Personalisation & Social Work

Personalisation & Social WorkDr Simon DuffyTalk for University of Huddersfield, 2011

1Monday, 23 January 12

Agenda

9.20 What is ‘Personalisation’10.30 Opportunities & Concerns - tables11.00 Break11.15 Debate12.00 Social Work Rescript12.45 Lunch2.15 Applications - tables3.00 Feedback3.30 Break4.00 Polling Questions4.30 Final Questions5.15 Finish


Dr Simon Duffy

• Invented Individual Budgets and Self-Directed Support

• Founded Inclusion Glasgow, In Control, Shop4Support and many other charities and social enterprises

• Honorary Senior Research Fellow at University of Birmingham’s Health Service Management Centre

• Director of The Centre for Welfare Reform

• Policy advisor to The Campaign for a Fair Society

• Based in Sheffield


The Centre for Welfare Reform

• Research & development network

• Independent - no government or private backing

• Founded upon belief in human equality and diversity

• A community of 60 voluntary Fellows...

• ...people who created person centred planning, individual budgets, self-directed support, support planning etc...

• 200+ publications at www.centreforwelfarereform.org


http://www.centreforwelfarereform.org


The welfare state is good



it’s just designed wrong5Monday, 23 January 12


it’s just designed wrong5Monday, 23 January 12

• Personalisation is not defined by government

• Personalisation is about social justice

• Good ideas don’t just happen

• The challenge is to make it work for you

4 Thoughts


What is the meaning of personalisation?



Photos from “Christmas in Purgatory”


Institutions don’t just come with walls...

They start in the mind...

And can be hidden in systems of power, education, funding and culture


‘inclusion’ ‘normalisation’‘individualised’‘community’‘empowerment’

Great language...

...shame about reality


44 women with complex needs


Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t !nish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children have experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%

Of 44 women working with WomenCentre:






Service label N Urgent problem N Real need N

Victim of domestic violence 55 Debt 50 Better self-esteem 64

Mentally Ill 39 Housing 48 To overcome past trauma

54

Criminal 35 Benefits 46 To manage current trauma

51

Poor Mother 33 Health 37 To stop being bullied

50

Misuses Alcohol 24 Rent 32 Guidance 50

Uses Drugs 22Criminal Justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic Health Condition

16 Others 3 Others 1


is there a different way?


is there a different way?


in practice, this means


personalisation in practice

• Smith family story

• Reforming care management

• Self-directed support

• Personalised support

• Personalised transition

• WomenCentre

• And many more innovations...



individual (or personal) budgets


7 steps of self-directed support





Personalised Support flexible & creative

support





Personalised Transition

control: health, education & support



Jonathan’s health needs are complex.In the 3 years before leaving school Jonathan spent 150 days in hospital - responding to problems with breathing. In the 3 years since leaving hospital he has spent only 2 nights in hospital - for elective dental treatments.Jonathan’s family have overseen the development of a personalised package of support for Jonathan with flexibility, employment and learning - but not learning in college - but learning on the job. Over the last 3 years, Jonathan has acquired two City & Guilds Qualifications and is now learning new independent living skills. Over the last 3 years, the individual budget system has enabled Jonathan and his family to make significant efficiencies in the costs of his care and support and save the NHS:•Over £100,000 in hospital stays•Over £300,000 in residential care costs•Over £100,000 of funding contributed by the LSC


A couple of weeks ago in Sheffield, I met a wonderful woman called Katrina. She's got three disabled sons. e oldest is Jonathan, a charming, warm hearted young man of 19. He can't walk or talk clearly, or feed himself alone. He's had a breathing tube in his neck since he was a toddler. Under a scheme the new Liberal Democrat council in Sheffield is extending, Jonathan's just got his own individual budget and care plan. Now he's doing work with a local charity, attending a music group, has his own personal assistant - a child whose potential seemed so limited. Finally as a young man, engaged in life in a way he and his mother never thought possible. Katrina told me with the biggest smile I've ever seen, she said: We've gone from having nothing to having everything. I wish every child's needs would be taken this seriously. (Nick Clegg, 17 September 2008).


WomenCentre a creative and positive

community




What are the opportunities?

•What benefits are in personalisation?

•What threats are in personalisation?


time for debate


good ideas don’t just happen




social work is the art of helping people be active citizens


social work is the art of helping people be active citizens

in practice citizenship means...43Monday, 23 January 12


1. being in control

2. with direction

3. enough money

4. your own home

5. enough help, and

6. being active in community



but citizenship isn’t easy



poverty attacks citizenship



and poverty comes in many forms


and poverty comes in many forms

• loss of hope

• no power or control

• disadvantage

• exclusion & prejudice

• isolation & abuse



challenge poverty

so social workers




and social workers do this by


★ inspiring - hope and recovery




★ empowering - individuals & families





★ strengthening - personal development






★ connecting - to community






★ connecting - to community

★ building - safer networks



but social workers cannot do thison their own


these are not things you can do for people


these are things you have to do with people


it is people themselves who make a changebuilding on their own





resilience = hopeful human spirit



control = money and the power to use it




strengths = gifts, skills & knowledge





community = opportunities to join in





community = opportunities to join in

relationships = safe and loving networks







personalisation = social work

so what’s the big problem?58Monday, 23 January 12

the big problem for social workers is...


