The challenges of personalisation for social work and the health and social care workforce

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The challenges of personalisation for social work
and the health and social care workforce

• Guy Daly and Annette Roebuck
• JSWEC 2009

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Structure of the Paper Presentation

• Introduction/Background
• Policy Context
• The Research Project
• Findings and Discussion
• Framing the factor that impact upon
  interactions between professionals and service
  users who have an IB
• Summary and Conclusion

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Introduction/Background

• Local Evaluation to Investigate Service User
  Experiences of Having an Individual Budget (IB)
• The city council was also a part of the national
  pilot project investigating IBs quantitative
  study
• Sample differed somewhat from the majority of
  other national sites in that all service users
  were in transition

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Policy Context (1)

• choice
• independence
• personalisation
• outcomes-based care
• direct payments
• individual budgets
• personal budgets

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Policy Context (2)

• Choice and Personalisation agenda
• Problematic (see Clarke Daly)
• in social care direct payments, individual
  budgets, personal budgets
• IBSEN evaluation benefits but still barriers
  exist
• Government still pushing ahead Darzi Review
• There is clearly real enthusiasm and energy
  across health and social care for personal
  health budgets.... During the consultation for
  the Next Stage Review, people said clearly and
  consistently that they want a greater degree of
  control and influence over their health and
  healthcare. (DH, 2009b)

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Learning From Previous Studies (1)

• develop and manage social care markets
  effectively
• commission social care effectively
• develop effective partnership working
• develop an understanding and raise the profile of
  individual budgets

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Learning From Previous Studies (2)

• overcome various barriers including attitude of
  certain local authorities and social care
  professionals
• promote outcomes focused social care
• ensure users are empowered
• ensure real choice is provided

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IBSEN Findings (1)

• holding an IB was associated with better overall
  social care outcomes and higher perceived levels
  of control
• the IB group were significantly more likely to
  report feeling in control of daily lives, their
  support and how it was accessed

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IBSEN Findings (2)

• specific benefits for particular groups
• for people with mental health problems,
  significantly higher quality of life and a
  tendency towards better psychological well being
• physically disabled people with IBs were
  significantly more likely to report higher
  quality of care and more satisfied with help
  received
• people with learning disabilities with IBs more
  likely to feel that they had control over their
  daily lives

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IBSEN Findings (3)

• less positive findings for some groups
• most significant was that findings were less
  positive for older people
• psychological well-being was not improved for
  some groups
• for people with mental health problems, while
  experiencing potentially significant benefits,
  still major barriers to greater take up

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Social Work and Care Training

• There is a strong evidence base to show that
  frontline staff and first-line manager training
  is vital for the implementation of individual
  budget schemes (particularly where people receive
  a direct payment) to manage change, improve
  knowledge and assessment practice, to promote
  equality and diversity awareness and to challenge
  perceptions about risk and certain groups
  (particularly older people and people with mental
  health problems or severe learning disabilities)
  who could benefit from the direct payment
  option.
• (Carr and Robbins, 2009, pp. 19-20)

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The Social Work Task (!)

• The social work profession promotes social
  change, problem solving in human relationships,
  and the empowerment and liberation of people to
  enhance wellbeing. Utilising theories of human
  behaviour and social systems, social work
  intervenes at points where people interact with
  their environments. Principles of human rights
  and social justice are fundamental to social
  work. (International Association of Schools of
  Social Work, 2001)
• ... both an art and a science which
  practitioners draw on knowledge(s) and evidence
  in reflexive and creative ways, applying ethical
  approaches to make a difference in the lives of
  vulnerable or marginalised people. (Lymbery and
  Postle, 2007, p. 113)

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Local Evaluation to Investigate Service User
Experiences of Having an Individual Budget

• Project Aims
• to evaluate the extent to which the Individual
  Budget project has been effective in empowering
  service users to make decisions for themselves.
• Ethical approval was gained from the local
  authority and Coventry University

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The Research Context Methodology

• Qualitative action research
• Aiming to capture the lived experience of having
  an individual budget from the perspective of
  service users and carers
• Empowering participants to tell stories in ways
  that were meaningful to them
• Methods included use of art, photography,
  interviews, film, blogs

