53367000 PersonalisatIon Through Person Centred Planning

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DH INFORMATION

PolicyHR/Workforce

ManagementPlanningClinical

EstatesCommissioning

IM&TFinanceSocial care/Partnership working

Document purpose BestPracticeGuidance

Gateway reference 13345

Title Personalisationthroughpersoncentredplanning

Author DepartmentofHealth

Publication date 31March2010

Target audience PCTCEs,NHSTrustCEs,SHACEs,CareTrustCEs,FoundationTrustCEs,LocalAuthorityCEs,DirectorsofAdultSSs,DirectorsofHR,

DirectorsofChildrensSSsCirculation list MedicalDirectors,DirectorsofPH,Directors

ofNursing,DirectorsofFinance,AlliedHealthProfessionals,GPs,VoluntaryOrganisations/NDPBs

Description ThisguidanceseekstosharelearningabouthowpersoncentredthinkingandplanningcanmakeausefulcontributiontothedeliveryofPuttingPeopleFirstandValuingPeopleNow.Itisofferedasaresourcetopeoplewhouseservices,familycarers,managersandpractitioners.

Cross reference ValuingPeopleforpeoplewith

Now:anewthree-yearstrategylearningdisabilities(2009)

Superseded documents N/A

Action required N/A

Timing N/A

Contact details SocialCarePolicyandInnovationDepartmentofHealthRoom110WellingtonHouse133-155WaterlooRoadSE18UGwww.dh.gov.uk/en/Policyandguidance/Socialcare/Deliveringadultsocialcare/Learningdisabilities/index.htm

For recipients use

Crowncopyright2010

FirstpublishedMarch2010

ProducedbyCOIfortheDepartmentofHealth

Thetextofthisdocumentmaybereproducedwithoutformalpermission

orchargeforpersonalorin-houseuse.

www.dh.gov.uk/publications
http://www.dh.gov.uk/publicationshttp://www.dh.gov.uk/publications


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Person-centred planning


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1

Contents

Executive summary 3

1.PuttingPeopleFirstand person-centred planning and approaches 6

2. Person-centred planning a different kind of listening, a different kind of action 9

Approachestoperson-centredplanning 14

Person-centredthinkingtoolsthefoundationforperson-centredplanning 14

Deliveringpersonalisationthroughperson-centredthinkingandplanning 17

Gettingstartedwithperson-centredthinkingandplanning 18

Creatingaperson-centredsystemtodeliverpersonalisedservices 23

3. Delivering PuttingPeopleFirst and achieving the local government milestones using

person-centred thinking and planning 25

Whatworksandwhatdoesntworkinimplementingperson-centredplanning? 25

Supportingdeliveryofthemilestones 26

Whereareyounow? 26

Whatcanyoudonext? 26

Appendices

1.Backgroundonperson-centredplanning 27

2.WhatDHpoliciessayaboutperson-centredapproaches 28

3.Whatworksandwhatdoesntworkinimplementingperson-centredplanning? 32

4.Person-centredplanninganddeliveringthemilestones 37

5.Whereareyounow? 46

6.Whatcanyoudonext? 50

Links to useful resources 55

Acknowledgements 57


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Executive summary

1. Putting People Firstrecognisesthatperson-centredplanningandself-directedsupportarecentraltodeliveringpersonalisationandmaximisingchoiceandcontrol.1Thisguideoutlineswaystoachievethis.

2. Thisguide:

isnotcompulsoryguidanceforlocalauthorities.Ratheritseekstosharelearningabouthowperson-centredthinkingandplanningcanmakeausefulcontributiontothedeliveryofPutting People First.Itisofferedasaresourcetopeoplewhouseservices,familycarers,managersandpractitioners;

isoneofthePutting People Firstnationalplanproducts,offeringideasandapproachesbasedonlearningandexperiencefromaroundthecountry;

canhelpcouncilstomeetsomeofthemilestonesidentiedinthelettertocouncilsfromtheAssociationofDirectorsofAdultSocialServices

(ADASS)andtheLocalGovernmentAssociation(LGA).2Thesemilestones

havebeendevelopedasawayforcouncilstochecktheirprogressastheymovetowardstransformingtheirsystemsusingtheSocialCareReformGrant,whichendsin2011;

canalsohelptodeliverothercross-governmentstrategies,including

Valuing People NowandValuingEmployment Nowforpeoplewithlearningdisabilities.3

What is person-centred planning?

3. Putsimply,person-centredplanningisawayofdiscoveringwhatpeoplewant,thesupporttheyneedandhowtheycangetit.Itisevidence-basedpractice4that

assistspeopleinleadinganindependentandinclusivelife.Person-centredplanningisbothanempoweringphilosophyandasetoftoolsforchange,atanindividual,ateamandanorganisationallevel.Itshiftspowerfromprofessionalstopeoplewhouseservices.

4. Therearedifferentapproachestoperson-centredplanning.Thisguidancefocuses

mostlyonEssentialLifestylePlanning(ELP),whichisdesignedforusewithin

3

1 Putting People First: A shared vision and commitment to the transformation of Adult Social Care(2007),DepartmentofHealth.

2 Lettertocouncils(September2009),ADASSandLGA.

3 Valuing People Now: a new three-year strategy for people with learning disabilities(2009),DH;Valuing Employment Now: real jobs for people with Learning disabilities(June2009),DH.

4 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,The Impact of Person Centred Planningfor People with Intellectual Disabilities in England: A Summary of Findings(2005),LancasterUniversity:InstituteforHealthResearch.


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servicestodeliverself-directedsupport.Whenperson-centredplanningis

combinedwithanupfront(indicative)allocationofmoney(apersonalbudget),itiscalledsupport planning.

Key messages

5. Thekeymessagesinthisguidanceareasfollows:

Person-centredplanningandsupport

planningarepracticalwaystodeliverpersonalisedservicesandself-directedsupport.

Person-centredplanningandsupportplanningaresimplewaystoachieveco-production,enablingpeopletoshapeandcommissiontheirownservicesandtomakedecisionsabouthowtheywanttospendtheirpersonal

budgettolivetheirlives.

Person-centredplanningisnotintendedtoadd,norshoulditadd,unnecessarycomplexityorcoststoself-directedsupport.

How it works

Thefoundationofperson-centred

planningcomprisesarangeofsimple,practicalperson-centredthinkingtools.Thesecanbeusedtocreateday-to-daychangeforpeopleusingservices,aswellastobuildaperson-centredorasupportplan.

Waystogetstartedwiththisapproachacrossservicesinclude:

creatingone-pageprolesthatleadtoaction;

implementingperson-centredreviewsandperson-centred

thinking;and

usingperson-centredapproachesinsupportplanning.

Who will this benet?

Person-centredplanningisapracticalwayforpeopletohavechoiceandcontrolintheirlives.

Usingarangeofapproachestoplanning,andperson-centredthinking,willbenetanyoneassistinginsupportplanningforpeoplewhoaremakingdecisionsabouthowtheywanttoliveandusetheirpersonalbudget.Theseapproachesshouldalsobeavailabletopeoplewhowanttodeveloptheirownsupportplan,includingself-funders.

Informationfromperson-centredreviewsandoutcome-focusedreviewscanbeusedtoco-producecommissioningstrategiesandproviderdevelopment.

Suggested actions for councilsare to:

provideclearinformationandadviceaboutperson-centredplanningandsupportplanning.Peopleneedtounderstandwhatsupportplanningis,whattheycanspendtheirmoneyon,andwhocanhelpthemplaniftheywantassistance;

makesuretherearearangeofpeoplewhocanassistwithsupportplanning,

notjustcaremanagers.


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focusonprovidingguidesforpeopletoplanforthemselves,with

support,forexample,fromuser-ledorganisations;

implementperson-centredreviewsofservices,anduseoutcome-focusedreviewswherethepersonhasapersonalbudget;

deneleadershipforperson-centredthinking,planningandreviews;

investinperson-centredthinkingandsustainalocalresourceofpeoplechampioningperson-centredthinkingandplanning;and

adoptWorking together for change(DepartmentofHealth2009)orasimilarapproachtoco-producecommissioningandstrategicplanning.

There is only one way and that is the person-

centred way it is a journey worth taking.

Sally,memberoftheTransformingAdultSocialCareserviceuserreferencegroup


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CHAPTER 1

Person-centred planning and self-directed

support to become mainstream and dene

individually tailored support packages.

Putting People First5

1. Putting People Firstisapublicservicereformprogramme,whichisco-produced,co-developedandwillbeco-evaluated.

Itrecognisesthattoachieverealchange,usersandcarersmustparticipateateverystage.Thismarksachangeinstatusofpeoplewhouseservices,fromconsumerstoco-producers.

2. TheGovernmentsGreenPaperShapingthe Future of Care Together6statesthatitsvisionisfora system where people willbe able to live their lives in the way they

want, supported by the services that theychoose,andthatservicesshould respondto local conditions.Tomakethevisionareality,theGreenPapergoesontosaythatunderthenewsystem,organisationswill continue to have the same

responsibilities set out for them in PuttingPeopleFirst, but there will be implicationsfor the way in which local authorities

and other partners work together and

with people who need services.ThiswillbesetoutinaforthcomingWhitePaperexpectedinearly2010.

