Delivering personalisation in health and social care – An interview with Helen Sanderson and Jaimee Lewis
Helen Sanderson is Director, Helen Sanderson Associates and has written extensively on person-centred thinking, planning and community building. She co-authored the first Department of Health guidance on person-centred planning, as well as the 2010 guidance ‘Personalisation through person-centred planning.’ She was the expert advisor on person-centred approaches planning to the Valuing People Support Team.
Jaimee Lewis is strategic communications adviser to the Think Local, Act Personal Partnership, the sector-wide commitment to transforming adult social care that follows on from Putting People First. She has worked on communicating the personalisation agenda for several years, following her appointment as an advisor to the Department of Health’s individual budgets pilot programme in 2006.
Here, they discuss their new book, A Practical Guide to Delivering Personalisation, and explain what personalisation is and what it looks like; give some examples of how the tools in their book can be used in practice; and discuss why a person-centred approach to social care planning across all services, from mental health to end of life care, is the way forward – especially in difficult economic times.
What is personalisation and person-centred thinking? What kinds of problems did it develop in response to?
Personalisation means more than just personal budgets; it means people having real choice and control over their support on a day-to-day basis. Handing over financial control – as required by current national policy – is crucial, but so too is social workers, support workers, health professionals and others working in a way that sees people as individuals and equal partners; treats people, their families and carers with respect; and does not make assumptions about who people are or what they might want to do, based on labels or lifestyles.
To deliver personalised services, we need to know what is important to a person; how to best support them; the way they communicate and make decisions; and how we are doing in delivering personalised services – what is working and not working. To do this, we need to work to change some of the systems, processes, practices and cultures that have developed over the years around helping people access care and support, building on the good things and changing those that get in the way of personalisation.
Personalisation and self-directed support can be delivered through person-centred practice, which recognises that staff have a key contribution to make in changing people’s lives by adapting and improving the way support is provided. This enables people to take greater control in developing arrangements that make sense to them, their families and carers – which is the reason most social workers and other helping professionals enter their profession in the first place.
‘Person-centred Thinking’ refers to a range of practical tools and skills that staff can use on a day-to-day basis to deliver more personalised services. ‘Person-centred Reviews’ are a way to transform and replace the statutory required reviews in services; to create person-centred actions. ‘Person-centred Planning’ refers to processes for planning around an individual that focus on creating a positive future and being part of a community. ‘Support planning’ is a way for an individual to describe what they want to change about their life and how they will use their personal budget to do so.
Can you tell us about your book and who you wrote it for?
This book focuses on how person-centred practice can be used across all services – including mental health and other services for people with long-term conditions or those approaching the end of their lives – by staff (in whatever role) supporting people in health and social care (and ‘prevention’). We use the term ‘staff’ to include any paid staff or professional role that helps disabled and older people, their families and carers.
When writing, we have tried to include quotes and stories to bring person-centred practice to life and to show what good practice looks like. The examples we share are from a wide range of people in different situations, with people telling their own stories or staff talking about how they have used different approaches. Earlier writing on person-centred planning (for example, People, Plans and Possibilities) shared stories from the lives of people with learning disabilities. In this book, we have intentionally tried to balance this with stories and examples from people with long-term conditions, older people and people who use mental health services.
Some people you will meet several times: James, who is managing a long-term condition; Jennie, a young woman with a personal budget who has autism, and her mum Suzie; Madge who is thinking about the end of her life; and Sandra who describes herself as being in recovery. Although the focus of this book is on delivering personalised services through using person-centred practice, person-centred thinking and planning are for everyone, regardless of whether you are currently receiving a service or not, so the examples also include people who don’t receive services, families and carers. So you will meet Michelle, who planned with her Dad around his future; Helen who is part of a support circle; and Jaimee who has used person-centred thinking to improve her well-being.
The book features lots of practical tools and photocopiable templates. Can you give some examples of the ways in which the book can be used?
Health and social care workers, support workers and other professionals need to understand person-centred thinking tools and person-centred plans – and to coach their staff and colleagues in using them – to deliver self-directed support. The tools offer a way of learning and understanding the balance between what is important to and for a person; enhancing voice, choice and control; clarifying roles and responsibilities; and providing analysis and action. By looking at what’s working and not working in someone’s life, you can determine which person-centred thinking tools to use and build a person-centred description to inform a person-centred plan or support plan.
