1. Unit 518: Assess the individual in a health and social care setting
Person-centred care (PCC) and partnership working
Learning outcome 1, 2 Assessment criteria 1.1, 1.2, 2.2, 2.3
Introduction page – click on the words you want to replace

2. Person-centred care (PCC)
The following presentation looks at the principles of PCC.
It can be used:
as an tool to audit your own systems
as a training presentation for staff to implement change.
You can modify this presentation as you wish. It has been developed to support staff working with older adults.

3. The Joseph Rowntree Foundation
The term 'person-centred care' is mainly used in the literature about older people, particularly in relation to dementia care.
Although the exact term used varies, there is a general consensus that person-centred care is:
focused on the individual
promotes independence and autonomy rather than control
involves individuals choosing from reliable, flexible services
tends to be offered by those working with a collaborative/team philosophy.
The term 'person-centred care' is mainly used in the literature about older people, particularly in relation to dementia care. Although the exact term used varies, there is a general consensus that 'person-centred' or 'quality' care is: user focused; promotes independence and autonomy rather than control; involves users choosing from reliable, flexible services; and tends to be offered by those working with a collaborative/team philosophy.
Service users identify personal characteristics, such as gender, ethnicity and cultural background, as important to receiving good quality support/care. In addition, they also value personal qualities, such as patience, compassion, sensitivity and empathy.
The relationship between the service user and frontline worker is pivotal to the experience of good quality/person-centred care/support.
Barriers to the delivery of person-centred care predominantly relate to bureaucratic structures. A move towards increased management and budget-led services constrains frontline workers. Services which fail to provide person-centred care are often service-, rather than user-, led.
People from minority ethnic groups experience a range of barriers to receiving person-centred care. These include: lack of accessible information; services which often lack cultural understanding; and language and communication difficulties.
Management practices tend to overlook the importance of relationships between frontline workers and clients; frontline workers often feel they receive little support from management in their day-to-day work.
Training opportunities vary for different frontline workers and appropriate training courses are not always available. There is little consensus about the impact of training on practice. 3

4. Person-centred care respects the dignity and completeness of each adult
To embed this, service providers must evaluate current practice and explore and address any stereotypical attitudes about the individuals using services.
They often lurk somewhere within most organisations and are identified by people saying: ‘Well that’s a good idea, but it wouldn’t work here…’
This is often used in a superficial way – we talk about dignity, respect, valuing and rights and then go into a meeting and talk about the person as if they weren’t there. This is not as surprising as it may seem because for years anyone with ‘authority’ in professional terms has adopted a ‘superior’ position. (If not in their own eyes – this is the way they are often perceived by individuals using services and families). The very fact that much care assessment still carries on without involving the individual or informal carer underlines this. Why on earth we should imagine that we know more than the person themselves or the informal carer who has been with the person for 24/7 for years? But we do! We need to look at whether we are really practicing person centred care or whether we are paying ‘lip service’. 4

5. Is it really different now?
The medical model
Historically, planning was based on a medical model – where the professionals had complete control…
The professionals
Problems
Assessments
Tests
Treatment
If you are not sure about the medical and social models of care you need to find out more. Basically it is around whether we look at the illness or the disability – or whether we focus upon the person and put the illness or disability into perspective. Very often the person gets lost ‘behind’ the disability. Careless use of language reinforces these attitudes – the feeders – the walkers – the confused. Broadly with a medical model the disability is paramount and often almost perceived as the person's fault – they have Y so they can’t do Z.
The social model is very different it starts from the person's perspective and looks firstly at what the person is able to do and what the person wants and then looks at ways of enabling them to do every day things by changing the environment, attitudes – whatever we can. If someone needs a wheelchair to move around independently and is having difficulty because of lack of access then that is society’s fault and we should be trying to change things to enable the person to maintain or retain independence.
The attitudes or society and media focus tend to promote medical models and stereotype the people using services. This means we have to work really hard to keep the focus upon valuing each person and avoid ‘complacency’ in practice which always leads to short cuts and poor practice.
Is it really different now? 5