3. Person-centredplanningandsupportplanningarewaystosupporttheachievementofco-production.

Co-productionmeansworkingtogetherwithpeopletodeliverapolicyorservice.Listeningtohowpeoplewanttolivetheirlivesiscrucial.Itmeanspeopleareincreasinglyabletoshapeandcommissiontheirownservices.Throughsupportplanning,peoplewithpersonalbudgetscanmakedecisionsabouthowtheywant

tospendtheirmoneyinordertomovetowardsthelifetheywanttolead.

4. Supportplanningisanimportantpartoftheself-directedsupportprocess.Itrequiressimpleandproportionatesystemssothateveryonereceivesenoughinformationaboutthetypeofsupporttheycouldbeentitledto,withouthavingtogothroughcomplexorburdensome

processes.

People want better quality services that are

personal to them and more control over

decisions that affect them.

Putting People First the whole story7

5. DeliveringPutting People Firstrequiresorganisationalandsystemtransformationtodeliverperson-centredsupport.Thiswill

helppeoplemovefrommarginalisationtoinclusion;andfrombeingtheobjectsofcaretoactingascontributingcitizens.Thisrequiresfarmorethanperson-centredthinkingandplanningitrequiresavisionofinclusionandindependentliving.Person-centredthinking,person-centred

PuttingPeopleFirstand person-centredplanning and approaches

5 Putting People First(2007),DH,p.3.

6 Shaping the Future of Care Together(2009),DH.

7 Putting People First the whole story(2008),DH.


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planningandperson-centredteamsarewaysofachievingthisvision.Inaddition

toPutting People First,person-centredapproachesareeitherrecommendedorexpectedinawiderangeofpolicies.AsummaryofthesecanbefoundinAppendix 2.

6. Inthediagramoverleaf,werecommendanumberofperson-centredthinkingtoolsthatcanhelppersonaliseadultsocialcareacrossthefourelementsofPutting People

First.

Putting People First the whole story8setoutfourareasonwhichcouncilsandtheirpartnersshouldfocusinordertopersonaliseservices.Theseareasare:

universalservicestransport,leisure,health,education,housingandaccesstoinformationandadvice;

choiceandcontrolshapingservicestomeetpeoplesneeds,ratherthanshapingpeopletotinwiththeservicesonoffer;

socialcapitalcareandsupportthatindividualsandtheircarerscangetfromtheirlocalcommunity(friends,family,neighboursorcommunity

groups);and

earlyinterventionandpreventionsupportthatisavailableforpeople

whoneedhelptostayindependentforaslongaspossible,tokeeptheirhomeorgardentidy,ortostarttakingregularexercise.

Thediagramoverleafshowsexamplesofhowperson-centredthinkingcanhelpdeliverPutting People First.

8 TransformingAdultSocialCareProgrammeBoard, Putting People First the whole story (2008),DH.


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Unive

rsal

servic

es Early

intervention

andprevention

Soc

ial

capi

tal

Choice

and

control

Universal services

Introducing MaureenMaureen has a learning disability and difculty

communicating with people, made worse by a hearingimpairment. She became gravely ill and was admittedto her local hospital. The hospital sta struggled tocommunicate with Maureen, and this had a dramaticimpact on the way she responded to her treatment.Maureens key worker went straight to the hospitaland explained to nursing sta how to speak with herby getting up close to her right ear and using a loudvoice, while at the same time, using body language thatMaureen was used to. Her key worker wrote a one-page prole, and this helped hospital sta understandwho Maureen was, what she liked and the kind osupport she needed. When there was a change o shit,the profle enabled the new nurses to communicate with

Maureen and continue with her treatment, meaning hercondition improved dramatically and she was ventuallyable to return home.

Early intervention and prevention

Introducing PatPat has Reynauds condition, chronic obstructive

pulmonary disease (COPD) and type 2 diabetes. Sheis supported by her daughter Su. Together, they used theimportant to/important for tool to work out what Patneeded or peace o mind without eeling like she wasbothering her daughter. They also used the workingand not working tool to fnd ways o easily improvingPats home. They rearranged her bedroom so she couldmove about more easily and reach the mattress variatorcontrols to help her get in and out o bed. Pat also saidshe would like to go to the supermarket hersel and topick her own ood so that she could be more creativewith her diet. They bought a reezer so she could stockup on the basics and manage her anxiety about beinglet in the house without anything to eat. The decision-

making agreement helped Pat explain that shesometimes elt Su made too many decisions onher behal. Pat now goes to all her medical

appointments on her own. When she wasrecently admitted to hospital, she said

she elt much more inormed abouther condition, and much more

in control.

Social capital

Introducing IanParish plans encouragecommunities to come together toidentiy their needs, prioritise theissues raised and address them with anagreed action plan. Although parish plansare not statutory documents, best practiceshows that local authorities can incorporate theminto community strategies, service delivery and localdevelopment rameworks.

The idea o a parish plan excited members o a villagecouncil in Suolk. This resulted in the largest turn-out or a parish meeting or many years. There wasconcern that the agency presenting the idea seemedto ocus more on the cost to the village to train peopleto carry out the process, rather than the real beneftso a local action plan. Residents elt the process couldengage with a wide range o people, rom the veryyoungest to the most senior. Ian, a person-centredplanning coordinator who lived in the village, was awarethat these issues existed, but they were difcult toclariy and address. Ian wanted to get people togetherto think about what they could do and thought theperson-centred review process could be useul. Thismeant that as a group, the village was able to pose anddiscuss a number o questions: What do we appreciate

about our village?, What is important to us about it?,What do we want or the uture? and What is workingand not working now?

Choice and control

Introducing KevinKevin experienced major

episodes o paranoia and wasdiagnosed with schizoaective

disorder. This has had a big impacton his working lie, leading to cycles

o joblessness, homelessness and hospitalstays. He and his social worker started

developing a support plan using the important to/important for and working/not working tools. ForKevin, its important he keeps well and only usesmental health services i he is unwell. He described

his love o cycling and said that social interactionand a work routine to keep him occupied helped tostabilise his mood. They talked about what could beachieved with his personal budget and explored theidea o sel-employment providing training or cyclingmechanics and the things Kevin would need to setup in business. Kevins personal budget now coverssome o his business costs and allows him to do a tradequalifcation as a cycle mechanic. There is also moneyset aside or respite i things get too much.


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CHAPTER 2

1. Arthursstory(seebelow)showshowunderstandingwhatisimportanttosomeoneandthenndingoutandactinginawaythatisexactlyhowtheywanttobesupportedcanmakeahugedifferencetotheirlife.Thisinformationwasrecordedonasinglesideofpaper(calledaone-pageprole)afterGillspent

acoupleofhourstalkingtoArthurandmeetingwithhisstaffandfamily(ataperson-centredreview).Togethertheycameupwithaplanthataddressedwhatwasnotworkingforeveryone,andwhichmeantthathisstaffworkedwithhiminadifferentwaytoachievethechangeshewanted.Changingwaysofworking,basedonhowArthurwantedtobesupported,representedashiftinpowerandachange

ofculture.

2. Thisapproachiscalledperson-centredplanning.

IntroducingArthur

Arthur, 86, is a charming man. Peopledescribe him as the salt of the earth; a true

character and a real gent. He has lived in

his own at in an inner-city area for 35years. He lost his wife Madge 20 years ago

and treasures her wedding ring that he

wears on his little nger. He loves talking

to people and is an amazing storyteller.

Sometimes, he likes to talk about his time

driving tanks during the war, but only

when he is in the mood. He also likes

to talk about the old boxers, especially

Cassius Clay, but would not know him as

Muhammad Ali.

Arthur is supported by the local domiciliary

care services. His district nurse, Marie, was

concerned Arthur may need residential

care. Arthur is terried of being put in a

home, so Marie spoke with Gill, the local

person-centred planning coordinator. Gill

spent an hour with Arthur. She asked him

about things like his past and what makes

up a good or bad day. She found out howhed like to be supported and what kind of

routine he enjoys. She used this to develop

a one-page prole, which contained all this

information. Gill then organised a person-

centred review with Arthur, his nephew

Stephen and wife Sally, the manager of the

domiciliary service and a staff member.

Together they looked at the one-page

prole and talked about what was working

and not working in Arthurs life from eachof their perspectives.

From Arthurs perspective, the highlight

of his week was spending Friday evenings

with Stephen, Sally, and their three

children, whom he loves dearly. Stephen

also phoned him at 5pm every day. Arthur

felt both of these actions worked well for

him. He also said it was important to have

someone to talk to, especially at mealtimes. His staff spent their time making his

evening meal and left it with him, but did

not have time to sit and chat. He also said

it was important his meals were served

piping hot. It didnt work for him when

the staff gave him his dinner lukewarm

and left him just a sandwich for lunch.

Arthur usually threw both meals into his

back yard. This caused problems with his

neighbours and a rat infestation.

Person-centred planning a differentkind of listening, a different kind of

action


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Arthur also said he was sick and tired of

people telling him to take off his wool bob

hat.

