The Personalisation Problem
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.
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.