With the continuously growing number of older population in the country and the life expectancy that keeps on increasing, the demand for the elderly care is also equally on the increase. Consequently the government are also putting in effort in order to continue improving the service provided for the elderly care such as the introduction of personalisation into the care service in the government policy in December 2007, when the Putting People First concordat was published. This is the reason why this assignment will be looking into this concept of personalisation in further depth along by looking at the strengths and limitations of implementing it into the social care.
The term personalisation as picked up by the Department of Health and is being used as a term to describe the series of reforms drawn out in the 2007 concordat Putting People First. In its formulations the policies have been set within the following framework of improving access to universal services, the prevention and early intervention, the increase of choice and control by the users and also growing social capital for the care (Department of Health, 2009). In addition to this, personalisation is about giving people more choice and control over their lives in all social care settings. It also means to recognise the user as a person with strengths and preferences and it starts with the user instead of the service (Social Care Institute for Excellence, 2012).
The reasons why personalisation is introduced in social care is because the government is against the ‘one size fits all’ concept in terms of providing care as it has been found to have not met most of the needs of the user especially with the fact that all users are different. The second reason is to finish up the The 1988 Griffiths Report on Community Care in which it advises that social services should become ‘brokers’ to a range of care and support providers. It also proposed that social workers should take on a ‘care management’ role.Thirdly is to combat the McDonaldisation in social care. This McDonaldisation thesis consists of five primary components of efficiency (minimising time in delivering care), calculability (trying to get user to believe that they are getting quality care for lesser money spent), predictability (where the care provided are highly routine and predictable), control (standardised and uniform care provider) and also, culture (as part of the standardised control). Finally, personalisation is implemented due to the convergence of disability movement and also the increasing neo-liberal marketisation. The disability movement as a part of service user movement and the social model of disability have been a really powerful driving forces in lobbying for government reforms. An evidence for this is the Community Care (Direct Payments) Act, 1996 where the direct payments have been made available to the disabled adults of working age in England and have since been extended to other groups (Carr, 2010). The popularity and success has stimulated much of the personalisation around service users and also the development of personal budgets (Glasby and Littlechild, 2009).
In November 2010, A vision for adult social care: capable communities and active citizens document was published, with personal budgets and personalisation, put central along with prevention, health and social care integration and the development of a plural and creative social care market to enable choice forming central aspects of the continuing social care reform. In this document too, it was made clear that personal budget alone does not in itself mean that services are automatically personalised. People should get personal choice and control over their services rather than the inflexible block contracts – from supported housing to personal care (Department of Health 2010). Glasby (2012) explained that the concept of personal budgets is rather than assessing the user’s needs and selecting services from fairly limited menu of options, personal budgets start by placing each individual into a cost band and being up front about the resources available. By knowing how much of money is available for them to spend on their needs then allows them and their circle of support to make decisions about how the money could best be spent (by direct services, direct payments, public services, the independent sector, paying family and friend or any of the combination).
Some of the strengths of using personalisation concept are the user’s outcomes can be improved and at the same time, costs can be reduced as people who control their own budgets are able to find smarter solutions for meeting their needs and can reduce their need for paid support. This is possible because the person is empowered to make the better, right kind of decisions, seize new opportunities and respond more quickly to their own problems. In the old welfare system the government pushes resources into those services that it believes people need. Users can only receive little benefit from these resources because it is unlikely that the services are perfectly tailored to meet their needs and there is no opportunity for the user to mobilise those resources to ‘pull in’ in other resources. However, when someone has a Personal Budget they are able to make quality, efficient use of those resources. Such as rather than paying £10,000 per year at the day centre and the user will simply have to put up with whatever services offered there that they do not value. Instead, if the user is given a £10,000 Personal Budget they then can actually spend some of their budget on those particular services they value, e.g. only coming into the centre on the ‘good days’. This process explains why people can get better lives with less money as the money that can be controlled works better with the new found freedom than the money that cannot be controlled (Duffy, 2010).