From the staffs perspective, it did not work

when Arthur sometimes hit out with his

walking stick when they came to wake him

in the morning. As he cant see well, he had

assumed they were burglars. Arthurs poor

eyesight means that good support would

be for staff to call him from the bedroom

door to wake him up and never to approach

him and shake him while he slept. Staffwere also concerned that he sometimes

wandered out late at night, which was not

safe. They say Arthur makes sense of his

days by sticking to his routines. He needs

to be reminded daily if something out of

the ordinary is happening; otherwise, he

becomes disoriented, confused and is likely

to go outdoors in search of help.

Stephen said that something that did notwork for him was Arthurs late night phone

calls when he couldnt nd the 10 note he

usually kept in his pocket in case he needs

it. Some of the staff had taken this out for

safekeeping and put it away in a drawer,

but Arthur would become distressed

looking for it, sometimes struggling on his

hands and knees for hours.

Together, Arthur, his family and staff agreed

some simple actions that meant that Arthur

could stay living in his own home, andaddressed what was not working for him.

Staff agreed to use the one-page prole as

the way to support Arthur particularly

around how to help him wake up in the

morning (by calling from the door) and

never taking his 10 out of his pocket. The

family suggested that Sally provide frozen

meals for Arthur, so that the staff simply

heated these until they were piping hot.

They could then use their time to stay andtalk to Arthur while he ate. This made life

better for Arthur; he started to eat well,

had company and no longer had problems

with his neighbours. They treated the rat

infestation, and Arthur agreed to a mat

sensor, which can be activated at night in

case he wanders out of the house confused.

These small, but signicant changes mean

that Arthurs life improved. He avoided hisnightmare of going into residential care,

and staff could support him in the way that

he wanted.


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Whatisperson-centredplanning?

3. Putsimply,person-centredplanningis

awayofaskingwhatpeoplewant,thesupporttheyneedandhowtheycangetit.Itassistspeopleinleadinganindependentandinclusivelife.Whenperson-centredplanningiscombinedwithanupfrontallocationofmoney(apersonalbudget),itiscalledsupport planning.Together,person-centredplanningandsupportplanningarepracticalwaystodeliverpersonalisedservicesandself-

directedsupport.

The purpose of person-centred planning is to

inform action that makes life better for people

with disabilities and the people who know

and love them.

JohnOBrienandConnieLyleOBrien(co-developersofperson-centredplanning)

Person-centred planning is our label for

learning how people want to live, to learnwhat is important to them in everyday life

and to discover how they might want to live

in the future. However, a plan is not an

outcome. The only reason to do the planning

is to help people move toward the life that

they want and person-centred planning is

only the rst part of the process.

MichaelSmull(co-developerofperson-centredthinkingandplanning)

4. Person-centredplanningisapracticalwayforpeopletohavechoiceandcontrol

intheirlives.Itisnotamagicbulletforeverythingthatneedstobechangedinpeopleslivesorinservices,norisitjustanewsetoftoolsandtechniques.Person-centredplanningisaphilosophyandanapproachthatisrootedincitizenshipandempowerment.

5. Person-centredplanningfocusesimmediatelyonthepositiveaspects

ofapersonsliferatherthanassessingwhattheycannotdo.Thedeciency-ledassessmentissodeeplyentrenchedinpolicies,proceduresandresource-allocatingmodelsinhealthandsocialcarethatitcanbothdiminishthehumanityofitsclientsandunderminetheirabilitytomakeacontributionbothtotheirownwelfareandtothewidercommunity.Oftenfamiliesandindividualsfeel

assessedtodeath,yetdiscoverthatthisleadstonopracticalhelpatallortotheallocationofaservicewhichatbestapproximatesthehelprequired.Thiscanbeprofoundlydisempowering.9

6. Focusingonthepersonsstrengths,passions,interestsandthethingsthatotherslikeandadmireaboutthemprovidesatremendousstartingpointfor

aco-productiverelationship.10

9 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley

Publishers.10 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley

Publishers.


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Background

7. Thiswayofworkinghasevolvedoverthe

last25years,mainlyinNorthAmericaandtheUK.Itstartedwithpeoplewhohavelearningdisabilitiesandinrecentyearshasextendedtoincludeeveryoneusingadultsocialcare,focusingonindependentlivingaswellasinclusion.Thousandsofpeople,likeArthur,andtheirfamilies,haveusedperson-centredplanningtohelpthemmakedecisionsandchangesintheirlives.Itisstartingtobeusedinhealth,too.For

example,thereisnowawebsitecalledThink about your life,11wherecancersurvivorscanuseperson-centredplanningtohelpmanagetheirtreatmentandsupport.

8. Valuing People12andPlanning withPeople Towards Person-centred

Approaches13weretherstgovernmentpolicyandguidancedocumentstobe

basedontheprinciplesofperson-centredplanning.Theysetoutexpectationsforlocallearningdisabilitypartnershipboardstodevelopframeworksfordeliveringperson-centredplanning.

Doesperson-centredplanningwork?

9. In2005,theDepartmentofHealth(DH)publishedresearch14intotheimpactofthis

wayofworkingonpeoplewithlearningdisabilities.Itfoundthat:

Very little change was apparent in peoples

lives priorto the introduction of person-

centred planning. Afterthe introduction ofperson-centred planning, signicant positivechanges were found in the areas of: social

networks; contact with family; contact with

friends; community based activities;

scheduled day activities; and levels of

choice The research supports the current

emphasis within health and social care policy

on using person-centred planning to improve

the life chances of people with learning

disabilities.

10. Notonlydidperson-centredplanningresultinsignicantpositivechange,itwasachievedatnoextracosttocouncilsotherthananinitialinvestmentintrainingandsupport.

11. Person-centredplanningenablesindependentlivingandrealchoiceand

controlfordisabledpeople.

Person-centred planning has given us hope

and a vision for a better future for

Mohammed. We feel now we can have a say

in how and what service support he receives.

We no longer believe that only professionals

know best for our son. Mohammeds faith

and cultural needs are recognised and

responded to.

Joynab,Mohammedsmother

11 www.thinkaboutyourlife.org

12 Valuing People(2001),DH.

13 Planning with People Towards Person-centred Approaches(2002),DH.

14 Valuing people and research: the Learning Disability Research Initiative overview report(2007),DH.


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Approaches to person-centredplanning

12. Therearefourmainapproachestoperson-centredplanning,eachdevelopedforaparticularcontextandeachexertingapowerfulinuenceincreatingchange.Theyreectadifferentwayoflistening,askdifferentquestionsandfundamentallyresultindifferentactions.

Thefourmainapproachesare:

essentialLifestylePlanning;

PATH(planningalternativetomorrowswithhope);

MAPS(makingactionplans);and

PersonalFuturesPlanning.

13. ThisguidancedealswithEssentialLifestyle Planning(ELP)asawaytoachievethePutting People Firstrequirementofmainstreamingperson-centredplanning.Theapproachcanbeusedwithinservicesthatpeopleuse.AnEssentialLifestylePlan15isadescriptionofhowsomeonewantstolive(whatpeopleappreciateabouttheperson,whatisimportanttothemandhowbest

tosupportthem)andactionstomovetowardsthis.Usingthisapproach,person-centredplanscanbegrownovertime,beginningwithinformationononepage

(aone-pageprole);thenthinkingaboutwhatisworkingandnotworkingfor

thepersonandthencreatingactionsforchange.ThisiswhatGillusedwithArthur,hisfamilyandstaffinthestoryatthebeginningofthischapter.

14. Theotherthreemainstylesofperson-centredplanningarecalledPath,16Maps17andPersonalFuturesPlanning.18Theyfocusonthefutureandhavebeendesignedforuseoutsideorattheedgesof

services.

15. Appendix 1providesamoredetailedcomparisonoftheotherthreeapproachestoperson-centredplanning.ThisguidancefocusesprimarilyonELP.

Person-centred thinkingtools the foundation forperson-centred planning

16. Thefoundationforperson-centredplanningisarangeofsimple,practicalperson-centredthinkingskillsandtools.

17. Usingthesetoolscanbringimmediatechangestopeopleslivesandtothewayprofessionalsandstaffsupportingpeoplework.Onthefollowingpagesisasummaryofsomeoftheperson-centred

thinkingtoolsandhowtheycanbeuseful.

15 SmullM,SandersonH,SweeneyC,SkelhornL,GeorgeA,SteinbruckM,Essential Lifestyle Planningfor Everyone(2005).

16 OBrienJ,PearpointJandKahnL,The PATH and MAPS Handbook: Person-centered Ways to BuildCommunity(inpress),Toronto:InclusionPress.

17 FalveyM,ForestM,PearpointJ,RosenbergR,All my Life is a circle(1994).

18 MountB,Capacity Works: Finding Windows for Change Using Personal Future Planning(1995).


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what it does how this tool a quick glimpse

sorting Sorts whats important TO

helps

As a way to think through aimportant TO important FOR

important

to/for

(what makes us happy,

content, fulfilled) from

whats important FOR us

situation before deciding what

should happen next.

As an everyday tool. need to learn/know

(health and safety, being As part of reviews.

valued) while working As the beginning of an

towards a good balance. individual, family or team plan.

the Identifies specific Helps you know where you

doughnutresponsibilities:

core responsibilities

can be creative without fear.

