Author: Tanya Moore
Personalisation moved quickly from a grass-roots innovation into an all encompassing and government sponsored policy. In the process the opportunities to engage academics, students and the social work professional were minimal. The University of Hertfordshire is trying to redress the balance by developing a broadly based curriculum on personalisation that reflects both its best hopes and the real challenges.
We may have missed a trick in priming Social Workers for an empowering, person centred and creative means for mobilising support and then flattening them with extra layers of bureaucracy instead. Here at the University of Hertfordshire, we want our MSc Social Interventions module in Personalisation to give practitioners the chance to remember why we initially all became so fired up and enthusiastic about individual budgets. We also want to consider in the light of experience, whether or how Personalisation can support enabling and creative practice in the way we had hoped.
There has been significant good will for this to happen. The module was oversubscribed and we enjoyed insightful, thought provoking contributions from students, who were all experienced Social Work, OT or Nursing practitioners as well as from high profile contributors to the Personalisation agenda and from people whose lives had been significantly changed by Personalisation.
This article describes how we structured our module, the expectations brought by the students, (all experienced practitioners and managers) and the impact that the module has had upon them.
The first day gave the students opportunity to consider what they understood Personalisation to be and to pose their questions for the module. Not surprisingly for a group of local authority practitioners, focus was on individual budgets and Resource Allocation Systems. From the practice managers, there were concerns about mis-spent budgets and from all, the difficulty of having to withdraw or reduce original allocations as allocation criteria change.
Questions and expectations for the module included:
The module was spread over 4 months. Students came into the University for a total of 8 days. A comprehensive reading list was made available on the University of Hertfordshire Studynet system. Regular updates were given and discussions amongst the students took place on study-net.
The demands placed on the students were high. They were expected to read broadly and quickly develop an understanding of what Personalisation means outside of the statutory sector. Class discussions were lively and well informed. We were particularly fortunate to have secured engaging and influential speakers who challenged whilst they inspired new ways of understanding.
Simon’s session gave students an opportunity to put their questions to the architect of the Resource Allocation System but also, to revisit the roots of Personalisation and to understand the determination of disabled people to assert their ability to shape their own lives and determine what support they might need and how this should be offered.
His presentation of the Professional Gift model in which the individual needs direction and control from the professional and the Citizenship model in which the individual is an essential part of the community with expertise and entitlements created heated debate amongst a workforce that is used to having to ration public funds and has an understanding that their role is to see that scarce public money is responsibly spent.
The discussion became an enactment of the internal struggle that professionals can face in giving up power and responsibility for public resources to the people for whom they have been made available. Students’ own experiences from practice seemed to confirm Simon’s view that the processes that have been developed around allocation and monitoring of individual budgets are now more about keeping an eye on the cash than thinking about whether people could use the money to which they are entitled, to improve their own quality of life.
Gill is a Law Lecturer works in the office of the Health Ombudsman and is also a law lecturer here at the University of Hertfordshire. Gill gave an overview of the current legislation and guidance underpinning Personalisation and also focussed upon mental capacity, mental health, carers’ assessments, contracts and employment law issues and the role of the Local Government Ombudsman.
Students worked in groups with a case study to test their own application but also took full advantage of the session to explore their own legal issues from practice.
Creating Links is an organisation made up of people who use services or care for people who use services. The university Social Work group work closely with Creating Links who participate in admissions interviews and take a number of workshops with qualifying students.
Creating Links offered the experiences of one carer, whose brother experienced a brain injury as the result of a road traffic incident. The carer described her experiences of being with her brother as he and his family came to understand his new condition and his need for extensive support. This was uncomfortable listening for all as the shortcomings of the professional services were highlighted. This carer, with her family are now managing a personal budget for her brother and have managed to recruit a small team of workers in whom they feel they can place their trust.
The second carer’s son needs support because he has an enduring mental health need. His direct payment is used to pay for a ‘befriender’ to go out with him. This family’s experience of the Social Workers involved has been highly positive.
This was a reflective session delivered to a room filled with empathy. The natural urge of the practitioners to offer support couldn’t quite be contained and both carers found themselves in the perhaps unique position of having 21 service experts offering help and information.
