate of personal budgets. They can be life changing. But by focusing almost exclusively on them, we are not giving enough attention to the alternative routes to personalisation that might be more appropriate for some groups of care users.
A person living in a care home may achieve personalisation more effectively by participating in (properly run and influential) residents’ forums and opportunities to co-design the services on offer. Personalisation for many people (in and out of residential care) is less about the money and more about staff cultures, a sensible approach to risk and a better integration of heath, care and housing.
As part of the project we visited Dee View Court, a Sue Ryder home for those with neurological conditions where the residents help recruit new members of staff, agree between them when their therapy would take place and what social activities they would organise, and live in four-bed units within the home where they could opt to cook for themselves and have visitors.
The atmosphere was one of a home run by the residents, for the residents. Services were organised to suit the individual and the collective rather than decided by staff or management diktat. And there wasn’t a personal budget in sight.
But examples of people enjoying personalisation without a personal budget will remain the exception rather than the rule until the government invests more time and effort into developing alternative vehicles for personalisation, and puts more thought into staff cultures, the integration of services and other ‘external’ conditions which are vital in making personalisation a reality.
And it will only do this when we stop relying on personal budgets as a one size fits all solution. We need a more personalised approach to personalisation.