It clarifies the roles of the

sort using judgement and dierent professionals andcreativity agencies supporting people

not a paid responsibility. and families.

It can inform a family

support plan.

It clarifies roles and

expectations in a team plan.

matching sta A structure to look at both Helps people think about

what skills/supports and what kind of paid support

what people/characteristics they want and need.

make for good matches. Helps in recruiting team members.Gives the information for

the characteristics section

of a plan.

relationship Identify who is important to Learn who is important to

circlea person or family. people.

See if there are any

important issues around

relationships.

Helps identify who to talk to

when developing a plan.

Identify relationships that

can be strengthened or

supported.

communication Helps us focus on peoples A quick snapshot of how

chartscommunication whether they someone communicates.

use words to speak or not. A way of enriching the level of

To be used whenever a persons information available about

action communicates a message people who use words to

more clearly than their words. speak and particularly about

people who dont.


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what it does how this tool a quick glimpse

helps

learning log Directs people to look for Provides a way for peopleto record ongoing learning

ongoing learning.(focused on what worked

A structure that captures details well, what didnt work well)of learning within specific for any event or activity.

activities and experiences. Tells us what is important to

and for individuals, familiesProvides a way of recording

and team plans.information on what needs to Can replace traditional

stay the same and what notes or records to help

us focus more clearly onneeds to be dierent aboutcritical information about the

how we support people. person.

Can be used to focus on

someones whole life or

specific areas of their life,

e.g. someones health, or how

they like to spend their

time.

sorting Clarifies what to build on Analyses an issue/situation

whats (maintain or enhance) and across dierent perspectives.what to change. Provides a picture of how

working/notHelps in looking at how: things are right now.

working any part of a persons life

is working

medications are working people providing paid

support are doing in their

work

any eort, activity or project

is working.

Helps with mediation where

there are disagreements.

a quick glimpse

perspective 1

perspective 2

perspective 3

whats whatsworking not

working

IntroducingGraham

Graham uses a wheelchair, has profoundlearning disabilities and doesnt

communicate verbally. For years, the most

signicant part of his life was attending

a day service where there was an over-

reliance on repetitive activities like jigsaws.

By using person-centred thinking tools to

work out Grahams abilities and what was

important to him, staff members realisedhe suited ofce work. He consequently

attended a job centre interview and

now works at the Derbyshire Centre for

Integrated Living. He has thrived there,

is happier, more engaged and more

communicative. Using person-centred

thinking made that happen.


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Delivering personalisationthrough person-centred thinking

and planning

18. Inorderforpeopletohaverealchoiceandcontrolovertheirlifeandservices,thepeoplewhosupportthemwillwanttoconsiderthefollowingquestions(seealsothetablebelow):

Whatisimportanttotheperson,sothatservicesandsupportsarebuilt

aroundwhatmatterstothemasanindividualinsteadofpeoplebeinglabelledaccordingtoacondition,animpairmentorastereotype.

How,whenandwherethepersonwantssupportorservicesdeliveredratherthanastandardonesizetsallapproach.

Howthepersoncommunicatesthewayinwhichtheywanttheirservices

personalised.IfthepersondoesnotusewordsorifsomeoneelseismaingdecisionsontheirbehalfundertheMentalCapacityAct,thereneedtobeclearwaystomakeandrecorddecisionsandjudgementsaroundtheirsupportchoices.

Howwellprofessionalsandstaffaredeliveringpersonalisedservices.What

doindividualsthinkoftheservicestheyreceive?Whatworksanddoesnotworkforthem?Whatdopeoplesaytheywantinthefuturesothatpeopleresponsiblefortheservicescanrespondanddeveloptheservicesaccordingly?

a well dened understanding of important

to and for and a regular review of whats

working/not working that actually guides

Person-centredthinkingandplanningprovidespracticalwaystoaddressthesequestions:

What we need to know to deliver

personalised services

Person-centred thinking tools or processes

that can help

Whatisimportanttotheperson?Theimportantto/fortool,inone-pageproles,person-centredplansandsupportplans.

Whatisthebestwaytosupporttheperson? Bestsupportdescribedinone-pageproles,person-centredplansandsupportplans.

Howdoesthepersoncommunicateandmakedecisions?

Communicationcharts.Decision-makingproles.

Howarewedoingindeliveringpersonalisedservices?

Whatisworkingandnotworkingaspartofaperson-centredreview.UsingthistoinformchangeinserviceprovisionandcommissioningusingWorkingtogether for change.


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action is a necessary condition for any form of

service provision.

JohnOBrien

Getting started with person-centred thinking and planning

19. Thereareanumberofwaystostartusingperson-centredplanswithinorganisations,andtomakethisapproachstandardpracticeinservicedelivery.Optionsincludeto:

createone-pageprolesforindividualsthatleadtoaction;

implementperson-centredreviews19;and

useperson-centredplanningandthinkinginsupportplanning.

One-pageproles

20. Aone-pageproleisawaytosetoutinformationaboutwhatpeopleappreciateinanindividual,whatisimportanttothemandhowtheywanttobesupported.Itcanbecreatedbylookingatwhatisworkingandnotworkingforthepersonandwhatneedstohappentochangewhatisnotworking.Thiscanresultinbig,

smalloreverydaychanges,forexamplerearranginganolderpersonssupportsoshecangotothetheatreonceamonth.

19 BaileyG,SandersonH,SweeneyC,HeaneyB,Person Centred Reviews in Adult Services(2009).

Personalisation

Person-centred thinking

Person-

centred

reviews

Supportplan

Person-

centred

planning

Every person who receives support,whether provided by statutory

services or funded by themselves,

will be empowered to shape theirown lives and the services theyreceive in all care settings.

A range of practical toolsthat form the basis of person-centred planning. They helpfocus on the person, their gifts

and skills, what is important tothem, and how best to support

them.

A review process that can be used as a

statutory review. The review looks at apersons life and supports whats workingand not working, whats important to theperson now and in the future and agrees

outcomes for change. When the person has apersonal budget, the person-centred reviewis called an Outcome Focused Review.

A plan that shows howthe persons personalbudget will be spent to

achieve their outcomes.

A continual processof listening and

learning about what

is important to andfor the person nowand in the future, and

in alliance with familyand friends and makingchanges based on this.


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Caseexample

Onewoman lives in a residential setting.

To keep her memories and experiences of

working in a pub alive, she started having

a glass of red wine and a bag of crisps each

evening and now goes to bed at 11.30pm.

She says this has made her much happier.

21. Person-centredthinkingisawayofhelpingpeopletoworkoutwhatthey

wantandthesupporttheyneed.Itthenshowshowtheycangetthatsupport.Thisiscentraltoself-directedsupport.

One sheet of information on what matters to

me as a person and how best to support me

would be very useful.

Farzana,memberoftheTransformingAdultSocialCareserviceuserreferencegroup

22. Aone-pageproleisthebeginningofaperson-centredplan.InthediagrambelowyoucanseePatsone-pageprole.Pathaschronicobstructivepulmonarydisease(COPD)andtype2diabetesandyoucanreadherstoryinthediagramonpage8.

Important to Pat: Speaking and being in the company of her

family (daughter Su and granddaughterJessica) every day and enjoying her sleepovers with them.

Seeing friends and neighbours and beinginvolved with her local community.

Being part of other peoples lives.

Having a nice home and having the gardenlooked after by the gardener.

Looking her best in nice clothes andjewellery, being pampered and having herhair done at the local hairdressers onsenior day.

Always having enough food in the house!

Getting out and about with her scooter todo some shopping locally.

Going on holiday and sitting on the beachin the sun at least once a year.

Always having some money in her purse.

Having a weekly TV magazine.

Keeping busy and enjoying her manyinterests such as good food, gardening,drawing, watching TV (Big Brother andStrictly fan).

Enjoying the odd glass of Liebfraumilch.

Being busy, pottering around can take up alarge part of Pats day.

Making decisions and being organised.

Riding a Harley Davidson for her 70thbirthday.

Enjoying life!

How best tosupport Pat:

Share your day withher she loves beingin the company offriends and family.

Dont talk to her abouther illness.

Pat will worry if shethinks that Su ishaving to cope withtoo much.

Always give Pat plentyof time to get ready inthe mornings.

Dont rush her if goingout.

Dont fuss over her if

she is out of breath. Be aware that the

winter weather doeshave an effect on herhealth and she will needmore support at thistime.

Going with Su to thesupermarket oncea week and using ascooter trolley to do abig shop.

Pat enjoys going outat least once a week.

What those who know Patsay they like and admireabout her:

Bubbly lady.

Confident.

Independent.

Classy chick and always lookslovely.

Never lets her illness get her down.

A good friend and listener.

Cracking sense of humour.

Selfless.

Lives life to the full!

Pats one-page profile


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Person-centredreviews

23. Aperson-centredreviewisaperson-

centredapproachtotheannualreviewsrequiredinallservices.

24. Aperson-centredreviewisaspecicprocessthattakesbetweenanhourandaquarter,andanhourandahalf.Itrequiresatrainedfacilitator,whohelpsthemeetingalongbyusingthefollowingquestions:

Whatdoweappreciateaboutthe

person(thismaybecalledlikeandadmire)?