the old system

gets in the way


the old care management system


the old care management system

makes it hard to do social work61Monday, 23 January 12

it’s really hard to


• empower people - without entitlements




• strengthen capacity - focusing only on needs





• connect to community - inside segregated services





• connect to community - inside segregated services

• build safe networks - without family, friends and love



replace care management


replace care management

with self-‐directed support63Monday, 23 January 12

this means social workers can


this means social workers can1. empower people - tell people their budget



2. strengthen capacity - focus on personal outcomes




3. access community - use funding flexibly




3. access community - use funding flexibly

4. build safe networks - work with family, friends & others


systems sit on systems -‐ like sedimentary rock


Protection/Safeguarding Responsibilities

Comprehensive Assessments

Annual ReviewsJoint Assessment Processes

Care PlanningEligibility Criteria & Resource Panels

Monitoring Systems

Social Care Law for Children and AdultsMental Capacity Law

Care ManagementPersonalisation


We’re all still workingin the

old system 66Monday, 23 January 12

we’ve changed words


added new complexities


But thesystem is still the same


social workerssometimes even feel

personalisation has made things

worse70Monday, 23 January 12

we must simplify


and redesign

the whole system


we need a New Script for social work


the New Script looks like this...


the New Script looks like this...


Assess people’s ELIGIBILITY for:



• guidance



• guidance

• rehab or



• guidance

• rehab or

• a budget


Assess CAPACITY & clarify where the leadership is:



• the individual



• the individual• a representative



• the individual• a representative• or a professional


Don’t plan for people -‐ instead ENABLE other people to plan


Don’t plan for people -‐ instead ENABLE other people to plan

But always make sure that you...



is is Community Brokerage


OR79Monday, 23 January 12

Plan with people DIRECTLY yourself, especially when:



• it’s a critical situation



• it’s a critical situation• the solution is obvious, or



• it’s a critical situation• the solution is obvious, or•nobody else can help


AGREE plans as soon as possible if they are:



• sensible



• sensible• safe



• sensible• safe• and in budget



• sensible• safe• and in budget

Plans should NOT be perfect!81Monday, 23 January 12

If people need help to set things up then DIRECT them to the right people and places


It is the REVIEW that is central to really learning what is working and to helping people be in control of their own life.


This is a New Script for Social Work


What the New Script means is


★ things speed up



★ things speed up

★ bureaucracy goes down



★ things speed up


★ social workers use their best skills



★ things speed up



★ people connect to community



★ things speed up



★ people connect to community

★ but most importantly...



lives are transformed


e New Script helps us to...


1. empower people - people and families in control of their own lives




2. strengthen capacity - people living positive lives, achieving, growing





3. access community - people as active citizens





3. access community - people as active citizens

4. build safe networks - reducing abuse and isolation



Share Expenditure Cost PP Hours PP

1. First point of contact - initial sign-posting 9.5% £414,437 £63 2.6

2. Overview assessment 13.7% £599,514 £91 3.7

3. Comprehensive/full assessment 19.0% £831,038 £126 5.2

4. Basic planning 13.7% £597,272 £91 3.7

5. Intensive planning, service design or support planning 16.3% £713,343 £108 4.4

6. Problem solving & responding to crises 16.0% £700,749 £107 4.4

7. Short reviews - basic 7.5% £327,924 £50 2.0

8. Long reviews - intensive 4.3% £189,200 £29 1.2

Total £4,373,478 £665 27.288Monday, 23 January 12



17%

12%

13%34%

23%

Indiv idualFamily/Fr iendsProviderBrokerCare Manager

Who is the best planner?

N = 801


16%

17%

28%

31%

9%

Indiv idualFamily/Fr iendsProviderBrokerSocial Worker

Who is the best organiser?

N = 774



Personalisation should be efficient

but it can easily be made wasteful94Monday, 23 January 12

Number of care managers (WTE) 111.55

Cost of care management £4,373,477.75

Number now served by authority 6465

Ratio (number of people to 1 care manager) 68.73

Total hours of care management available 185507.18

Hours available per person 27.24

Average cost per person £664.87

Time on slimmed down core functions 81623.1592 44%

Time on crisis management 44521.7232 24%

Residual time to reinvest 59362.2976 32%

Share of residual time 32%

Residual time expressed as money £1,399,512.88

Residual time per person 8.7168

Residual money per person £212.76


how do you make a ‘good idea’ really useful


Know how to take things. Never against the grain, though they’re handed to you that way. There are two sides to everything. If you grab the blade, the best thing will do you harm; the most harmful will defend you if you seize it by the hilt. Many things that caused pain could have caused pleasure if only their advantages had been considered. There are always pros and cons; the trick lies in knowing how to turn things to your advantage. Things look different when seen in a different light. So look at them in the light of happiness. Don’t confuse good and bad. This is why some people find contentment in everything, and others sorrow. This is a sure defence against the reversals of fortune, and a great rule for living, at all times and in every pursuit - Baltasar Gracian



What are the opportunities

• safeguarding children and adults from abuse?• empowering disabled people?• helping people manage long-term conditions,

dementia or end of life care?• allocating resources more fairly?• improving the quality of planning and support?• strengthening communities and improving

connectedness?• improved family work?


www.campaignforafairsociety.org100Monday, 23 January 12

http://www.campaignforafairsociety.org

http://www.campaignforafairsociety.org

© Simon Duffy 2011. Rights Reserved. Full copyright details at www.centreforwelfarereform.org 101Monday, 23 January 12





Agenda

9.20 What is ‘Personalisation’10.30 Opportunities & Concerns - tables11.00 Break11.15 Debate12.00 Social Work Rescript12.45 Lunch2.15 Applications - tables3.00 Feedback3.30 Break4.00 Polling Questions4.30 Final Questions5.15 Finish


Health & Medicine

Personalisation & Social Work