Making it personal – how serious are we?

Since then, some cracks have opened up.  More importantly, very little seems to be happening on the ground to make it a reality.  Perhaps there have been other fish to fry – balancing budgets and NHS reorganisation.

Personalisation is a classic umbrella term. The principle that services should be shaped around the needs and preferences of individuals, seems uncontroversial. However, when equated with personal budgets giving individuals direct control of resources, it raises many more concerns, in particular with some professionals.

It’s 15 years since legislation was passed opening the door for Direct Payments to be made to individuals, enabling them to buy their own support.  For many people receiving these payments, in particular younger people with physical or learning disabilities but other groups as well, the experience has been transformatory. It puts them in charge of their own support and promotes a culture of independent living rather than dependent disability. 

Take-up of personal budgets has been low amongst people with mental health problems, but those who have had them, seem to be particularly happy with the system. Many say that the process of having control over their own support was a contributory factor in their recovery.

Not surprisingly, politicians have been keen to extend what seems like a winning idea. Hence initiatives to extend direct payments to other groups such as older people and the move since 2008 to pilot personal health budgets. Let’s be clear, what the parameters of this debate are.  In essence personalisation (whether it involves the exchange of money or not) is about shifting control from professionals to service users and their families. 

It presumes that individuals better understand the support they require and will experience better outcomes if they can decide how and by whom that support is provided.

Personal budgets are a mechanism for personalisation, not an end in their own right and they have their risks. Not everyone will want one and there must always be the right for service users to opt out.  Perhaps many of the objectives of personalised care can be achieved without the need for money to change hands, but if so, why is meaningful care planning still distinguished by its absence.

As with most things in life there can be downsides. Like professionals, service users might on occasions make the wrong choices and the system may have to intervene to deal with the consequences. Occasionally services users might spend their money on something which to the public or more significantly the Daily Mail seems unsuitable.  There is the danger that the individualisation of choice will undermine the viability of services which worked most of the time for most of the people who used them.

These risks should be acknowledged and managed, but they are not a reason to reject the policy. The evidence so far is that personalising care and giving service users and carers greater control of the resources available for their support will help the integration of care and lead to more timely interventions which can prevent the need for crisis intervention and improve outcomes. 

Whether this saves money is not an issue on which we have the evidence to make an irrefutable claim but it is likely, at least, to lead to better outcomes for the same resources. 

There seems to be some continuing desire on behalf of Ministers to promote this agenda.  But in the new world of localism, its delivery will be dependent on the actions of local stakeholders.  Whatever national politicians say, ambitions to extend personalisation can be stifled by mountains of red tape or professional shroud waving.  And there is no doubt that the move to personalisation is harder to achieve when money is as tight as it is now.

So where next? 

Next year’s proposed Social Care White Paper provides an opportunity for Ministers to move things forward. This could be achieved by giving three new rights to people who use mental health services.

• First, new social care legislation should give people needing care and support a statutory right to a meaningful process of care planning,  which involves them in key decisions about the care and support they receive.  Such a right should embrace not just social care, but include a duty to involve the NHS, housing and other agencies which need to contribute to someone’s support.
• Secondly, the legislation should give all service users the automatic right to receive a personal budget which they can opt out of if they choose, but which puts them in the driving seat if they want.  Such a right should include, for people with long term physical and mental health conditions, the ability to access a personal health budget.
  
• Thirdly, service users should have a right to access information and advocacy to support them in planning the care and support they require.  

Given the state of public finances it may be prudent to phase the introduction of this new framework.  However these new rights would help to give a clear signal that personalisation was here to stay.

Personalisation is the logical extension of the philosophy of putting services users and families and not professionals at the centre of decision making in health and social care.  Like all good ideas it is not a panacea and attention needs to be giving to implementing it away that minimises unintended consequences. 

However concerns about implementation should not obscure the potential impact this approach could have in transforming the lives of people who need long term care and support.

Find Out More

• Learn more about personalisation
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