OPM Public Interest Debate – Personalisation in Health and Social Care

Debate: the success of personal budgets will rely on the skills, knowledge and
confidence of frontline workers

Argument against the motion by Mike Adams, Chief Executive of Essex

Coalition of Disabled People

[Note for people who didn’t attend the debate: the views contained within this
paper represent those put forward as part of the debate. The actual views
held by ECDP are much more nuanced, and not necessarily the same as
those expressed below]

The perspective of social workers

It is hard to disagree with much within the personalisation agenda in social

care.

Unless you’re a social worker, that is.

Whilst some take the view that personalisation is closer to what social work
was always about, many others seem to feel threatened that the
personalisation agenda will take away their professional prerogative and place
it firmly into the possession of service users.

To take one example: in a survey for Community Care, 93% of social workers
thought that CRB checks for Personal Assistants should be compulsory. At
ECDP, we support over 3,600 service users on a Direct Payment who employ
a Personal Assistant. Just 2.5% of those service users took up a CRB check
on their PAs, despite the fact it effectively costs them nothing.

Who’s right? I take the view that it’s the service user who is right, and it is this
tension between the professional view and the user view which epitomises the
perceived threat to social work as a profession.

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The statistics bear this out

The most recent survey of practitioners by Community Care seem to bear this
out, which compares results of a 2010 survey with those of 2009 and 20080
(i.e. the two other years of Putting People First).

The survey noted that 51% felt personal budgets would benefit people in their
areas in the medium to long-term. This was down from 67% the previous
year.

40% said the impact of personalisation on their jobs had been positive, almost
a third said it had been negative, up from 18% at the start of the process

And 43% of respondents believed there had been a reduction in the number
of social workers practising in adult services in England, with just 5% saying
there had been an increase.

So before we even consider the skills, knowledge and confidence of frontline

workers, we need to consider the cultural web within which they sit.

The role (and responsibility) of service users

Within the social care economy, frontline workers are on the supply side.
What of the demand side, otherwise known as service users?

As an equal part of the social care economy equation, the success of

Personal Budgets will therefore also rely on the skills, knowledge and
confidence of service users as well

And in this area there is much to be optimistic about

The skills, knowledge and confidence of service users as service users are
improving

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We all have our local Direct Payment champions who extol the virtues of the
choice and control that a cash payment represents, be it through season
tickets, air conditioning units or handgliding sessions

Overall, the take up of Direct Payments has steadily grown since their
introduction in April 1997, and the target of 30% of all eligible service users to
be on Personal Budgets by April 2011 looks like it’s going to be achieved

I also get an increasing sense that service users are embracing the
responsibility that comes with holding a cash payment

Service users as frontline workers

But what of service users as frontline workers?

At ECDP, we think that the service users of today will be the support planners
of tomorrow.

What better person to provide information, advice and support than someone
who has been through the process, learnt some of the tips and tricks and can
apply that knowledge to help someone else?

The benefits are clear.

To the person who has to create the support plan, they benefit from peer
support and the knowledge of someone who has already navigated the social
care system

To the person who is supporting the creation of the plan, there is the sense of
using their lived experience and the knowledge they have developed for some
wider good than just themselves, perhaps even in a formal employment
setting.

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And for commissioner there is the chance to tap into a wealth of untapped
knowledge and experience through less formal routes than may traditionally
exist.

In Essex, we’re working through the process that enables service users to
become support planners, and the things we as a ULO, as well as ECC (and
health colleagues) as commissioners can do to ensure that pathway is clear.

This idea played only a small part in the DH’s Social Care Workforce Strategy.
We think it could play a huge role in the future social care economy.

The roles of the different sectors – the public sector

What of the roles of the different sectors – particularly the public and voluntary
sector?

It’s the easiest thing in the world to criticise the public sector, but that criticism
is only justified to a certain extent

For example the personalisation agenda has seen most of the Social Care
Reform Grant and management attention focused inwardly on local authority
transformation itself, in the hope that better outcomes for service users will
follow.

In the main, I couldn’t easily argue the outcomes have definitely followed,
though isolated pockets of excellence do exist (Jeff or Sam will probably be
able to tell you more)

I suspect the systems and processes side of things has been relatively
straightforward.

It’s the cultural aspects of the transformation, though – going back to those
frontline staff again – will be the management challenge for senior colleagues
in social care

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The roles of different sectors – disabled people’s organisations

But it’s not just the public sector who shoulder responsibility for the
transformation required

Where they are strong and effective, user-led organisations have played a key
role in ensuring disabled and older people have the independent information,
advice and guidance they need to navigate the care and support system.

Indeed PSSRU noted that a local Direct Payment Support Service was the
critical factor in aiding the effective implementation of Direct Payments.
Equally, the lack of an effective Support Service hindered the effective
implementation.

Notwithstanding the problems of having a strong and effective user-led

organisation in the first place, I think to date disabled people’s organisations
have a poor sense of their responsibilities when it comes to social care

This is one of the most conducive policy environments for the development
and strengthening of user-led organisations there has been.

And yet DPOs are still engaged in a first-principles debate about whether they
can justifiably combine service provision with their campaigning-based
activities.

Under a new coalition government – one that has expressly said it would like
to see the voluntary sector deliver more public services – disabled people’s
organisations and the voluntary sector more widely are going to have to
grapple with, and come to a firm view on, balancing their business activities
with their voice activities. Otherwise, those core grants from commissioning
bodies will start to finish and the organisations which depend on them will not
– and should not – exist in 5 years’ time.

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The irony being, of course, that ULOs are in fact uniquely placed to strike this
balancing act between voice and business, because of the following USPs.

Where services are delivered by ULOs they are typically shaped (and
delivered) by service users

ULOs work across more than one policy area – they are more easily able to
‘join up the dots’ on the ground, responding to the needs of an individual
rather than a care-and-support or housing recipient

ULOs are more nimble than statutory agencies – they are informed by the
‘what works’ dynamic and can adjust quicker in response to changing
circumstances

To find solutions to individual / collective issues, ULOs are able to pool

creativity, knowledge and experience. This equates to using the ‘lived
experience’ of disabled people for the benefit of their peers

Conclusion

To come back to the original proposition

Only to a small extent the success of personal budgets rely on the skills,
knowledge and confidence of frontline staff

Into the mix must go the skills, knowledge and confidence of service users –
both as service users and as members of the frontline workforce, making the
most of their lived experience to provide peer support based on lived
experience

And, alongside all the usual requirements heaped upon a local authority, so
into the mix must go an increased sense of responsibility and positive
contribution from user-led organisations, on both the supply and demand side
of the social care economy.

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