There is a process for making statutory reviews person-centred. This is called a person-centred review or an outcome-focused review (where the person has a personal budget). These create shared actions for change, based on a reflection and analysis of what is working and not working for the person, and others. They can be used across services, and in mental health services, to change a typical care programme approach for the better.
Person-centred practice contributes to every stage of a person’s journey of support through adulthood. Improving an individual’s connection with the community by making them feel ‘good’ and improving their well-being is one way of meeting the prevention agenda and potentially reduces the need for unnecessary support.
Person-centred practice can also provide a different approach to recovery – based on partnership – that asks people what they would like to achieve and then helps them to do that. It means doing things with people rather than to them.
When people have long term-conditions, person-centred thinking tools can help in the development of personalised care plans that, when done in partnership with healthcare practitioners, meets a person’s support needs in a way that suits their ‘whole life’. This extends to dementia where care mapping occurs in residential homes.
Person-centred thinking can also help the re-ablement journey, as the way people maximise their independence will be unique to them. It allows for people to be involved in all discussion and decisions about their support and strengthens natural support networks and community involvement.
When people need ongoing support, carers may find person-centred thinking tools helpful in ensuring their own support needs are acknowledged. Investment in person-centred thinking and a determination to ensure people have as much choice and control over their support means it is possible to personalise domiciliary care, even if only 15 minutes is available, and ensures that people keep their individuality in residential care settings.
When people are approaching the end of their life, person-centred thinking tools and plans can help a person, their families and carers to better manage this and experience things in a way that makes most sense to them.
It should be possible for a person to get support that enables them to manage identified risks and to live their lives in ways which best suit them. In order to achieve this, a person-centred approach is required, based in the use of person-centred thinking tools. This will help people and those who care about them think in a positive and productive way about achieving the changes they want to see while keeping risk in its place.
Do you think there are misconceptions about personalisation? What are some of them, and why do they persist?
Personalisation is often thought of as only being about personal budgets. It isn’t.
Personalisation is about people having better lives through more choice and control over the support they use. We believe that services and support should be more personalised, according to the needs and wishes of the people who use them. They should also be provided in ways that help people to be active and contributing members of supportive communities and take into account preventative help and services that affect a person’s whole life, including health, transport, housing and leisure activities.
Misconceptions prevail because of the focus on reaching targets – the most measurable one being the NI 130 indicator for personal budgets. The launch of “Making it Real” – citizen-led benchmarks for success with personalisation – should go some way to addressing this.
Also, there is a risk that people think the delivery of personalisation is undermined given the challenges of the current financial climate. Person-centred thinking and planning helps people think about all the resources available to them, and then helps them and the people who support them use those resources to their full effect. It makes every penny of funds they receive – either from public or private sources – stretch so much further. When money is tight, it is even more important to use resources as effectively as possible. And what better resource is there than what a person (or those close to them) believes is important to them and works well for them and what they want for their lives? We can’t afford not to listen to people well and to act on this information.
Personalisation has been championed by the current UK Government. How do you see it being employed within health and social care in future?
Further and faster it seems.
The current vision for health and adult social care in England requires ‘individuals, not institutions’ to take control of their support. It calls for all eligible disabled and older people as well as people with long-term health conditions or who are approaching the end of their life to have access to direct payments or personal budgets. This hands financial control of the support available over to people, their families and carers so they have maximum flexibility in deciding how they can achieve their desired life outcomes. So that people are truly empowered to do this, person-centred practice and self-directed support should become mainstream activities in personalising health and social care.
The Law Commission’s proposals for modernising community care law and Dilnot’s report on funding options Fairer Care Funding are also clearly crucial as we head towards the forthcoming White Paper in 2012.
Organisations and individuals working with people who need support are starting to understand that in order to deliver personalisation, there must be root and branch changes to policies, practice and culture. This increased awareness has been supported by the disabled people’s movement – the introduction of direct payments legislation in the mid 1990s was one of their key achievements – but also by the work of successive UK governments from both sides of the political spectrum.
Copyright © Jessica Kingsley Publishers 2011.