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CCC Sample

• Sample
• all service users were in transition from one
  care setting to another
• 44 service users in the Pilot
• 30 service users participated in the evaluation
• 19 male, 11 female
• third 16-18 years, third 19-25, third over 25
• Twenty two participants were identified as having
  a learning disability, seven a severe physical
  disability and one an enduring mental health
  need.
• vulnerable individuals with additional
  communication needs

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Key Findings

• Many different themes focus today on strand of
  the challenges of supporting / being supported in
  an IB
• Service users and carers had both positive and
  negative experiences of interactions with people
  supporting them to undertake the individual
  budget
• Social workers too had mixed experiences of
  managing the pilot scheme
• Despite the challenges, the vast majority found
  the individual budget to be empowering for
  service users

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Framing the Challenges Facing People Supporting
Service Users with an Individual Budget
Service Users and Carers
Environment
Professionals
Reasoning
Communication
Knowledge
Skills
Action
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Goodness of Fit Between Factors and the Impact on
the Service User Experience
Good Fit

• Our experience of the Individual Budget is that
  it is easy to manage and flexible. (family
  member)
• well Im not very clever..I have got a little
  bit agitatedIve been stressed, Ive actually
  been at the doctors.Ive been getting stressed
  (carer)
• A lot of professionals we have encountered are
  not used to dealing with parents and carers as
  the coordinators of their service users care.
• They have not been ready to accept our necessary
  level of involvement as the direct purchasers of
  our daughters care and support. (parent)

Poorer Fit
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Unpacking Key Points

• Knowledge
• Skills and Reasoning
• Impact upon communication and action

ENVIRONMENT
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Knowledge

• Some new knowledge is required e.g
• Assessment methods
• Brokerage
• Available partnerships
• Available support and training for service users
• And whats going to happen after the pilot
  finishes? Even the Social Worker doesnt know
• (service user)
• it is yet another service for disabled people
  that the government are taking away
• The government are just throwing money at people
  and telling them to get on with it

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Knowledge

• Not all the knowledge required is new, even if it
  initially appears so
• Outcomes focused assessments bring together the
  two approaches we had before

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Reasoning and Skills

• At first social workers were a little
  preoccupied with the language. How can we be
  sure what people really want?
• New situations often require us to apply our
  existing skills in new ways, or to develop new
  skills.
• Reasoning is frequently tacit, but to be
  effective, we need to make these processes
  conscious.

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Empowerment rhetoric and reality

• Empowerment principles a core value of many
  professions
• In reality, empowerment is frequently constrained
  by the environments within which we operate
• Not all service users wish to be empowered or
  have an IB
• The principles inherent within the
  personalisation agenda in theory at least may
  offer new opportunities to service users
  provided we recognise and act upon them.

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.

• When individual budgets were first talked about
  I have be honest and to admit I immediately
  adopted the ostrich attitude. I put my head in
  the sand and pretended it had nothing to do with
  me.slowly it dawned on me that this was an
  opportunity to change the way.people are
  assessed and offered services. Personally- well
  Im not the ostrich any more! There are still
  some things I dont understand,..but my
  commitment to individual budgets and the
  difference they can make is whole hearted.
• (social worker)

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Partnership Working Rhetoric and Reality

• but I just think possibly maybe because its a
  new pilot the organisation of the social services
  and Ps Trust or maybe its the communication
  between both of them ..organisations it doesnt
  seem to be very good at the minute (carer)
• at times it has been difficult to get information
  from SS about how the plans are progressing but
  since getting person-centred planning
  organization involved the communications channels
  seem to be much more effective
• its a concern that if I challenge the SS, they
  could label me a trouble maker and this could
  affect my daughters care packages

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Reflecting within a framework

• The way that we think and reason impacts upon
  both our communications with other parties and
  our actions
• Service user and carers within the project often
  moved between the type of support they required
• Professional staff need to be able to adapt
  interaction style to suit needs often within
  the course of a conversation

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Not an easy journey.but worthwhile

• Goodness of fit can result in some good outcomes
• The IB has been great for L but the process was
  very stressful for me.
• Its complicated, not user friendly The social
  worker has been very helpful (sister)
• What is encouraging is that we have had hugely
  positive feedback about our assessments (social
  worker)

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Conclusion

• The pilot represents not only a new way of
  assessing and delivering personal assistance, but
  also a new way of working as the social worker
  and service user work in partnership to ensure
  the right level of personal care is provided in
  the right manner
• (service user)