Whatisimportanttothepersonnow?

Whatisimportanttothepersoninthefuture?

Whatisthebestsupportfortheperson,tostayhealthyandwell?

Whatarethequestionstoanswer/issuestoresolveforthisperson?

Whatisworkingandnotworkingfromthepersonsperspective?

Whatisworkingandnotworkingfromthefamily/carersperspectives?

Whatisworkingandnotworkingfromthestaffandmanagersperspectives?

Whatisworkingandnotworkingfromtheothersperspectives(e.g.healthprofessionals,caremanagers)?

25. Thereviewinvolvestheperson,keypeoplewhohavetobetheretomeet

statutoryrequirements,andotherpeoplethatthepersonwantstoinvite.Themeetinggeneratesperson-centredinformationwhichcanbeusedtocreateaone-pageproleandbeginaperson-centredplan.Moreimportantly,itcaninitiateactionsthatwillpositivelychangethepersonslifeanddeliveramoreperson-centredservice.

26. Thequestionsposedareimportant,astheyareusedbycommissionerstoinformstrategiccommissioningandproviderbusinessplanning.ThisapproachisdescribedinrecentlypublishedDHguidanceWorking together for change:using person-centred information for

commissioning.20

A person-centred review can create

signicant change in how people live theirlives, based on what people want to achieve

it makes a difference.

Wendy,memberoftheTransformingAdultSocialCareserviceuserreferencegroup

27. Person-centredreviewsgenerateinformationforperson-centredplanningwhilemeetingstatutoryrequirementsandwithouttakingmoretime.Theyare

effectivelydirectedbythepersonandaddresstheirpriorityissuesbecausetheyarebasedonwhatpeoplesayisimportanttothem;theyshowwhatgoodsupportlookslikeanddiscoverwhatisworkingandnotworking.

20 Working Together for Change(2009),DH.


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21

In Wigan, the commissioner,aproviderandWiganPeopleFirst, a self-advocacy

group, came together to look at 20 person-centred reviews as part of the DH PuttingPeopleFirst co-producing commissioningwork programme. The group looked at what

people said in their person-centred reviews

about:

what is working;

what is not working; and

what is important for the future.

The group clustered the information into

themes. Together, they thought about

the underlying reasons for what was not

working for people and what the outcome

would be if each of these were addressed.

The group then decided what they would

do to move towards a successful outcome.

Person-centredplanningandsupportplanning

Using person-centred tools helped

it amazed me how everything came

together when I was developing Hannahs

support plan.

Alan,familycarer

28. Asupportplanisarecordofthedecisionsapersonhasmadeabouthowtheywanttospendtheirpersonalbudgettoachievetheoutcomesthathavebeendened.Person-centredthinkingandplanningareexcellentwaysofhelpingpeoplethinkaboutwhatisimportantintheirlife,what

theywanttochangeinthefutureandhowtheywanttousetheirresourcesand

money.Thisistruewhetherthemoneycomesfromexternalsources(thelocalauthorityforexample),oristhepersonsown.Everyonewhoassistspeoplewithsupportplanningneedstoknowhowtouseperson-centredthinkingandplanning.Juliadescribesbelowhowtheperson-centredthinkingtoolsimportanttoandworking/notworkingwereusefulwhenshedevelopedhersupportplan.

IntroducingJulia

My name is Julia and I am married with

an 11-year-old son. I have been disabled

for 13 years and I have been using social

services for ten years.

For the rst two years I had direct services.

This meant that I had carers who came

when they could, did what was written on

my care plan and then left.

I moved to direct payments in 1998 and

enjoyed the new freedom of being able to

choose who came through my door and

what they did when. I must admit when

personal budgets came along I was quite

sceptical. How could things get better than

this? But I decided to investigate more.


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The rst major difference was that I was

in control of my support planning and I

decided what the priorities for me were.This was a bit like having a life coach. The

types of questions asked were:

What is important to you?

What is working?

What isnt?

What needs to change?

They were very different to the usual social

services assessments. These questions

threw up some interesting answers for me

and as a result I have changed my care

radically.

I was given a budgetary gure for the whole

year and together with a support planner

(this can be someone outside of social

services, or you can do it on your own)

we wrote a plan of how I would spend

the money to meet my eligible, assessed

needs. The plan we came up with included

buying lightweight modular ramps to nally

make my house wheelchair accessible; air

conditioning to help my breathing andreduce my admissions to hospital; and an

accessible patio to enable me to access my

garden.

BUDGET:

WHAT DO I

WANT TO

CHANGE?

SUPPORT PLAN GRAPHIC for

NOT WORKING WORKING

NOW

WHAT DO I BRING?

WHATS

IMPORTANTTOME?

BOTTOM LINE

SUPPORT

SUPPORT

HOW CAN I

KEEP GOING

AND STAY IN

CONTROL?

HOW DO I WANT

MY LIFE TO BE?

ACTION PLAN

2006 Helen Sanderson Associates

Created by The Grove Consultants International


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Creating a person-centred systemto deliver personalised services

29. Person-centredthinkingtoolsareversatileandcanbeusedwithindividuals,teamsandorganisationstothinkdifferentlyandcreatedifferentkindsofactions.

30. Todeliverpersonalisedservices,peopleneedtobeabletouseperson-centred

thinkingtoolsandapproachesintheirday-to-daylivesandwork.Person-centredplansdescribehowpeoplewanttoliveandbesupported.Plansshouldbethebasisofthejobroleandtasksforthe

staffwhosupportpeople.Theprocessofusingperson-centredplanstoguidewaysofworkingforsupportstaffneedstobecentraltohowteamsworkanduseresources.Arthurssupportstaffusedtoapproachhimwhenhewasinbed,althoughhethoughttheywereburglarsandusedtohitoutwithhiswalkingstick.Creatingaone-pageprolehelpedthemrealisethattheyneededtowork

differently.Staffnowrespectthatwhenheisinbed,theycallhisnamefromthebedroomdoor.

All these were achieved with the same

amount of money I had had as a direct

payment. And I was able to do it becausethe process let me make more use of my

informal networks of support, like my

husband and friends. They were happy to

help me more as they beneted from less

lugging of wheelchairs and fewer hospital

visits. I also vowed to spend less time

working and more time with my family!

I would say that direct services allow you to

survive at home, direct payments give you

more choice and control over your life but

personal budgets allow you to live!

IntroducingMichael

Michael, who has a learning disability anddoes not use words to communicate, will

periodically yell and pound on the tray

attached to his wheelchair. One of the

people supporting him noticed that while

he was yelling, he was also staring. She

picked up the pea that he was starting at on

the oor and the yelling stopped.

It seemed that he felt strongly that

everything has a place and could not

tolerate mess. Now, every time he startsto yell, people ask him if something is

out of place and look where he is staring.

Together, he and the person supporting

him, work it out and the yelling stops. This

is recorded on his communication chart.


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Workbookstosupportperson-centredplanning

31. Person-centredplansaremorelikelytomakeadifferencewherethereisaperson-centredculture.Tocreatepersonalisedservices,managersneedtoembedperson-centredthinkingandapproachesintoalloftheirmanagementpractices.Researchhasshowedthatperson-centredplanningwasmostsuccessfulwhenmanagerswereactivelyinvolvedinplanning.21Person-centredthinkingiscentralto

deliveringIndividualServiceFunds,whichisdescribedintheAdviceforProviders(workbook1).

32. Healthprofessionalsandcaremanagershaveanimportantroletoplayindevelopingperson-centredpracticesacrossorganisations.Practitionerscanuseone-pageprolesorperson-centredplanstosupportpeopleintakingmorecontrolovertheirhealthandtheirlives.Professionalscanensurethereviewstheydoareperson-centred,outcome-focusedandleadtochangingwhatisnotworkingforpeople.Professionalsmayalsocontributetoindividualsperson-centredplans.Whenitcomestopersonalbudgets,professionalsplayanimportantroleinensuringeveryonehastheinformationtheyneedforsupportplanning.Finally,caremanagersandhealthprofessionalscanuseperson-centredthinkingtoolsintheirday-to-daypracticeandteamworktoenhanceeffectiveness.Therolesofhealthprofessionalscaremanagers,practitionersandotherprofessionalsaredescribedinmoredetailintheAdviceforProfessionals(workbook2).

33. Thereneedtobeconsistentmessagesfromcommissioners,procurementstaff

andregulatorsaboutperson-centredthinkingandplanning.Commissionersneedtoknowhowtocommissionperson-centredpracticeandbasecommissioningonperson-centredplans.Theythenneedtoworkinpartnershipwithproviderstodeliverchanges.Procurementstaffmaytenderandestablishcontractsbasedonperson-centredinformation;evaluatetendersontheirabilitytodeliveraperson-

centredserviceandreviewcontractsusingperson-centredreviews.Regulatorsneedtolookforperson-centredpracticeandrecognisebestpractice.TheseissuesarecoveredintheAdviceforCommissioners(workbook3).