6. Person-centred planning
The individual says:
This is my life and I have the right to:
make my own decisions
have my own individual plan
be on the planning team
have my hopes, dreams and goals as central to my plan.
This is probably the most difficult thing for those of us who have been brought up in the old ways to accept – we make all sorts of excuses – ‘He may fall, there's a risk…’ But who tells you ‘you can’t go out to the pub in case you have too much to drink and trip over on the way home’? And more to the point how would you react if they tried to!!
Put participants into small groups with a coffee and ask them to look at the following statements (next slide) ask them to feedback with – agree or not and reasons why – with examples if they have them.
Statements to consider:
Life without any risk is living death.
The aggressive/challenging clients are often those who are still fighting for their rights and independence.
The ‘favourite’ clients are those who are institutionalised and pliable.
Nurses and care workers will be the most difficult services users when their time comes.
An environment where no-one complains is one where service users have ‘given up’. 6

7. Some comments to discuss in your groups (10 minutes)
Life without any ‘risk’ is a living death.
The most difficult or aggressive/challenging individuals are often those who are still fighting for their rights and independence.
The ‘favourite’ individuals are often those who are institutionalised and pliable.
Nurses and care workers will be the most ‘difficult’ individuals to care for when their time comes!
An environment where no-one ever complains is one where individuals have ‘given up’.
Tease out all the comments and discussions around these statements – how do they challenge our attitudes and practice?
How would you feel if after years of being independent you had an accident, a few weeks in hospital them were moved to an environment where you weren’t allowed to make a cup of tea in case you burn yourself? 7

8. Person-centred care for adults
Person-centred care helps provide to support to adults in a way we would want for ourselves!
Care giving can be easier when we use person-centred care.
The lives of adults and care givers will be more interesting and meaningful.
One of the main problem in providing care is the tendency to slide into an ‘us and them’ situation. ‘They’ are vulnerable, they cannot make decisions, we know what is best for them, they become a homogeneous group with one common feature, which is that they are lesser human beings. We begin to talk about individuals as them or they we group them and label them.
Ask the participants to suggest some common labels. What does this say about our attitudes towards these individuals? 8

9. Principles and values of PCP
Natural supports can help improve the person’s quality of life by:
maximising independence
creating community connections
working toward achieving the person’s dreams and goals.
Person-centred care is a continuing process of:
listening
trying things
seeing how they work
changing things as necessary.
Natural supports are the individual’s support networks – key people, friends, family, advocates, care workers. 9

10. Natural supports can help improve the person’s quality of life.

11. Natural supports help:
maximise independence
create community connections
work toward achieving dreams and goals.

12. Natural supports:
provide a reciprocal relationship where both sides benefit
are champions who support the person in achieving dreams and goals
are family, friends, neighbours, club members, church members and others.

13. What do natural supports do?
Visit.
Help with hobbies.
Go on outings.
Attend church.
Drive to the cemetery.
Just sit and chat.
Help with the computer.
Help us learn about the older adult.
Help achieve dreams and desires.

14. Family
Friends
Paid Help
Others

15. Person-centred care is about:
providing individuals with opportunities to participate in all decisions about their lives
encouraging and inviting natural supports to help individuals achieve dreams, goals and desires
taking affirmative steps to help individuals develop natural supports
making sure individuals know about all support, treatment and service options
ensuring ways to let individuals express needs, desires and preferences, and to make choices
creating opportunities to get feedback from individuals on how things are working, and being responsive to the feedback. 15

16. listen to and actively acknowledge what is important to individuals
To practice in a person-centred way with older people, we need to be able to:
listen to and actively acknowledge what is important to individuals
ensure older people and their carers are kept fully informed
give respect
demonstrate tactfulness and understanding
be willing to share both power and responsibility with older people. 16

17. Person-centred care is about treating individuals the same way we want to be treated.