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The Personalisation Problem

January 31, 2014

Prof Simon Duffy has written an excellent but depressing piece in The Guardian, with the strap line that “Personalisation has failed”. http://www.theguardian.com/public-leaders-network/2014/jan/30/personalisation-social-care-support-bureaucracy-service-failure. And this is from the man who was the pioneer of Personalisation.

I wouldn’t say that it has failed but it is clearly failing. Here are a few thoughts into why that might be happening:

Regular readers will know that I have just had what could be called a success for “personalisation”. Horrified that the local authority were proposing to cut Steven’s support package because they saw the costs of continuing the directly commissioned services (that they commissioned) were unsustainable, I put together a proposal that cut out all the middle men making a profit out of Steven’s package and requested come directly to me, reducing the overall cost by a third. That was agreed but then a whole new set of middle men suddenly appeared. I was told the council contract a payroll company to run the staff’s wages and I would have to use them. More money coming from the package into someone else’s pocket. And this I feel, is one of the biggest problem with personalisation – there is such a huge industry involved now in running the scheme, that there is less money to go round than ever before. And that’s before we even consider councils making efficiency savings. Take the RAS (Go on, someone please take the RAS). Most councils purchased this expensive system that was meant to calculate a personal budget based on the person’s needs and produce a figure that reflected the cash equivalent of their needs. I haven’t met one person who has gained from going through the RAS. I heard that after Steven’s recent FACS assessment (and before my proposal was accepted) that his FACS was fed into the RAS and produced a figure that was “laughable and nowhere near enough to meet his needs”. Some LAs will enhance the RAS budget by taking the case to Panel for a higher amount, which rather defeats the object of having the RAS. Others dont and just pay out whatever the RAS comes up with and then the person needing the care is left with a sum of money but is unable to use it because there are no services available at that low cost. All in all, I guess the inventors of the RAS are laughing all the way to the bank, whilst those on the receiving end of the RAs are not laughing all the way to the foodbank.

The massive personalisation industry has also seen incredible job growth within the authorities charged with running the scheme. I remember looking at the management structure of my LA when we were in court (the judge described it as “impenetrable) and was astonished by how many posts existed to achieve personalisation. And all those people will be coming up with systems that are just as impenetrable as the job chart. For a user, you have to learn a whole new language to even get out of the starting blocks. There are lots of things you are actively not advised about. And you are expected, if successful, to take on roles that are completely new to you. Accept personalisation and all of a sudden, you become an employer and have to start worrying about payrolls, tax returns, employment law etc. All this, just so your son can have support to get to the gym twice a week.

My goodness, you need an awful lot of inner strength and need to be very psychologically robust to get through the Personalisation process. There seems to be an awful lot of mistrust within the system – you are seldom believed and your experience of the person you are caring for is seldom valued. It is disheartening to be trying to get the best service for the person you care for whilst having to withstand these attitudes.

Then if you eventually get a package, you have to live with the daily possibility that it could all be taken away from you. Personalisation is very fragile. A change in policy, a new push on cutting costs, even the appointment of new staff can suddenly remove all the things that you need to live a life. It needs a good degree of emotional robustness to keep going with the knowledge that everything you value could end tomorrow.

I don’t know the answer. It can be done and if it’s done, the people needing the care can have a life that they might want to live. Perhaps it needs all these horrendous systems that have grown out of Professor Duffy’s fundamentally simple idea to be torn down and start again. Trouble is, the system that evolves these systems isn’t usually very good at self relection and even if it was, I’d worry that one gigantic system would quickly be replaced by another. The people running the systems, and those outside who make huge profits out of the system, have too much of a vested interest to be entirely open to changing it.

So, in the meantime, people will continue to live off the crumbs of a RAS, unless they have someone who has massive resources of emotional energy to challenge these systems and really fight for the outcomes that Professor Duffy intended all those years ago.

Update;

There we go. Five minutes after posting this blog, I received an email from the Support Planner, in response to my request to manage the payroll myself and cut out another middle man. It says that using the payroll company is the council’s “prefered way of managing the direct payment scheme”. It’s reasons – (a) It is not seen as a “service” like the transport allowance, and (b) it allows for the council’s auditing process of the personal budget.

Steven won’t lose out with this (I hope). It will involve a major change to the current way the support staff are paid an I hope they can manage without pay for a few weeks to accomodate the payroll company’s system as opposed to mine.

But it’s a sad irony that everything I just wrote about above is encapsulated in this decision – the inclusion of the middle men; the need of the council to keep control; the inherent distrust of the council in the carers.

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9 Comments
  1. ‘Reach Principles’ the elephant in the room.Perhaps an independent review including why councils are ditching or ignoring the 11 principles and how much this has costed both in monetary terms and misery and poverty since 2002 .Councils are now using the 11 principles to develop services even today using the big 11 instead of properly developed community care assessments .Who benefits from the big 11 ?

  2. A contradiction, I meant including the 11 principles but then doing everything in their power to avoid supporting or paying for them .