34. Schoolsandchildrensserviceshaveanimportantroletoplayinraisingyoungpeoplesexpectationsthattheywillgointo

workandleadfulllives.Youngpeopleandtheirfamiliesneedaccessibleinformationfromthestartofthetransitionprocessaboutwhatispossibleintermsofcareers,employmentandindependentlivingandwhatsupportisavailabletoachievetheiraspirations.Usingaperson-centredapproachintransitionplanningresultsinbetteractionplansandhelpspeopletomakedecisionsabouttheirfuture.We

arenowlearninghowtobringtogethertransitionplanningandsupportplanningsothatresourcesareusedeffectivelytohelpyoungpeoplegetthesupporttheywant.TheseissuesarecoveredintheAdviceforUsingPerson-centredThinking,PlanningandReviewsinSchoolsandTransition(workbook4).

21 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,The Impact of Person Centred Planningfor People with Intellectual Disabilities in England: A Summary of Findings(2005),LancasterUniversity:InstituteforHealthResearch.


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CHAPTER 3

In the future we want people to have

maximum choice, control and power over the

support services they receive.

Putting People First22

1. SincetheintroductionofValuing Peoplein2001,importantlessonshavebeenlearntfromtheimplementationofperson-centredplanninginlearningdisabilityservices.Thischapter:

setsoutsomeofthelearninggatheredthroughresearch,consultationandpractitionerexperience;

setsoutthecontributionthatperson-centredthinkingandplanningcanmaketodeliveringonthepersonalisationagendaagainstlocalgovernmentmilestones;

providesquestionstohelpreviewprogress;and

suggestssomenextsteps.

What works and what doesntwork in implementing person-centred planning?

2. Whatactionsworkinimplementingperson-centredplanning?

Effectiveleadership.

Investinginlocalcapacity.

Trainingandsupportingstafftouseaperson-centredapproachwhatevertheirrole,throughuseofperson-

centredthinkingtools.

Havingastrategicfocusoncreatingaperson-centredculture,byusingperson-centredthinkingatalllevelsofanorganisationandnotjustimplementingplanning.

Embeddingperson-centredapproaches,byndingopportunities

touseperson-centredthinkinginallaspectsofthesystem.

3. Whatdoesntworkinimplementingperson-centredplanning?

Expectingfacilitatorstodevelopperson-centredplansandtoensurethattheyareimplementedorhandedovertomanagers.

Relyingonexternal,independentperson-centredplanningfacilitatorstoberesponsibleforcreatingperson-centredplans.

Appendix 3setsouttheseareasinmoredetail.

Delivering PuttingPeopleFirstandachieving the local government

milestones using person-centredthinking and planning

22 Putting People First(2007),DH,p.2.


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Supporting delivery of themilestones

4. ThelessonslearnedfromimplementingtheValuing Peopleperson-centredplanningguidance23informhowperson-centredplanningcancontributetothedeliveryofPutting People FirstandthelocalgovernmentmilestonessetoutbyADASSandtheLGA.24

5. Theappendicesfocusonthemilestones

thatrelateto:

self-directedsupportandpersonalbudgets;

effectivepartnershipswithpeopleusingservices,carersandotherlocalcitizens;

preventionandcost-effectiveservices;

informationandadvice;and

localcommissioning.

6. Appendix 4looksat:

whathasbeentriedandlearnedthatisrelevanttoeachofthesemilestones;

somequestionstoevaluatewhereyouarenow;and

suggestionsfornextstepswithlinkstotoolsandresources.

Where are you now?

7. Appendix 5setsoutsomequestionstohelpyoustartthinkingaboutyourprogressinusingperson-centredthinkingandplanningtodeliverPutting PeopleFirstandtomeetthelocalgovernmentmilestones.

What can you do next?

8. Appendix 6suggestspriorityactions:

Providingclearinformationandadviceaboutsupportplanningandperson-centredreviews.

Makingsuretherearearangeofpeoplewhocanassistwithsupportplanning,notjustcaremanagers.

Implementingperson-centredreviews

inservices.

Deningleadershipforperson-centredthinking,planningandreviews.

Investinginperson-centredthinkingandcreatingalocalresourceofpeoplechampioningperson-centredthinkingandplanning.

AdoptingWorking together for changeorasimilarapproachtoco-producecommissioningandstrategicplanning.

9. Appendix 7listsadditionalusefultoolsandresources.

23 Planning with People Towards Person Centred Approaches(2002),DH.

24 Lettertocouncil(September2009),ADASSandLGA.


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Theotherthreemainstylesofperson-centredplanningarecalledPATH,25MAPS26andPersonalFuturesPlanning.27Theyfocusonthefutureandhavebeendesignedforuseoutside,orattheedgesof,services.Theyinvolveonepersonatatimeandfollowameetingformat.Thesestylesofplanningrequireanindependentfacilitator

andacommittedgroupofpeoplewhomeetregularlytoimplementtheplans.JohnOBrien,oneoftheco-developersofPATH,MAPSandPersonalFuturesPlanning,describesthesestylesasanartorcraftandtalksofthedangersofseekingtoassimilatethesestylesofperson-centredplanningintotheservicesystem.PATH,MAPSandPersonalFuturesPlanningareveryhelpfulininformingsupportplanningbycreatingasharedimage

ofadesirablefuture.JohnOBriensuggeststhatPATHandMAPSaremostlikelytoresultin:

people making satisfying community

contributions

when a circle that continues to support the

person holds the plan than when a group

gathers to plan and then disperses.

when a person who requires assistance and

the circle plan alongside an organisation

committed to person centred work.

Typically the person involved people who

know and like them to come to a meeting.

One or two facilitators guide and record the

discussions and decisions. After the meeting

people do what has been agreed. This hardlysounds revolutionary. But the frame which is

put around the meeting, the questions the

meeting asks and the way the meeting is

organised often mean that new possibilities

emerge, new understandings develop, new

alliances are formed and peoples lives take a

denite turn for the better.

PeteRitchie28

Appendix 1

Background on person-centred

planning

25 OBrienJ,PearpointJandKahnL,The PATH and MAPS Handbook: Person-centered Ways to BuildCommunity (inpress),Toronto:InclusionPress.

26 FalveyM,ForestM,PearpointJandRosenbergR,All My Life is a Circle(1994).

27 MountB,Capacity Works: Finding Windows for Change Using Personal Future Planning(1995).28 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley

Publishers.


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Appendix 2

What DH policies say about

person-centred approachesPerson centred approaches in current policy

Policy What it says about personalisation and person centred approaches

1. Valuing People Now and Key Priorities

Valuing Employment For 2009 -10 the key priorities include: to ensure that the Personalisation agenda is embedded within

Now all local authority services and developments for people with learning disabilities and their family carers,and is underpinned by person centred planning.Regional Action and SupportThe Deputy Regional Directors and the Valuing People Regional Leads will establish a regional deliveryplan to respond to the national delivery plan and the key priorities. For 2009-2010, these are: ..to ensurethat the Personalisation agenda is embedded within local authority services and developments forpeople with learning disabilities, and is underpinned by person centred planning and support.Education, work and getting a lifeToo few people with learning disabilities have opportunities to work and study after leaving school, orto enjoy a full range of leisure and social activities in their local communities. The policy objective is toincrease the number of people in employment and who have access to post-16 education. The followingaction will be taken: ...The Transition Lead in the office of the national Director, with support from theValuing People Regional Leads, will continue to oversee a programme to embed Person CentredTransition Planning in the statutory Transition process nationally (2009-10) (p35)Making it happen - commissioningGood commissioning, based on sound information from Joint Strategic Needs Assessments and collationof information from person centred plans, is the key to improving outcomes for people with learningdisabilities. It enables Local Authorities and Primary Care Trusts to identify gaps in services, developnew models of service provision, working with providers, and decommission inappropriate models.

Valuing Employment NowJoint working to create employment paths for individuals. Where people with moderate and severelearning disabilities have jobs, it is achieved through very close partnership working between statutory,voluntary and private agencies, with funding streams brought together. Starting from a person centredapproach, this joint working needs to map out a clear employment pathway for people with learningdisabilities. (p15)Making it happen regionally and locally - recommended actions ...Social care staff to embed employmentin the person centred support plans of working-age adults, including bringing together funding forsupported employment. (p37)Person centred employment planning...social care services should use person centred planning to help individuals to explore theirinterests and aspirations, and specifically to think about the implications of these for work. Getting a

job should be a priority for all working-age adults. DH will issue guidance on this. (p46)Key actions for government departments...DHs forthcoming person centred planning guidance will emphasise that the individual supportplanning process for all adults of working age should prioritise employment as an outcome.

