New Models for Old; Changes in thinking in Community Care Andrew Reece P+SI Service Manager Personalisation Lead for Adult Social Care

User Led Change Disabled People’s Movement Social Model of Disability –Escape Committees –‘Ordinary Living’ (LD) –‘Survivors’ (MH) –Independent Living –User Led Organisations eg CILs –‘Choice and Control’ –‘Assistance’ not ‘Care’ (Morris 93)

From Service Led to Needs Led Pre 93; Service led; –choice from existing services or nothing –Home help or res care via DSS? –Campuses or Day Care –Old ILF NHS+CCA 1990; Needs Led –Create services to meet needs –Commissioning –1997 Direct Payments Needs = ‘Problems’

…… to Personalised Person Centred Choice and Control –Know resources –Choices how used –Focus on Outcomes –‘Support’ not ‘care’ –Direct Payment or provided Outcomes = Possibilities

A Service Led Pathway Person referred for support No/little assessment Offered choice of existing services In House only? No budget transparency Residential, campus or day care Out of area?

A Personalised Pathway Focus on outcomes –Encourage ambition –Consensus –Co-production –Strong relationships –Active Citizenship in own community Employment ‘Social Capital’ Real relationships

A Personalised Pathway (2) Promoting Independence –Enablement –VI Rehab –Real life experiences –Self Confidence and Self Esteem –Learn new skills –Self development

A Personalised Pathway (3) Use of other resources –Mainstream Housing Leisure Transport –ILF –Access to Work

Continuum of services Universal Bus Targeted Universal Ring and Ride Social Care Route Forward Health Care Ambulance

Information, advice and advocacy for all Self-directed support Personal budgets Self-assessment Early intervention What will change? Carers Neighbours Volunteers Enablement

Coventry’s approach to Personalisation Outcomes Focused Assessments Not Self Assessment Questionnaire

Why? Evidence base via SPRU More likely to take and support risk taking Reduces conflict Encourages ambition

Self Assessment? Preparation Co-production Joint Ownership Own Outcomes Own Voice Carer’s Voice = Self Assessment

Coventry’s approach to Personalisation (2) Personalised Procurement Not Resource Allocation

Why? Person focused not technical solution Doesn’t depend on ‘risk transfer’ Ian Ferguson BJSW 2007 Doesn’t ‘burden’ carer Luke Clements 2007 Personalisation not just about In Control Andrew Reece, Journal of Integrated Care 10/2008

IBSEN and SAQ/RAS ‘there was no consensus on the appropriateness of the RAS compared with processes where professional judgement and discretion play greater roles, or with the outcomes-focused approaches adopted ….in a few sites.’

Care Management Cycle DH 1991, p8 1. Publishing Information 2 Determine the level of assessment (following referral) 3. Assessing Need 4. Care Planning 5. Implementing the Care plan 6 Monitoring 7 Reviewing

Support Management Cycle Market Shaping activities 1. Publishing Information 2 Determine the level of assessment (following referral) 3. Outcomes focused assessment 4. Support Planning through 'co-production' 5. Personalised Procurement to implement the support plan 6. Monitoring 7. Reviewing

What is an Outcomes Focused Assessment? 2; ‘determine level of assessment’ Promoting Independence? –Yes Outcomes Focused Assessment? –If done properly! Community Care Assessment? –Can be ….

Terminology Outcomes –‘ Goals people wish to achieve’ (SPRU) –Personal not organisational –Outcomes  Aims  Goals Support or assistance not Care Care = assumption of dependence = oppressive (Morris 1993)

References Clements, L (2007) Individual Budgets and Carers, accessed from Ferguson I (2007) Increasing User Choice or Privatizing Risk? The Antinomies of Personalization, British Journal of Social Work; vol 37: 387 – 403 IBSEN accessed from Morris, J (1993) Independent Lives; Community Care and disabled people Reece, A (2008) The social Care System - Beyond repair or missing vital parts? Journal for Integrated Care vol 16 No. 5 pp SPRU; All the Social Policy Research Unit's Outcomes work can be accessed at Stevens, S (2008) personal blog on individual budgets at