The power and impact of their stories seems to me to have been made more apparent in subsequent weeks as the student group had powerful and emotional shared case experience upon which to reflect as aspects of policy and practice were explored.
Jerry Evans, Senior Lecturer in Social Work at the University of Hertfordshire was asked to present a critical discourse of Personalisation. Jerry described the evangelical framework to the presentation of Personalisation. He noted that Personalisation is often described in warmly persuasive terms, its stories being told as parables and the development of Personalisation being presented as epochal change.
Jerry also considered the radical critique; which sees social justice as a collective project and criticises Personalisation as a neo-liberalist approach which expects individuals to almost heroically throw off the oppression that they face.
Jerry’s presentation of the Managerialism critique offered a framework for the frustrations experienced by many of the students as Personalisation can be presented as an organisational process with a tick box format and maddening levels of bureaucracy.
His presentation of the political philosophy critique questioned the expectation that we can all construct ourselves as consumers and his understanding of the service user critique in which people who use services have ironically been absent during much of the reshaping of organisations struck resonance and led to a discussion about the impact of user-led organisations locally.
Chris and Lesley are personal budget holders and employ 3 personal assistants, two of whom came into the session to support them during their presentation. Chris and Lesley described their ‘life before In Control’ as having been mostly spent in bed as they were not getting the support that they needed. With the support of the direct payments team in Hertfordshire, they contacted two workers, from a day centre they used to attend and asked whether they would be interested in becoming personal assistants. Four years later, these two are still employed by Chris and Lesley and Chris and Lesley are living life.
Chris and Lesley showed a DVD of the some of the reasons that they now have for getting out of bed; cooking, shopping, day trips, holidays, moving flat, decorating, gardening, visiting and getting married (to each other).
The relationship between Chris and Lesley and their personal assistants is obviously warm and trusting. The two assistants are dynamic and organised but Chris when asked, was quite clear that it is he and Lesley who make the decisions as they decide what they want to do and their assistants must them help them to work out how to make it work on their limited budgets.
This was an inspiring session. It was good to meet people who were so successful in the recruitment of good staff and in the management of their budget. It was evident throughout however, that the success of this arrangement lies within the very genuine relationship of mutual respect and enjoyment that the Pickerings enjoy with their staff.
The budget cuts have already hit Chris who has already had his personal budget reduced.
Brian Littlechild offered a discussion of Personalisation in terms of Kantian ethics, utilitarianism and virtue ethics. He asked students to place their own codes of practice within the context of these three and to consider the social worker’s dilemma of balancing the rights of the person they are supporting with the rights of others.
Brian noted that people who use services don’t tend to define themselves in terms of the service that they use yet professionals ‘pigeon hole’ people into service groups. He suggested that this is one aspect of the way that we work that will need to change if workers are to achieve genuine collaborative partnerships with people they support. He also highlighted a need for good understanding of alternatives to the prevailing medical model and a recognition of the need for people to speak and act for themselves. He also emphasised the value of user controlled organisations.
Sarah Pickup, President of the Association of Directors of Social Services (ADASS) and also Director of Hertfordshire Social Services, presented a future based upon the 2010 DoH paper A Vision for Adult Social Care. She explained this to be a focus on Prevention, (information and advice, community infrastructure, targeted prevention services, predictive modelling), on Recovery (intermediate care, enablement beds, telecare, equipment, one off solutions) and on ongoing Support (enabling homecare, telecare, equipment).
Sarah outlined the role of the new Health and Wellbeing boards and the Public Health Transfer, which brings a new duty on local authorities to promote the health of their population.
Sarah focussed upon partnership and the role of the voluntary sector in carrying out some of the requirements of personalisation noting that in the future, ‘bundled support’ will not be sought, instead, local authorities will be looking to purchase from a menu of services. This will have significant impact upon all providers of traditional residential care.
Sarah introduced Personalisation as a policy conceived in a time of perceived boom but being implemented at a time of bust. Sarah highlighted the difficulties in finding a shared understanding of what personalisation means but offered: independent living and citizenship; choice and control; person-centred and relationship-focused working and the collective and community dimension as all being common understandings of its principles and aims.
