Personalisation: The Choice Agenda Dr Guy Daly & Dr John Woolham

1. Personalisation: The Choice Agenda Dr Guy Daly & Dr John Woolham

2. Personalisation – The Choice Agenda Dr Guy Daly & Dr John Woolham g.daly@coventry.ac.uk j.woolham@coventry.ac.uk West Midlands Supported Housing Network BVSC, Birmingham 21 January 2010

3. Structure • Context – social political context • Choice Agenda • Personalisation • PBs & SDS • Learning from previous studies generally • IBSEN Evaluation • Coventry Pilot • Recent reseach • Conclusions

4. Context • Choice and personalisation are just part of the ‘latest’ refashioning of social welfare services? • Hierarchies (top down) to markets (customers) to partnership (co-production)?

5. New Labour’s Choice Discourse - personalisation & democratisation • Personalisation • Blair, 2004 • Reid, in DH, 2003 • Democratisation • Milburn, 2005 • Reid, in DH, 2003 • Reid in Hinsliff G, 2005

6. New Labour’s Choice Discourse - personalisation & democratisation “I know what it was like to grow up where people were completely disempowered and had no choice…. Now the public debate is this: people exercise choice in every other branch of their life; increasingly they recognise that the private sector offers choice; that is a real problem for the public sector…. If the private sector offers choice and the public sector does not, it ceases to command confidence. It’s also an egalitarian argument. [Demand] for choice is out there; if we try to avoid it, there will be a tidal wave. It’s inevitable. It’s coming. What we want is a system [of choice] based on need, not the size of your wallet.” (Milburn in White and Wintour, 2005, emphasis added)

7. The Choice Agenda • ‘choose and book’ • city academies & foundation schools & faith-based schools • ‘choice based lettings’ • third sector in social care • direct payments, individualised budgets & personal budgets

8. Choice is New Labour’s New Brand • Schwartz (2004) • less is more • Clarke et al (2006) • proxy • Clarke et al (2005) • choice may exacerbate inequalities

9. Personalisation: an elusive policy aspiration over last quarter of a century • Disability rights in USA • Case /Care Management • Social model of disability • Valuing people • Personhood & Kitwood’s work • Core social work values

10. Direct Payments, Individual Budgets and Personal Budgets • direct payments - 1995 • individual budgets – 6 budget sources • personal budgets

11. Personal Budgets & SDS • another means of achieving: • personalisation • empowerment • choice • Evidence base remains weak at the present time • Contested areas – are service users ‘customers’ or are they ‘citizens’?

12. Social Care Markets: Learning From Previous Studies (1) • develop and manage social care markets effectively • commission social care effectively • develop effective partnership working • develop an understanding and raise the profile of DPs/IBs/PBs

13. Learning From Previous Studies (2) • overcome various barriers including attitude of certain local authorities and social care professionals • promote outcomes focused social care • ensure users are empowered • ensure real choice is provided

14. IBs National Pilot • 13 local authorities chosen to pilot the introduction of individual budgets during 2006-2008. • national pilot programme evaluated through the Individual Budgets Evaluation Network (IBSEN). • national research project aims: • experiences and outcomes for service users • resourcing and management • cost effectiveness, workload management, training, legal and professional issues • Randomised Controlled Trial - hard data with nationwide validity.

15. IBSEN Evaluation Research Questions • Can IBs help people get better outcomes from social care resources and services to improve their lives? • Can improvements be achieved without additional costs? • What might make individual budgets work best for different people in a range of circumstances? • What are the challenges and obstacles that need to be resolved?

