Town Hall Sheffield 17 April 2008 Domiciliary Care Workshop

Person Centred Care Gill Herbert March 2008

Gill Herbert, Consultancy & Development Ltd3 Where did the idea come from? Social work professional values – driven by social models of care rather than medical models Social work professional values – driven by social models of care rather than medical models HAP professional values HAP professional values Tom Kitwood’s work in dementia care Tom Kitwood’s work in dementia care NSF Older People Standard 2 NSF Older People Standard 2 “NHS and social care services treat older people as individuals and enable them to make choices about their own care. This achieved through the single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services.” And most policy initiatives in the last decade

Gill Herbert, Consultancy & Development Ltd4 Practice Conflicts & Inconsistencies in the last decade Service-led responses vs person-centred care Service-led responses vs person-centred care avoiding process and pathway oriented case management and clinically focused approaches (Matrix, 2005) Resource management for cost efficiencies vs commissioning and provision for quality Resource management for cost efficiencies vs commissioning and provision for quality finding “smart commissioning” solutions with outcome focus (SPRU, 2003) High caseloads driving short-term interventions vs whole person approaches over time High caseloads driving short-term interventions vs whole person approaches over time long-term care management models

Gill Herbert, Consultancy & Development Ltd5 And more conflicts… Tight eligibility criteria vs investment in prevention and well-being Tight eligibility criteria vs investment in prevention and well-being Modernising social care, 2007 Bureaucracy vs professional integrity Bureaucracy vs professional integrity duplication & single assessment process Uni-professional interventions vs inter-disciplinary working Uni-professional interventions vs inter-disciplinary working experiences in intermediate care & experiences in intermediate care & mental health Task-centred time allocations vs enablement & person centred support packages Task-centred time allocations vs enablement & person centred support packages Social care and PFIs

Gill Herbert, Consultancy & Development Ltd6 Initiatives that make a difference Everybody’s Business – DH guidance on making sure all services respond to OPMHP Everybody’s Business – DH guidance on making sure all services respond to OPMHP “In control” – support for people with learning disabilities to use direct payment “In control” – support for people with learning disabilities to use direct payment “HOOP” – support for people to make their own decisions relating to housing needs “HOOP” – support for people to make their own decisions relating to housing needs “Intermediate Care” – a real shift of emphasis to rehabilitation and re-ablement for those who access it “Intermediate Care” – a real shift of emphasis to rehabilitation and re-ablement for those who access it

Gill Herbert, Consultancy & Development Ltd7 Challenges for commissioners Understanding how outcomes for individuals relate to outcomes for populations or groups Understanding how outcomes for individuals relate to outcomes for populations or groups Making sure commissioning does result in person- centred care for individuals – across agencies and professions as well as within service Making sure commissioning does result in person- centred care for individuals – across agencies and professions as well as within service Enablement focus rather than just crisis interventions Enablement focus rather than just crisis interventions Ensuring links are made to voluntary, community groups and social networks Ensuring links are made to voluntary, community groups and social networks Turning individual budgets into well managed market development Turning individual budgets into well managed market development

Gill Herbert, Consultancy & Development Ltd8 Challenges for Providers Ensuring quality through active listening to customers Ensuring quality through active listening to customers Achieving consistency, stability and practice which enables and supports independence Achieving consistency, stability and practice which enables and supports independence Developing partnerships with voluntary and community groups and social networks which work Developing partnerships with voluntary and community groups and social networks which work Developing monitoring and evaluation systems which can inform future commissioning Developing monitoring and evaluation systems which can inform future commissioning

Gill Herbert, Consultancy & Development Ltd9 And to make it all work? Active partnerships between commissioners and providers to encourage learning and service improvements Active partnerships between commissioners and providers to encourage learning and service improvements Good information Good information Supportive management that drives change Supportive management that drives change Encouraging, not disabling, social networks and voluntary support Encouraging, not disabling, social networks and voluntary support