OPM Public Interest Seminars: Personalisation

and the future of health and social care

OPM was pleased to welcome a panel of prominent speakers to its public interest seminar
on employee owned public services, which took place on 8 June 2010. The seminar followed
a traditional debate format, with the proposition being:
“The success of personal budgets will rely on the skills, knowledge and confidence of the
frontline workers delivering them.”
Speaking in favour of the motion were:
• Adrian Smith, the Adult Social Care Programme Lead and Regional Lead for London
and the South East at In Control, a social enterprise that has been a driving force behind
the development and implementation of Self-Directed Support; and
• Harry Cayton, Chief Executive of the Council for Healthcare Regulatory Excellence and
chair of the steering group for Macmillan Cancer Support’s Macmillan Solutions project, a
community-delivered personal budget model that provides support to people affected by
cancer.
Speaking against the motion were:
• Sam Bennett, the National Personalisation Advisor at the Department of Health for the
Putting People First Programme, the national policy driver of the personalisation agenda;
and
• Mike Adams, the Chief Executive of the Essex Coalition of Disabled People (ECDP), one
of the oldest user-led organisations in the UK that has had ongoing strategic and delivery
involvement with direct payments and personal budgets.
Panellists and participants enjoyed an energetic debate, discussing a range of issues: the
roles of different sectors; the balance of individual rights and responsibilities for care; and
successes and limitations of individual budgets. This note summarises some of the key
messages which emerged from the debate. The reader should be aware that the views
expressed by panellists were presented as resolutely for or against the proposition as a
means of stimulating debate. As such, what follows below is a summary of the main issues
discussed at the seminar, with no particular comments attributed to individual speakers.

Introduction
Personal budgets are part of the personalisation agenda that the government is currently
pursuing with the aim of empowering service users so that they can act as the major driver of
service improvement. In the last three years, over 96,000 people across 75 local authorities
are reported as having a personal budget. This is an allocation of funding given to service
users after an assessment, which should be sufficient to meet their assessed needs1.
Personal budgets enable service users to make decisions about the support they feel will
best meet their needs - for example, choosing individual care providers with particular skills
or interests, or those which offer them greater flexibility so they can live more spontaneously

1
http://www.communitycare.co.uk/Articles/2009/04/08/102669/direct-payments-personal-budgets-and-
individual-budgets.htm

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 OPM Public Interest Seminars: Personalisation and the future of health and social care

with less rigid routines. Through personal budgets, some people are also accessing
completely different services to those traditionally commissioned by local authorities,
enabling them to purchase services which reflect who they are as an individual. For others,
personal budgets can give them a greater sense of leverage and control to act if they feel the
services they receive are not delivering what they have promised.

Key facilitators of success

Choice and confidence of individuals
The successes of individual budgets can be attributed to the element of choice that is offered
to service users regarding the type of care they would prefer to have, based on their own
knowledge about their needs. This enhances patient empowerment, a key element of the
personalisation agenda.
Individuals need to be confident of their own needs and priorities, to enable them to make
informed choices and take on responsibility of their own health and social care. Individuals
have the right to choose the sort of care they require to suit their own personal needs. These
choices can be informed by professionals and supported by personal budgets. Although
individuals have a responsibility to maintain self-management practices and use personal
budgets wisely, this has to be balanced with the responsibilities of professionals in order for
the latter to be successful.

Devolution of responsibility and risk

The success of personal budgets also depends on the willingness and confidence of frontline
staff to devolve responsibility and risk to service users. This challenges the very nature of the
dynamic between the service user and front-line professionals, who need to be willing to
devolve risk to service users themselves. The success of personal budgets is predicated on
the notion that individuals are more likely to know how to manage their own risks better than
service providers.
‘The service users of today are better placed to be the support planners of tomorrow’
Service users are ‘wise about their own needs’ and do not necessarily always require health
and social care treatment, procedures or equipment specific to their condition or illness. Non-
health related activities can be more likely to make a positive difference to the quality of their
lives, as the following example demonstrates. A group of women with severe long-term
disabilities, which developed as a result of exposure to radiation contamination, received
compensation of £750 each to spend on equipment or treatment to facilitate their daily lives
(mainly practical devices to support them in their homes such as washing machines).
However, the recipients of this money chose to spend it on activities that make them happy,
such as holidays and gardening.
This shows how devolution of responsibility and risk from frontline staff to service users can
allow the latter to participate in activities that are more in line with their personal interests and
still contribute to improving their health and wellbeing.