Making it happen regionally and locally - recommended actions...Social care staff to use person centred planning to change peoples work expectations andidentify their path to employment, using personal budgets for this where appropriate. (P48)


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2 Living well with

dementia: a national

strategy 2009

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058

Case for Change... Emerging research-based evidence shows considerable benefits to both people with dementia andtheir carers from specialist dementia home care when compared with standard home care services.Improved outcomes include reduced stress and risk of crises for carers, and extended capacity for

independent living for people with dementia. Some examples of innovative practice are emergingfrom dedicated home care dementia teams. They ensure the provision of additional time prior to thecommencement of the care package, to build a rapport, learn about the person with dementia, theirfamily, their preferences and their life as a whole so that the service is truly person-centred. (p47)Community Personal Support ServicesObjective 6: Improved community personal support services. Provision of an appropriate range ofservices to support people with dementia living at home and their carers. Access to flexible andreliable services, ranging from early intervention to specialist home care services, which are responsiveto the personal needs and preferences of each individual and take account of their broader familycircumstances. Accessible to people living alone or with carers, people who pay for their care privately,through personal budgets, or through local authority-arranged services.A comprehensive community personal support service would provide: home care that is reliable, withstaff who have basic training in dementia care; flexibility to respond to changing needs, not determinedby rigid time slots that prevent staff from working alongside people rather than doing things for them;access to personalised social activity, short breaks and day services; access to peer support networks;access to expert patient and carer programmes; responsiveness to crisis services; access to supported

housing that is inclusive of people with dementia; respite care/breaks that provide valued and enjoyableexperiences for people with dementia as well as their family carers; flexible and responsive respite care/breaks that can be provided in a variety of settings including the home of the person with dementia;independent advocacy services; and assistive technologies such as telecare. (p 48)Carers - the most valuable resource for people with dementia - The Case for Change... Often, insufficient information is sought from relatives and carers. This means that person-centredcare is not delivered and it can lead to under-recognition of delirium and dementia.Objective 7: Implementing the Carers Strategy for people with dementia... Carers have a right to anassessment of their needs and can be supported through an agreed plan to support the importantrole they play in the care of the person with dementia. This will include good-quality personalisedbreaks...Improving care for people with dementia in care homes - The Case for ChangeThere is no doubt that residential care may be the most appropriate and effective way of meeting theneeds of someone with dementia and a service of choice. There are care homes that provide excellentcare for people with dementia. Such homes generally pay close attention to leadership and staffmanagement, staff training and development, and person-centred care planning. They also provide a

physical environment that enables people with dementia to move around the home safely. They providepurposeful activities that relate to individual preferences rather than general entertainment; activelyinvolve relatives and friends in the care of residents; and develop strong links with and involvement inlocal communities. There is a growing interest in Life Story work which provides an effective vehiclefor care home staff to communicate and develop relationships with residents, based on their unique lifeexperiences. Equally the provision of therapeutic activities within care homes, such as art therapy, musictherapy or dramatherapy, may have a useful role in enabling a good-quality social environment and thepossibility for self-expression where the individuality of the residents is respected. (p 58)


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2 Living well with

dementia: a national

strategy 2009

Commissioning a trained and competent workforceObjective 14: A joint commissioning strategy for dementia. Local commissioning and planningmechanisms to be established to determine the services needed for people with dementia and theircarers, and how best to meet these needs. Joint commissioning strategies will need to take accountof peoples needs for both mainstream and specific services. They will need: a community focus, linking

into Local Area Agreements and the development of sustainable communities; and an individual focus,drawing on the use of personal budgets and the commissioning of self-directed support...The strategiesshould inform the operational plans and budget cycles of PCTs and local authorities, and demonstratehow they plan to improve services for people with dementia. They should be informed by guidance onWorld Class Commissioning and ... as well as the Putting People First guidance. (p 67)

3 New Horizons Vision By 2020, we hope that: Mental health services will make special plans that give people a bigger say inNew Horizons (July what their treatment is and how they get treatment. This will be underpinned by:

2009), the emerging Guiding values (p 26)

national policy

framework for mental

We are aiming for a model of care in which service users can determine their own route to recoveryand the role of the professional is to support them in achieving this.

health, which replaces

the National Service

Framework for Mental

Health (2000), providesa further impetus

for personalisation in

mental health, calling

for a move from

something which should

Better mental health care for adults (p 61)Key message: People with mental health problems should receive high-quality, personalised care basedon recovery principles, whether in hospital or in the community.The foundations for mental health care services include: high-quality clinical services providing evidence-based interventions along a care pathway tailored

to individual needs, choices and preferences. a recovery philosophy focusing on building on individual strengths and improving quality of life as

defined by the service user.Assessment (p56)Timely, comprehensive assessment that considers the needs of both the individual and their family or

be done to service users carers is central to care planning and to the delivery of multi-disciplinary care. One such approach isby the system, towards a the 3 Keys method. (p126) This outlines three keys to a multi-disciplinary assessment that supports

system of support built

by the person and their

advocates...

National Mental Health

Delivery Unit (NMHDU)

Kevin Lewis

recovery and the development of self-management skills: active participation of the service user and where appropriate their carer in a shared understanding

with service providers. input from different provider perspectives within a multidisciplinary approach. a person centred ethos that builds on the strengths, resilience and aspirations of the individual

service user as well as identifying his or her needs and challenges.


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4 High Quality Care For

All - Final report of the http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825

Next Stage Review 2008...Providing personalised care should also help us to reduce health inequalities, as the households withthe lowest incomes are most likely to contain a member with a long-term condition. (p34)

Over the next two years, every one of the 15 million people with one or more long-term conditionsshould be offered a personalised care plan, developed, agreed and regularly reviewed with a named leadprofessional from among the team of staff who help manage their care. (p47)

Pilot personal health budgets. Learning from experience in social care and other health systems,personal health budgets will be piloted, giving individuals and families greater control over their owncare, with clear safeguards.

5 Carers at the heart of http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085338.pdf

21st century families

and communities 2008By 2018: carers will be respected as expert care partners and will have access to the integrated andpersonalised services they need to support them in their caring role... (p13)Personal BudgetsPersonal budgets signal the move towards a system where person-centred planning is at theheart of the services provided by central and local government, and services are tailored to meet theneeds of individuals and families...over the next few years, we are committed to giving every person

using social services, including carers, a personal budget. Personal budgets will enable carers to live alife outside their caring role while still ensuring that the people they care for receive the high-qualitysupport they need. (p79)Partners in careInformation prescriptions are part of the person-centred care approach which is a consistenttheme running through the department of healths vision for everyone who uses health services andsocial care. They should enable people with long-term conditions and their carers, from the pointof diagnosis, to make better informed choices when planning care and getting on with their lives.Information prescriptions will also support professionals in sharing information with those who useservices and assist them in their role of navigating people around the system. (p122)


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What works in implementingperson-centred planning?

Effectiveleadership

Researchhasstressedtheimportanceofleadershipforperson-centredplanning,particularlyfromindividualswhouseservices,families,managersandimplementationgroups.29Powerful,effectiveleadershipbypeoplewhouseservicesandfamilycarershasoccurredwhentheyhavehadsupporttodeveloptheirownperson-centredplans,andhaveseenthedifferencethishasmadetotheirlivesandhavewantedtosharethiswithothers.PartnersinPolicymakingandothercitizenleadershipcoursesareexcellentopportunitiesforpeopletodeveloptheirownperson-centredplansandseethemmakeadifference.

Mostlearningdisabilitypartnershipboardsandsomeprovidershaveestablishedgroupstoleadthedevelopmentofperson-centredplanning.Thesehavebeencalledimplementationgroups,taskgroupsorsteeringgroups.LeadershipexpertJohnKottercallsthistypeofgroup,whoformacriticalmassforchangeintheorganisation,aguidingcoalition.30Thisisnotjustanotherbureaucratictaskgroup;thisgroupneeds

todemonstrateperson-centredvaluesandinclusion.

Manyimplementationgroupsusethesefourgoalstodenetheirpurpose:

Workingtoensurethatperson-centredthinkingandplanningishappening.

Makingsurethatthisplanningisgoodquality.

Makingsurethatthatperson-centredthinkingandplanningchangespeopleslives.

Makingsurethatplanningischangingtheservices,sothatmorepeopleareworking,livingintheirownhomesanddirectingtheirownsupport.

Implementationgroupshavebeenmostpowerfulinmakingchangewhentheyhave:

theactiveinvolvementofpeoplewhouseservicesandfamilycarerswhohave

personalexperienceofperson-centredplanning;

committedleadershipatasenior,strategiclevel;

Appendix 3

What works and what doesnt work

in implementing person-centredplanning?

29 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,Research Health The Impact of PersonCentred Planning for People with Intellectual Disabilities in England: A Summary of Findings (2005),

LancasterUniversity:InstituteforHealthResearch.30 RitchieP,SandersonH,KilbaneJandRoutledgeM,People, Plans and Practicalities: Achieving Change

through Person Centred Planning(2003).


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aclear,sharedsenseofpurposedrawnfromavisionbasedoncitizenshipand

inclusion;

aclearlydenedwayofworkingtogethertoachievethischange;and

decidedwhatsuccesslookslikeandhowtheywillknowtheyarebeingsuccessful

thisincludeswhattheywillsee,hearandfeel.

DerbyCityPartnershipBoard

commissioned a programme of

development based on person-centred

thinking for its services. Neil, the person-

centred planning coordinator, explained

that these programmes are based around

one provider organisation: We cover the

city councils provider and commissioning

arms, three external providers and the

learning disability services of the mental

health trust. Family members, self-

advocates, board members and provider

representatives were part of the leadership

team. They thought about what success

would look like in three years, as theorganisations became more person-centred

and developed specic outcomes and

success indicators. The programme included

training in person-centred thinking and how

it could be applied to running meetings,

enabling risk, supervision and recruitment.

