Person-centred approaches in adult social care

David BrindlePublic Service EditorGuardian

Person-centred approaches in adult social care

Revolution or false dawn?

From the top….

‘ It’s time to make public services personal to the needs of the elderly: more control over personal social care budgets; more choice managing chronic care; a wider range of services from home helps to district nurses. Better personal care so that older people can choose to stay in their own homes’

- Gordon Brown, Labour Party conference, Sep 2007

What is person-centred care?

‘The most important thing that inspectors are looking for is that people are actually living the kind of lives they want with the support they need - that person-centred thinking and planning is transformed into person-centred action.’

- Commission for Social Care Inspection

How are we doing?

• Admissions to care homes falling• Direct payments up 33% 2006/07• Intermediate care at home up 14%• Intensive home care rising

- CSCI on council self-assessments

But ….

• Residential care still predominant• Help to live at home below target • Extra care housing 50% planned growth• 73% councils on ‘substantial’ needs bar

- CSCI

Self-directed support

• Direct payments - 32,000• Independent Living Fund - 19,000• Individual budgets - 2,300

Individual Budgets funding streams

• Supporting People (£1.7bn)• Independent Living Fund (£0.2bn)• Disabled Facilities Grant (£0.1bn)• Access to Work (£0.06bn)• Integrated Community Equipment Service

(£0.05bn)(additional to adult social care funding)

Seven steps of an IB

• Financial allocation• Plan how to use IB• Local authority approval• Decide level of control (six levels)• Flexible use• Outcomes in whole life/community contexts• Local authority checks, reviews

IBs - choices

• Support at home (20/22)• Personal assistants (8/22)• Use of day centre (12/11)• Days at day centre (4.5/3.5)• Community support (8/15) (sample of 22 early users)

Individual Budgets evaluation

• Thinking ‘outside the box’• Freedom and independence• Simpler than direct payments• Self-assessment empowering• Importance of support

- IBSEN team (PSSRU/SPRU/SCWRU)

IBs evaluation (2)

• Support/brokerage ‘embryonic’• Mental health taking longer• Funding integration ‘problematic’• Threat to financial planning

- IBSEN

IBs - what it means

Mr S, a full-time carer to his wife and increasingly frail himself, uses an IB of less than £35 a week to employ a male PA to take him out for a walk twice a week, give him a bit of male company and help him with DIY tasks he can no longer perform.

IBs - what it means (2)

Mr M’s daughter spent a great deal of her time cooking for her father when she visited. With a small IB, thery were able to purchase a freezer so that she can now cook a batch of meals at once. With the time saved, she is now able to take him out; they can enjoy one another’s company again.

IBs - what it means (3)

The local Hindu temple is being paid by Mrs S’s family, our of her IB, to top up her support. The temple’s previous involvement was informal and ad hoc.

IBs - resource awareness

• ‘People are shocked by how much their service costs - it makes them think’ (Manchester)

• ‘When you put money to it, people do start to wonder if what they’re getting is good value’ (Barking and Dagenham)

• ‘We’re not doing anything grandiose; it’s sensible, small things’ (Barnsley)

IBs - questions

• Capacity/ability of mass of service users• Effect on service providers• Will allocations be cut?• Dependency• Pay and conditions of PAs• Attitude of professionals