  3. Liz. permalink

    When I went through this, it took ten months and was completely bewildering. As you say, a whole new language, very opaque. I got very stuck on On Costs, followed by TUPE (rather late in the day). and the laws employment agencies use against you No idea whether my council bought an expensive RAS package or not. You didn’t mention the form the RAS is based on, nor the delicate (and largely illegal) question of how much care you will provide. RAS based on “unmet need” – and which parent allows any need to go unmet?

    I had to find my own payroll company, and on the whole find that bit works well. Enough to have to figure out employment law, health and safety, holiday pay, sickness pay (not permitted) I am happy to let someone else figure out tax and insurance for me. I can see that telling carers they have to wait to be paid is a problem, but the company I use is efficient, reliable and not too expensive. Once you get going, it is relatively simple, but time consuming and anxiety provoking. (The CoP only asks you to account once a year, the Council is rather more exacting in the “evidence” they insist on.)

    My own situation is complex and atypical, but I have been “running” it for three years now, and it does get easier when the negotiations are over and you can get on with it. The level of control is worth the hassle. I think.

  4. Great article Mark, so sad but so true. My in-laws had Direct Payments but gave up with these because they didn’t have the time, energy & skills to administer. I would not object to the people in the middle if they truly eased the administrative burden and ensured there was a plan B (and maybe even C) when things went pearshaped. The success of many care packages hangs by a thread, and most of the time it’s the carers making sure that thread doesn’t break.

  5. Mark,
    As per usual you write so well and passionately about this subject.
    One thing in particular stood out, and has done for days or even weeks, from your blog is the utter waste that goes with the privatisation of “services”.
    You make a fine point that the councils have created an impenetrable labyrinth of management, and then when you propose a cheaper option, and one that puts more money in the pocket of Steven, it is fought against,
    Your strength is an inspiration to me, and I have no dealings with local authorities in the way you do.
    Keep it up Mark, who knows, sanity may prevail in the end!

    Nigel

  6. Sally permalink

    Mark, I agree.
    I read the Guardian article and was taken aback by comments of people who worked within the system and believed passionately that personalisation was the solution to everything, that all carers loved it etc etc. They often then hanged themselves by describing just a few of the insanely complex systems carers need to put in place.
    Not one of these people had seemed to think-really think-what on earth it would be like to have an eye watering amount of administrative work and admin dumped on your unpaid shoulders and to know that you must keep doing work which used to use entire departments of paid staff.Being expected to know all the different systems-often with inane and confusing titles and initals, to know how they fit together and so on.For the rest of your life. Good luck finding someone to hand it on to.
    The elderly couple described who were told to go find a payroll company ,put an ad up at the newsagents and start interviewing/hiring/firing/scheduling staff, to me describe the reality. Oh. So I get to do what used to be your department’s job but with less power, less money, no pay no sickleave? Thanks. I have never felt more free!

    I just feel personalisation has become a gigantic con job, in which we all end up with all the work and responsibility. And lets just think for a minute about carers who for whatever reason are not up to the task.Who may be in poor health, troubled by other things, frail, not up to negotiating a payroll and so on. What will happen to their offspring?There’s no provision for people who are not up to all this. Its rather like the parents who congratulate themselves on hiring good enough legal representation to fight through their child’s educational provision. And well done. But please speare a thought for the less well off , less assertive parents who can’t do this.
    I also think a general rule is that the more complex the job titles the more responsibility is being dodged. As you say Mark, the judge should have been able to ask “Who does what?” and had a clear answer.You can do that in a brain surgery department.
    I feel punch drunk with the various battles we have already have had. Could someone reasonably well vetted just take my son to the pool? I don’t want to run a HR department.

  7. Liz. permalink

    In theory, though, personal budgets/direct payments IS the best option, I think. The trouble is, that isn’t really what we are getting.

    Mark, you are being told to use a payroll company and have no choice – I was relieved to find I could use one. I had a problem with being told how much I could pay. I find finding replacement carers a bit terrifying. The budget you get has little to do with what you need. People with the same needs get different allocations depending on how forcefully they or their carers can argue. If the system was more transparent and honest, and about people not systems, it needn’t be a nightmare. We need help with the difficult bits and a bit less heavy handed restrictions on the easier bits

  8. You write so well, Mark. As someone who’s recently gone back to social care after a couple of years off, and who’s also got the ‘job’ (lol!) of managing a neighbour’s personal budget, your blog is very relevant. In our area we’re allowed to deal with tax & NI ourselves or choose a payroll provider, and I choose to use a very inexpensive provider. However, the service I find missing, for those service users who can’t do it themselves, is managing the budget – ie running the bank account, doing the timesheets, paying the invoices etc. I’m happy to do it for my neighbour, but not everyone has a ‘Jane Young’!! I understand that those whose budgets are managed by the LA get very little choice and in many cases might as well use traditional services (but of course that wouldn’t help the personalisation statistics!!) So someone needs to work out how budgets can be managed in a way that delivers proper choice and control to service users without them having to do the admin themselves…

    Your comments on the RAS are spot on. I went thru a RAS assessment and the budget came out far too low. So I just gave the social worker details of what my PA time and other services would cost and she got it improved by her manager – which left me wondering what is the point of the RAS?? Hey ho…

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