16. Overall Findings (1) • holding an IB was associated with better overall social care outcomes and higher perceived levels of control • the IB group were significantly more likely to report feeling in control of daily lives, their support and how it was accessed

17. Overall Findings (2) - specific benefits for particular groups • for people with mental health problems, significantly higher quality of life… and a tendency towards better psychological well being • physically disabled people with IBs were significantly more likely to report higher quality of care and more satisfied with help received • people with learning disabilities with IBs more likely to feel that they had control over their daily lives

18. Overall Findings (3) - specific benefits for particular groups • less positive findings for some groups • most significant was that findings were less positive for older people • psychological well-being was not improved for some groups • for people with mental health problems, while experiencing potentially significant benefits, still major barriers to greater take up

19. Department of Health response • national evaluation confirmed to DH that introduction of personal budgets in social care is the right approach • specific challenges for older people and people with mental health problems • prioritise personalisation for people with learning disabilities • implications for carers of personal budgets and personalisation • Putting People First programme to meet commitment to co-production

20. Coventry Pilot - Challenges • varied levels of knowledge and awareness of Individual Budgets • difficulties experienced by some service users in obtaining an Individual Budget or available services • difficulties in securing adequate supply of good care staff • need to be skilled up in order to take on the responsibilities of being an Individual Budget holder • need for supply to become more flexible and responsive • need for professionals to recognise to a greater extent that their roles are changing

21. Coventry Pilot - Suggested Developments • effective advocacy services and support • database of available care staff* • support/assistance for service users and families in taking on roles of an employer • effective communication between departments • agencies work in partnership • aligned funding streams • real work opportunities developed • appropriate housing supply

22. The findingsResponse rates

23. FindingsFor SDS/PB Overall, SDS users were more likely to say • their health had improved, • they felt safer in their homes • they felt safe when they went out • they had more control over the support they used • feel their social life had got better, • that people treated them with more dignity • their quality of their life was ‘good’ on the whole • On a range of different ‘areas of life’ that their personal budget had been helpful. ….than people who used ‘traditional’ services.

24. Findings For SDS/PB • The kinds of care and support they chose to buy were different compared to people who used traditional services. • They also accessed more services

25. Findings For SDS/PB • Lower aggregate scores ‘well-being’ scores were found amongst SDS users across all main care groups.

26. Findingsconcerns • Comparison of ADL scores showed little difference between ‘traditional’ and SDS groups . • Substantial proportions of people also felt that SDS had not made a difference to them over the past year.

27. Findings:concerns

28. Findings concerns • Data above the horizontal line = worse than average. Data to the right of the vertical line = more expensive than average. • Younger SDS users (on left) had better outcomes than older people (on right) on both ADL and GHQ scales. • Costs were also greater for both older and younger groups.

29. The impact of SDS & personal budgets Conclusions • There was little evidence that SDS users were any more likely to be able to perform ADLs • Substantial numbers of SDS users said their budget hadn’t made a difference to them in respect of ‘areas of life’ • Impact was differential – younger adults had the best outcomes on the measures used. For older people differences between traditional and SDS users were much less marked. • ‘Transformational’ impact greatest amongst ‘self completers’ - implications. • Costs more for SDS users • If SDS costs were equivalent to ‘traditional’ packages, would this lead to poorer outcomes for SDS users? • If costs of ‘traditional’ packages were increased commensurately with SDS costs, would this lead to better outcomes for ‘traditional’ package users? • SDS as the ‘means’ not the end. • Are there better ways of achieving personalised services for some people than personal budgets and SDS?

30. The impact of SDS & personal budgets Conclusions : SDS/Personal budgets: a false prospectus? • Are the improvements in outcome sustainable within a local care economy based on market principles & values and a shrinking resource base? • Are people who use budgets customers or citizens? Is being a ‘customer’ empowering – now and in the longer term? • What impact will SDS have on people who have impaired mental capacity? • If SDS isn’t the most effective way of achieving personalisation for some people – will there be any turning back from market forces?

31. In Summary • PBs & IBs are a means to an end but not an end in itself or, necessarily, the means to an end • Service users will have different views and perspectives regarding choice and personalsiation, e.g depending on: • choice over what, when, how, where, whether (why not?) (after Le Grand, 2006)