Title: The challenges of personalisation for social work and the health and social care workforce
1The challenges of personalisation for social work
and the health and social care workforce
- Guy Daly and Annette Roebuck
- JSWEC 2009
2Structure 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
3Introduction/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
4Policy Context (1)
- choice
- independence
- personalisation
- outcomes-based care
- direct payments
- individual budgets
- personal budgets
5Policy 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)
6Learning 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
7Learning 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
8IBSEN 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
9IBSEN 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
10IBSEN 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
11Social 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)
12The 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)
13Local 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
14The 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
15CCC 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
16Key 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
17Framing the Challenges Facing People Supporting
Service Users with an Individual Budget
Service Users and Carers
Environment
Professionals
Reasoning
Communication
Knowledge
Skills
Action
18Goodness 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
19Unpacking Key Points
- Knowledge
- Skills and Reasoning
- Impact upon communication and action
ENVIRONMENT
20Knowledge
- 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
21Knowledge
- Not all the knowledge required is new, even if it
initially appears so - Outcomes focused assessments bring together the
two approaches we had before
22Reasoning 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.
23Empowerment 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.
24.
- 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)
25Partnership 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
26(No Transcript)
27Reflecting 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
28Not 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)
29Conclusion
- 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)