Managers were given direct support and

coaching from the person-centred planning

coordinator to help them implement what

they had learned. Providers shared thesechanges with the leadership team and

identied those that needed to be shared

with the partnership board.

Listen2Me is a group of service-user leaders

who offer training to help other service

users understand what is important to

them now and what will be important to

them in the future. This gives people the

choice and control to be in charge of what

happens in their own lives. The course is

co-facilitated by service users who have

been through the training themselves and

have used person-centred planning in

their own lives. Through their experiences,

they can offer direction to other service

users. A Listen2Me course can also help

people write their own one-page prole

and prepare for their own person-centred

review. Listen2me helps service users

understand how to get practitioners to

listen to them and their wishes.

Listen2me is brilliant it has helped me to

tell people what I want in my life.

Neil

Sally attended a PartnersinPolicymaking

course in 2003: It was like a light bulbswitching on, she said of her rst contact

with person-centred planning. I was told

on the rst day of the course that it would

probably change my life and of course I

thought, Oh yeah. It did though. The

very rst sessions were about person-

centred approaches and person-centred

planning. Sally now organises person-

centred planning meetings for her son and

other local people.


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31 Planning with People Towards Person Centred Approaches(2002),DH.

Investinginlocalcapacity

Havinglocalperson-centredplanning

coordinatorswhocouldtrainandsupportothershasworkedtocreatelocalcapacity.Localchampionswhocoachandsupportothersinusingperson-centredthinkingcanalsohelpwithfacilitatingperson-centredreviewsandplanning.

A nationalproviderhas invested inidentifying, training and supporting

champions throughout the organisation.

The champions undertaking person-centred

thinking and coaching skills training are

mainly rstline managers. They receive

regular support from an internal group of

person-centred thinking trainers. A local

leadership team supports the champions.

The leadership team functions like an

implementation team. They have a vision

of what success would look like if person-

centred thinking and planning were reallymaking a difference in the organisation.

From that vision, they have identied

annual targets and success indicators. At

each meeting, they examine how they are

progressing with their targets and hear from

the champions about what is working and

not working. Once a year, members from

all the leadership teams and the champions

meet together, to share what they are

learning. This informs the work of thedirectors. The organisation won a National

Training Award for how this work has made

a difference to people who use the service

and their staff.

Trainingandsupportingstafftouseaperson-centredapproachinarange

ofrolesusingperson-centredthinkingtools

ThisapproachwasdescribedasadepthandbreadthapproachintheoriginalDHperson-centredplanningguidance.31Thismeansallstaffhavingabreadthofexperienceinperson-centredthinkingandapproacheswhilealsoprovidingmorein-depthtrainingandsupporttoacoreteam(seeabove).Itisimportant

caremanagersandprofessionalshaveopportunitiestolearnaboutanduseperson-centredthinkingintheirrolestoenhancetheirexistingpractices.


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Findingopportunitiestouseperson-centredthinkinginallaspectsofthe

system

Usingperson-centredthinkingandapproachesneedstoextendbeyondrstlinemanagers,sothateveryoneinanorganisationisclearabouthowtheycanworkinperson-centredways.Insteadofjustimplementingperson-centredplans,thefocusneedstobeonhoworganisationscanbecomemoreperson-centred,creatingaperson-centredculture

inwhichpersonalisationcanourish.Itiseasyforpeopletothinkthatperson-centredthinkingandplanningisjustsomethingthatneedstohappenwithpeoplewhoaresupported.Manyorganisationsarendingperson-centredthinkingskillsbenecialinotherareasforexampleinhumanresources,meetingsandwithinqualityassurance.

What does not work in

implementing person-centredplanning?

Expectingfacilitatorstodevelopperson-centredplansandtoensurethattheyareimplementedorhandedovertomanagers

Inmanyplaces,person-centredplanning

facilitatorsandcoordinatorsaresolelyresponsibleforthedevelopmentofperson-centredplanning.Thishasledtothedevelopmentofcriteriagoverningwhocangetaplan,withinevitablewaitinglistsandinequalities.Managerscantakeresponsibilityforensuringthatstaffmemberssupportingpeopleknowwhatmatterstoaperson,howbesttosupportthemandhowtoactonthis.Facilitatorscouldplayaroleincoaching

andsupportingmanagersandstaffinusingperson-centredthinkingtodevelopplans.

Relyingonexternal,independentperson-centredplanningfacilitators

toberesponsibleforcreatingperson-centredplans

Somelocalauthoritiescreatedindependentteamstoofferperson-centredplans.Oneauthorityinvested100,000peryearoverthreeyearsandtheoutcomewas90person-centredplans.Thereweresomegreatoutcomesforafewpeople,butnotalloftheseplanswereimplementedoreffectiveincreatingchange.Outsourcingtheperson-centredplanningresourcealsomeantthatperson-centredthinkingandplanningwasseenassomeoneelsesjob.Itwasanotherservicetoreferpeopleto,ratherthananapproachforeveryonetouseintheirday-to-daywork.

Aninternalteamofchampionsforperson-centredthinking,planningandperson-centredreviewscancoach,trainandsupportpeopleinusingthesetoolsandbefacilitatorsoflastresortwhenthereisnooneelsewhocantakethatrole.Theoutcomeshouldbeaperson-centredculturewhereeveryoneworkstoensurethatchoiceandcontrolisinthehandsofpeoplewhousetheservice.Aninternalteamcanhaveasignicantimpactoncoachingandsupportingculturalchangethroughperson-centredthinking,fargreater

thananarmslengthservicethatdeliversperson-centredplans.Itcanbevaluabletohavepaidindependentfacilitatorsavailabletopeopleandfamilies;however,localauthoritieswillwanttoinvestincreatinglocalcapacityforchangeandnotrelyonexternalfacilitatorstoachieveculturalchangeandtodeliveronperson-centredplans.


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33 Operating Models: Learning From the Early Adopters(2009),ADASS.

34 Evaluation of the Individual Budgets Pilot Programme: Final Report(2008),IndividualBudgetsEvaluationNetwork.

35 Operating Models: Learning From the Early Adopters(2009),ADASS.36 Putting People First: Support planning and brokerage with older people and people with mental

health difculties(2010),DH.

Appendix 4

Person-centred planning anddelivering the milestones

Self-directed support andpersonal budgets

Assuggestedearlier,tobeabletodeliverself-directedsupportrequiresknowledgeofwhatisimportanttotheperson,howtheywanttobesupportedandthesupportthey

requiretomakedecisions.Adultsocialcarestaffmembersneedtoactuponup-to-dateinformation.Thisinformationcanbethebeginningofaperson-centredplan,whichisfundamentaltosupportplanning.

LearningfromEarlyAdopters33andtheevaluationoftheIndividualBudgetsPilot34showsthatsupportplanningprocessescantakelonger,buttheoutcomesarebetterand

peoplefeelmoreempowered.

Newthinkingisrequiredforsupportplanning

Thereisacautionaboutsomesupportplansbeingcomposedusingtraditionalcareplanningtechniquesandthinking,forexample,wherepractitionersusetheoldworldtimeandtaskmodeltotranslate

peoplesneedsintohoursofcare.35

Olderpeopleandpeoplewhousementalhealthserviceswhohavepioneeredsupport

planning,36suggestthefollowingbestpracticetohelppeopledevelopsupportplans:

Payattentiontohistoryandhearthepersonsstory.

Lettheindividualsetthepaceofthe

planningprocessandchoosewhoelsetoinvolve.

Planforcontingenciesandbeexible.

Trydifferentwaysoflisteningtopeople.

Focusonwhatisimportanttotheperson(notwhatisimportanttostaff).

Peopledonotneedtohaveaperson-centredplanbeforetheystarttheirsupportplan,buttheprinciplesandtoolsusedinperson-centredthinkingwillbefoundinallgoodsupportplanningapproaches.Ifpeopledohaveaperson-centredplan,theyhaveaheadstartontheinformationneededforasupportplan.

Athoroughgroundinginperson-centredthinkingandplanningforanyoneundertakingsupportplanningwillavoidtheoldworldtimeandtaskmodelmentionedearlier.Greatsupportplanningisanopportunityforpeopletothinkafreshabouthowtheywanttheirlife


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tobe.Itshouldnotbeaproceduredriven,formllingexerciseledbystaff.

Co-producingsupportplansandpeersupport

Co-producingsupportplanswithotherpeoplehasemergedasapowerfulwaytoplan.37Aco-productionapproachsupportsanddevelopspeer-to-peersupportandoffersthisinasmallgroupsetting,aswellasonaone-to-onebasis.Ascouncilslooktodevelopnewandmoreempoweringrelationshipswith

peoplewhousetheirservices,itisincreasinglyimportanttondeffectivewaysofteachingpeopletheskillstodesignandmanagetheirownsupportarrangements.Engagingpeopleasactiveparticipantsinsupportplanningisessentialindirectingtheirownsupport.Itgivespeopletheopportunitytodesignandbuildtheirownsolutionstotheirsupportneeds,basedonwhatisimportanttothem.38

ADHprojectthatprovidedeightcouncilswithasmallamountofseedfundinghasdevelopedinnovativewaystotransfersupportplanningskillstopeopleusin

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