The ‘process creep’ was identified as being its most significant hurdle. Whereas the original IBSEN study showed anxiety concerning fraudulent use of direct payments, this has not been borne out by the studies of people using direct payments and indications are that instead of front line Social Workers spending their time considering with people how they might safely take the risks needed to get on with living their lives independently, their role is being used to monitor how money is spent.
Sarah argued the need for ‘bottom up’ commissioning so that commissioning processes can shift away from a preference for big organisations towards becoming accessible to small organisations, co-ops and user-led organisations. Sarah suggested that commissioners should consider what social value a provider might have to the wider community
Dawn and Ian of Hertfordshire Adult and Children Services Workforce Development team presented a visualisation to enable students to focus upon what is important to them and to consider how any support that they might need could be delivered. This session offered a deeply personal experience for each of the students and interesting comparisons when group discussions revealed the very different ‘non negotiable’ aspects of support (from hair straightening to regular opportunities for gossip with friends).
This was the final session of the module and was my opportunity to speak from my experience in the voluntary sector. I highlighted the challenges laid out by the Think Local Act Personal "I statements" and considered what this might mean to the voluntary sector, both in the light of the freedom to create and innovate immediate responses but also in terms of the constraints such as complacency, lack of spare cash and fear of risk taking.
I looked at the experiences of Dimensions in their attempt to personalise a traditional residential care home and considered the need for traditional residential services to make fundamental adaptations in order to be able to respond to Sarah Pickup’s statement that support will no longer be bought in a ‘bundle’ and a ‘menu’ of services will become the expectation.
Finally, I introduced the HSA Progress for Providers tool not only to demonstrate stages that partner agencies might be working through but as a monitoring tool for local authorities to understand how much agencies have come to understand the requirements of personalisation.
There were two aspects to the assessment:
The in-class test caused significant anxiety to the students and although the results were generally high, this will be reviewed as a method of assessment for next year’s module.
Feedback for the module has been excellent. Students have reported significantly broader understanding of the meaning of Personalisation and despite their frustration at the bureaucratic focus within local authorities, suggest an optimism of the impact that a ‘ground up’ way of working could have upon the way support is offered in the future. Two of the students said that equipped with the knowledge from this course, they felt able to challenge their borough’s interpretation of Personalisation at a senior level. Another said that the money spent on consultancy in their borough could have been saved had the course speakers been brought in instead.
Understanding of what Personalisation means has certainly shifted amongst this group of students from a new and complex process system to a value base that recognises citizenship.
One student said:
‘I believe that I have always recognised people as the individuals that we all are but now I have a greater understanding of the need to build trusting relationships, to respect the person as a citizen and to enable active involvement.’
Another said that the course had enabled them to feel passionate and enthusiastic once again about what Personalisation can offer and noted the need for this cohort to act as ambassadors within the work place to combat the process created cynicism.
Several students said that the course had enabled them to gain an understanding of the grass roots of Personalisation; to understand where it came from, its potential impact on the quality of people’s lives and the need for local authorities and other larger organisations to change from the ‘bottom up’.
Other students commented that the course had taken the focus of Personalisation away from the local authority and back into larger society and that the challenge for local authority workers is to encourage and enable people to assume choice and control.
Hearteningly, none of the students rounded up their new understanding of Personalisation in terms of procedures and forms. Instead, they demonstrated broad understanding of Personalisation, beginning with what it might mean to the person at the centre, opening this up to those people involved in supporting them at different levels and drawing in the community in which they are based. This suggests to me that in participating in the Personalisation module, the students have expanded their understanding of Personalisation and tuned back in to their original enthusiasm for all that it could offer. How this will translate into an enhanced personalised approach to practice is not yet clear but there is promise as students through their critical incident analyses have been able to examine their own practice in the light of their new understanding and to think critically about how they feel practice should be changed or developed in the future.
Bureaucracy has not (yet) made creativity flat. Given the opportunity, practitioners remain fired up by the promise of Personalisation and they should be supported to explore its potential. Modules such as this offer space for development of understanding, detailed practice reflection and exchange of practical and inspirational ideas. It is hoped that more practitioners will be given the opportunity to explore Personalisation at this level.
The publisher is The Centre for Welfare Reform.
Teaching Personalisation © Tanya Moore 2012.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.