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 OPM Public Interest Seminars: Personalisation and the future of health and social care

Barriers to success of personal budgets

Lack of understanding and support amongst frontline workers
There has been an ‘uphill struggle’ within the third sector to ensure frontline workers
understand the concept of giving service users money to manage their own health and social
care, especially to those with disabilities and long-term conditions. Individuals with disabilities
or long-term conditions are at risk of being regarded by professionals as incapable of making
coherent decisions regarding their care.
A lack of support for personal budgets from frontline workers could potentially hinder the
success of the personalisation agenda.
‘People know what they want, but frontline staff need to provide the means for that to
happen’
A change of attitude and behaviour amongst frontline staff is therefore needed to facilitate
patient empowerment and effective support for self-management. This contrasts with a focus
on changing service users’ behaviours, which some frontline workers seem to think is
necessary..

The Perceived Threat to Professionalism

Some health and social care professionals may see the personalisation of services as a
threat to their professional identity. Where personalisation is viewed in this way, it can give
rise to differences of opinion and tensions between service-users and front-line staff. For
example, where care professionals may regard a CRB check as essential for the
appointment of a personal assistant, service users may not take the same view. A survey
commissioned by Community Care found that 93% of social workers thought that CRB
checks for personal assistants should be compulsory. By contrast, only 2.5% of ECDP
service users took up CRB checks on their personal assistants, despite the fact that these
individuals would bear no personal financial cost for CRB checks to be undertaken.
‘While some take the view that personalisation is closer to what social work is all about,
many others seem to feel threatened that the personalisation agenda will take away the
professional prerogative and place it firmly in the hands of service users’
Frontline workers have concerns that self-management of care packages may lead to service
users making the wrong decisions about their health or social care, thereby going against
professionals’ duty of care. According to this view, personal budgets may lead to the “de-
professionalisation” of frontline workers, whose roles as providers and advisers of health and
social care are likely to be questioned if service users have the right to choose their method
of care.

Who is best able to deliver personal budgets?

The changing relationship between the citizen and the state highlights the need for different
sectors to play a role in the delivery of personal budgets. Individuals are more and more
likely to ask friends and family for healthcare advice and do not necessarily follow guidance
given by health and social care professionals, particularly if they do not understand the
significance of it. This suggests that some services and recommendations may not be
suitable for the specific needs of individuals, and it seems more appropriate to let service
users decide what sort of health and social care they would prefer to have access to.

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‘The vast majority of people in need of social care support are not getting it from the
state. They’re getting it from friends and family.’
Statutory frontline healthcare professionals, such as GPs and dentists, are seen as critical
supporters of self-managed prevention techniques because of their role in encouraging
people to maintain a healthy lifestyle in ways that suit their individual needs. In-line with this
view, it is the role of frontline healthcare staff to support patients in successfully managing
their personal budgets. Similarly, social workers are often deemed to be key frontline staff
whom service users have direct access to for personalisation and self-management support.
In contrast, third sector organisations may be better placed to provide information and advice
to individuals managing personal budgets due to their advocacy roles. User-led
organisations, faith groups, community groups and volunteers offer peer support on
emotional, financial and practical aspects of personalisation with an emphasis on self-
assessment. As these organisations are ‘untainted by professionals’, and their frontline staff
often have personal experiences similar to those of their service users, third sector
organisations are seen by some to be more suitable than frontline statutory/professional
workers to support people with their self-management needs.
Experience so far demonstrates the important role which frontline staff in different sectors
can play in either opening up - or closing off - space for service users to think creatively
about ways to use their budgets and maximise positive outcomes for themselves and their
families.

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