It is sometimes useful to have a plan and sometimes local bodies may seek to confirm the competence of people with individual budgets by reviewing plans. This makes a framework, which clarifies the essential elements of a plan, essential. However plans are a weak guarantee of effectiveness and should never be treated as part of a contract.
The notion of 'care planning' has been central to health and social care in the Uk for many years. However it has often been seen as tending to encourage a view that it is the role of the professional to plan for us. In 1999 Simon Duffy worked with North Lanarkshire Council to develop the concept of a Support Plan, which would be authored by the person - with or without support. This concept was a very useful one when redesigning services around the idea of Self-Directed Support because it enabled lead professionals to see the Support Plan as a functional replacement for the 'care plan' which had become essential to their own role definition.
In the further development of individual budgets this concept of a Support Plan has taken on further weight and many public bodies are now using Support Plans as a means to guarantee the quality of a service - before it has been delivered and/or as a means for contracting for the service. This is an unfortunate backward step for two reasons: (a) plans do not assume quality - they can only provide someone initial and very limited data about the competence of the person who is to manage the individual budget in lieu of the real data that comes from seeing how people actually manage in reality; (b) if plans are treated as contracts they are in danger of encouraging people to do things which may - in reality - turn out to be inadvisable. A plan should never be a contract.
The term 'Personal Plan' is also perhaps to be preferred as we begin to see personalisation extend beyond social care to include health, education and other services.
A framework for Personal Planning can be helpful insofar as it helps people think about important issues. It is essential if the plan is to be used in any way as a test of competence of the planner as nobody should be expected to simply guess at the issues they are expected to cover.
In practice there are many ways of planning and documenting a plan, but the following 6 elements are frequently important to consider:
- Outcomes - what is the desired end-state
- Treatments - how will the outcome be achieved
- Support - who will be needed to achieve the outcome
- Risk - what measures will be taken to keep people safe and well
- Cost - what will all these measures cost
- Leadership - how will budgets and treatments be measured
A note on planning
There is a tendency for public services to fixate on plans, but not on the real competence that must be developed by actually being in control.
This brings with it a series of risks:
- To invest in planning and support to plan, rather than investing in people and mutual support
- To try to measure and control the quality of planning, even though this may be poorly correlated with success
- To fail to support those people who seem poor at planning, but who learn best by doing
- To create a false sense of security by focusing on a poor proxy for real competence
- To slip into damaging interference and rationing through the approval process
It is important that systems develop different, more realistic quality control systems, and move away from an undue focus on the initial plan.
The publisher is The Centre for Welfare Reform.
Personal Planning © Simon Duffy 2010.
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