Other than offering better quality choices and empowering the service user, personalisation also is shown to be consistently cost effective of the public finance as found by Glasby and Littlechild (2002) that direct payments support are on average 30-40 per cent cheaper than the equivalent directly provided services. In addition to this, it was discovered that carers feel the relationship between them and the service user has improved due to them or their relatives being able to access the direct payments (Rethink Mental Illness, 2011). Finlayson (2002) also suggested that this positive relationship between the carer and service user is central to carer’s job motivation and satisfaction as in turn it will increase the quality of care provided. Another advantage of this concept as suggested by Zarb and Nadash (1994) is that the flexibility of the service is enhanced. The service provided is fitted around the user’s time on top of their different needs rather than fitted around the carer’s timetable.
Although according to the findings discussed earlier that expressed the positive outcomes of personalisation, there are few limitations associated into practicing it. The first one is that it is inappropriate to some users especially those who are mentally incapable and the elderly. It is found to be a daunting experience as they are suppose to manage their own financial arrangements directly which will also add extra burden and unwanted stress for them. On top of this, most of service users are also anxious by becoming employers and having to deal with responsibility particularly when they are unwell. This is especially with regard to assistance with the direct payment’s managing of the service user, either by family member, friend or support agency on the user’s behalf. In addition to this issue, the potential problem that could possibly happen regarding the vulnerable user is being exploited and potential for their money to be fraud (Leece and Bornat, 2006). On the other hand, as suggested by Glasby and Littlechild (2009) the local authorities have a key role in making their systems as simple as possible and also proportionate to the risk, along with the availability of independent support (such as peer support and support agency) and the advent of self-directed support to reduce potential hassle from this concept should any problem arise.
Another limitation of this concept is the community care assessments that are carried out sometimes underestimated the needs of user, especially those with mental illness as their needs are subjective (for instance, not so obvious on a good day) and therefore failed to be met. To make matter worse, these assessments are often not person-centred as it lacks of user’s involvement in decision making thus, they tend to be passive recipients and disempowered. This highlights the need of a better person-centred assessment by the professionals involved as the central element in the direct payments is ‘good assessment’. Hence, a better, different kind of relationship needs to be developed between the professional and the users as well as other approach to allocate the community care resources for this particular service user (Leece and Bornat, 2006).
Another problem is direct payments and personal budgets are identified as a threat to the professional expertise of the social workers, as well as the longer hours due to the flexibility needed. It was also suggested that at one critical point, services will not be able to be managed properly as more users are becoming employers thus, changing the ‘balance of the services'(Leece and Bornat, 2006). In contrast, direct payments and personal budgets are able to free social workers up to focus on people who are in greater need of support and thus, reconnect their value base and principles of profession (Glasby and Littlechild, 2009).
Furthermore, the monopoly of market with the increasing choice through the direct payments is seen to be a problem. This will someway force the existing providers to make more effort to be more appealing to the service users in order to avoid of going bust. Additionally the real goals of these providers are often doubted as whether they will put quality care over profit-making (Leece and Bornat, 2006). The argument against this is that with the presence of competition, the providers will struggle to increase their quality of care along with a better value in order to keep up with the other providers.
The strengths of the concept of personalisation as per discussed have found to be outweighed by the limitations that are associated to it. This is also proved to be the case as nearly all users is found to be satisfied with their experiences of using the direct payment as they found it to be more convenient and secure in the research carried out for the Department for Work and Pensions (2004). Out of the total participants, 75% reported to have found no disadvantages when using the direct payment.
The concept of personalisation has had a long history on why the government want to put it into practice as a way of reforming the social care particularly in the last few years when the direct payments and personal budgets were introduced. This was proved to be a huge success with majority of the users are extremely satisfied with how it has changed their lives in terms of empowering and giving them better quality of choices. Moreover, it was also found to be cost-effective and thus, able to save large amount of the public fund. However, as this concept was also subjected to few arguments against it, such as it not being able to cater certain types of user, there is also backup plan, support and effort made by the local authorities to minimise this. Moreover, the arguments that it threatens the social workers profession and the market balance are found to be ungrounded. Thus, the benefit of implementing personalisation in social care was found to overshadow the limitations as discussed earlier.