April 2020: Changes in relation to Coronavirus
As outlined in the Coronavirus Act 2020, the local authority may have to make changes to conducting needs assessments, eligibility decisions, care and support planning and reviews for adults with care and support needs. In such circumstances, it is essential that a person’s human rights must not be breached and that the values and principles laid out in the ethical framework are considered and applied when working with adults and their families. These are respect; reasonableness; minimising harm; inclusiveness; accountability and flexibility. See Responding to COVID-19: the ethical framework for adult social care (Department of Health and Social Care).
There have been changes to S30 of the Care Act, where an adult expresses preference for a particular accommodation. The local authority now does not have to comply with the regulations, if the easements have been activated (see Care Act Easements: Guidance for Local Authorities (Department for Health and Social Care). The new legislation enables patients to be discharged rapidly from hospital when medically appropriate, therefore in relation to a person needing accommodation under S18 to 20 CA, this regulation may no longer need to be enforced.
‘Personalisation is a way of thinking about health and care services that puts people at the centre of understanding their needs, choosing their support and having control over their lives. It also means people have the support they need to live independently and actively in their communities.’ (Think Local, Act Personal; 2014)
Personalisation has a wide agenda, encompassing a number of different areas, some of which have been incorporated into the Care Act 2014. This includes information and advice; prevention and early intervention; community capacity building; improved use of universal services, personalising the formal support people need and providing person centred care.
Personalisation is an approach that was first adopted by adult social care services, culminating in Putting People First (Department of Health, 2007). It has since been developed further by the Think Local, Act Personal (TLAP) partnership and now incorporates other sectors including the voluntary and community sectors, people with care and support needs, carers and family, and the NHS as part of the Integrated Personal Commissioning (IPC) programme which brings together health and social care funding around individuals, enabling them to direct how it is used.
2. Personalisation for Adults and Carers
Personalisation is often associated with direct payments (see Direct Payments) and personal budgets (see Personal Budgets). These resources enable adults to choose the services they receive, rather than the previous approach of people having to adapt to available services.
It also includes the provision of improved information and advice on care and support for adults and carers, investment in services to prevent, reduce or delay people’s need for care and support and the promotion of independence and self-reliance among individuals, carers and communities.
The aim of the personalisation agenda is to improve the lives of adults and their carers. The challenge is to ensure that all people – including those with dementia and mental health problems who lack capacity for example – also fully benefit.
Adults are able to self-assess their own needs, with or without support, play a full part in drawing up a wide-ranging support plan and directly purchase or choose the services they want (see Assessment). Personalisation in relation to adults with care and support needs should, however, be considered within the context of risk; to the adult, their carers and others (see also Risk Assessments).
3. Frontline Professionals, Commissioners and Providers
Personalisation has significantly impacted on the work of social care professionals and the ethos of local authority adult social care teams. The core functions of care management – assessing adults, risk assessments, drawing up a care plan and purchasing services to meet needs – have all been transformed through personal budgets. This will continue with the implementation of the Care Act 2014 and be extended to include other sectors and professionals, including the NHS.
As a result of personalisation, local authorities have created a range of roles to support adults in carrying out these tasks or commissioned external organisations to do so, including user led organisations (ULOs).
The role of commissioner has changed as a result of personalisation. Instead of purchasing services in bulk from available providers and fitting adults who are eligible into those services that best meet their needs, commissioners now shape the social care market to promote the availability of a diverse range of high quality services from which adults, and their carers, can choose.
Local authorities must ensure adults can access a diverse market of providers, and producing a market position statement can set out how they plan to implement the duty (see 4.79 – 4.87 Care and Support Statutory Guidance 2014).
Personalisation also requires a change in approach from care providers. As councils devolve purchasing responsibility to adults and their carers, local authorities are using framework agreements rather than block contracts with local authorities. Instead, councils are setting up framework agreements, under which providers are accredited to provide services of a particular quality at an agreed price but are not guaranteed business, as decisions on whether to use them rest with service users. This should make providers more responsive to service users’ needs and wants and drive innovation.
Appendix 1: Ten Lessons for Personalisation in the NHS
The information below is taken from Getting Serious about Personalisation in the NHS, TLAP, 2014. However, it contains key information for all organisations and staff involved in the personalisation agenda.
- KEEP THE PERSON AT THE CENTRE – engaging people meaningfully in the design, delivery and evaluation of care and support is intuitively right to ensure it works in the best way possible. But services are often bad at this and genuine co-production with people as active partners in their care is challenging in practice. This is an ongoing journey in social care, but there is growing evidence of the benefits.
- CULTURE OVER PROCESS – personalisation is primarily an ethos requiring profound cultural change and different ways of thinking and working, but getting bogged down by process is easy to do. Much of the early story of personalisation in social care revolved around protracted efforts to devise the perfect method of resource allocation, with very mixed results. Getting the process right is important – but shifting the culture of care should be the primary goal.
- EVOLUTION NOT REVOLUTION – it is impossible to shift culture overnight and immediate change risks destabilizing things that are working well. There have been benefits to urgency and a place for targets in the social care story, but the transformation envisaged was always going to take a generation to deliver and the same will be the case in health.
- CREATE A COMMON LANGUAGE – the proliferation of different terminology surrounding personalisation in social care has caused confusion. Agreeing a common, jargon free language will help convey the benefits to people, staff and the public. New ways of thinking may need new language, but being person-centred shouldn’t require a thesaurus!
- BUILD AWARENESS – People with health and care needs should understand their rights, know what to expect and be able to explore the potential benefits of personal care and support planning and personal budgets. Insufficient attention was paid to these aspects of personal budgets in social care, but there can be no stronger lever for change.
- INFORMATION IS THE KEY – a lack of clear and accessible information and advice is always part of the problem when things don’t go well, yet is rarely top of the list of priorities. Universal information and advice is an essential building block for personalisation and the Care Act presents the opportunity to build on the learning from social care and take a more strategic, joined up approach.
- SOCIAL CAPITAL IS NOT A SIDELINE – personalisation has always involved a broader range of paradigm shifts than individualising funding, but some of these have had less attention than others in social care. The importance of focusing on building community capacity and recognising and strengthening people’s social capital is integral to the model and should be built in from the outset.
- CHOICE DOESN’T JUST HAPPEN – for personal budgets to deliver greater choice and control there need to be a greater range of options available. While providers do adapt over time to different purchasing decisions, commissioners have an important role to play in shaping what is available locally and working with providers to redesign services. This requires a different and more facilitative sort of commissioning – social care is only just starting to make this shift.
- GET PROVIDERS ON BOARD EARLY – personalisation is not just about commissioning differently, it has significant implications for providers and how services operate. This means it is important that providers are part of how the change is planned and delivered. In social care this focus was not sufficiently clear at an early stage leading to unnecessary anxiety and services delivering more of the same.
- MEASURE WHAT MATTERS – across the breadth of the agenda and starting from what is important to people with health and care needs rather than just measuring the things that are easiest to quantify. The social care experience has been instructive about the limitations of measuring culture change through the blunt instrument of personal budgets numbers. The narrative provides a useful starting point.