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Personalisation is considered as a process that involves the usage of technology to accommodate the differences between the individuals. It is becoming an increasingly popular area within health and education sectors (Department of Health, 2008). When discussed in terms of Health care, Personalisation involves thinking in relation to care and support services in a completely different way, building care provisions around the person in a way as an individual with preferences, strengths and aspirations and combining them towards the center of the process of recognizing their needs and making choices about their living (Department of Health, 2008). It demands a significant transformation of social care so that all the processes, systems, staff and services are combined to put the people first. In addition, personalisation is indicated as offering people with much more choice and control over their lives within all social care settings. However, it is much of a wider concept than simply providing personal budgets to the people who are eligible for council funding. It also involves ensuring access to the universally determined services (transport, leisure, education, housing, health) and employment opportunities regardless of their age and disability characteristics (Department of Health, 2008). In a very short span of time, the personalisation concept has occupied its central place within the field of social work and adult care discourses in United Kingdom (Department of Health, 2008).
A study involving a consultation process was carried out by Department of Health (2006), it was observed that people showed much interest in accessing personalised approach and they demanded for its need and they expected it to be made available to them easily and quickly. In order to make better provisions relative to personalisation, various people who participated in this consultation process questioned their need about the availability of social care providers and their services (Department of Health, 2006). But in order to make it possible, the health care sector needs a clear vision with a direction to make personalisation a strategic shift towards the initial prevention and interventions of dreadful diseases (Department of Health, 2008). However, this seems to be a challenging agenda that cannot be possible by social work alone and it requires effective working away from the boundaries pertaining to social care like housing, benefits, leisure, health and transport. On the other hand, demographic variations show a significant impact upon the number of people who care and support the family members and this in turn influence the available care provisions (Department of Health, 2010). Although personalisation is the corner stone of public service modernisation, in terms of social care it can be meant that everyone who is receiving care (regardless of their need level, statutory services) should possess an equal choice and control over the way through which the support is delivered. Social care providers (involved in carrying out social work) will be potentially able to direct the use of resources, building on the technological support, family and the wider community in order to enable them in enjoying their role as citizens in their communities (Department of Health, 2008).
The document released by the Department of Health in 2010 on “Putting People First” offers a clear insight regarding personalisation along with the potential ways of its development when investments were made within the following aspects of support (in relation to the individual carers):
Universal Services: support that can be made available to everyone in the community in addition to transport, leisure, education, information and advice (Department of Health 2010).
Early interventions and preventions: helping people to live independently as long as possible and designing future cost efficiency systems.
Choice and control: helping people in understanding about the way of spending in relation to care and support and thus allowing them to choose in accordance to their needs.
Social capital: creating supportive communities that enable in determining the value of each and every contribution made by the citizens (Department of Health 2010).
Personalisation by Effective Participation
Personalisation through effective participation helps us in creating a better connection between the individuals and the group in a way by allowing users a direct, informed and creative rewriting in the script through which the service used can be designed, planned and evaluated (Houston 2010). This approach involves the following steps:
Expanded Choice: enables users in providing a greater choice over the various ways of mix through which the needs might be met and to combine the possible solutions around the user instead of limiting the provisions in relation to any institution in question like hospital, social service department to which the user seems to be much closer (Leadbeater, 2004; Lymbery 2010).
Intimate consultation: Here professionals work in an intimate relationship with the clients to help in opening up their needs, aspirations and preferences through an extended dialogue system (Houston 2010).
Enhanced voice: This is very difficult to follow through a white paper agenda and it involves the use of expanded choice in opening up the user’s voice. Making comparisons through the various possible alternatives can help in articulating the preferences.
Provision of Partnership: Generally, it can be possible to combine the solutions which are personalised to the individual if the services work in partnership. In instance, any organization – a secondary school can form a gateway for the learning services provided not only by the school but also to various other companies, colleges and distance learning programs (Houston 2010).
Advocacy: In this section, the professionals act as advocates to the users and help them to move their way through the system. This process can enable the clients in attaining a continual relationship with the professionals (Houston 2010).
Co-Production: Professionals who were found to be involved in shaping the service were expected to be more active and responsible in offering their help in relation to the service delivery. However, Personalisation aids in involving service users, creating more efficient, and responsible package of care services.
Funding: Within this, authorities need to follow the options or the choices made by the users and in certain cases-offering direct payments to the physically disabled people to assemble and obtain their own care packages. Funds should be left with the users for purchasing any good or commodity and this should be done with the advice of the professionals (Houston 2010).
Role of Personalisation
When considering the role of personalisation as an organizing principle with relation to the public service reforms, certain comparative studies need to be definitely performed with a broader emphasis on contracted services. Nevertheless, other public services do exist where in which personalisation fail in making a sensible approach (Duffy 2005). This can be exemplified by:
Someone who is entering in to an accident or emergency service department do not need a dialogue but instead he needs a quick and competent action (Leadbeater, 2004; Lymbery 2010).
Although in a public sector, defense is another area where in which personalisation principles cannot be applied and the people play a pivotal role in fighting against terrorism.
Thus it can be understood that, personalisation can be used only in certain public services which can be of face-face (like education, social services and non-emergency health care departments), those depending to establish a long term relationships (disease management) and the services involving a direct engagement between users and professionals through which the users can play a significant role in shaping the service (Leadbeater, 2004; Lymbery 2010).
Personalization- A Reality in 21st century
Making personalisation, a reality for the 21st century definitely requires huge cultural and transactional transformations within all the parts of the system (not only in social care but also in public sector, whole local government). Over the past ten years, direct payment option helped some people by providing an ability to design the services they need, but the potential impact was found to be very less. But in the recent years, figures indicated that about 54,000 people out of a million received help through direct payment (Department of Health 2010). Since personalisation describes the change within the whole system it needs the presence of strong leadership to communicate and convey its potential vision and values. To achieve a significant shift towards its cultural side and to construct a delivery model (Department of Health 2008), it demands all the stake holders to work in partnership with others.
Nevertheless, in future social care system allows individuals in undertaking their own choices with an appropriate support at the level they needed. It should be understood that personalisation need to be delivered in a cost effective manner. In addition, it must be recognized that personalisation with its early intervention and efficiency are not contrary and need to be strongly aligned in future to obtain better results (Department of Health 2010).
Personalisation in relation to the Mental Health Residential Care Homes
Personalisation in relation to the mental health can be defined as understanding and meeting the needs of the individuals in various ways that can seem to work best for them (Carr, 2009). Principles of personalisation can be applied in early interventions, prevention and other self directed approaches where in which the users are involved in maintaining and managing their own social support services (Lymbery 2004). However, it accommodates mental health promotion and its maintenance with a wider choice and control and thereby contributing to the improvement in well-being and quality of life.
The above mentioned principles pertaining to personalisation can be applied in Mental Health Residencies to direct payments and other internal budgets (Mc Donald, Postle, Dawson, 2008).
Direct payments: are in general, cash payments that are paid to the individual during which they can design and control the tailored support in order to meet the social care needs. Funding for this direct payments arrive from the respective local authorities (Fernandez et al., 2007). Though these were available from 1996, they are now-a-days considered to be as the only option for the people who are provided with the personal budget. Statistics indicate that direct payments users were found to be increased at a steady rate ranging from 50 in 2001 to 3373 in 2008 (Care Service improvement partnership, 2008). From the year of 2007 and 2008, the percentage of people using this option in order to meet their mental needs increased by 62% which was found to be one of the largest among all the care groups (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008). But, when compared with the other impairment groups, the percentage of direct payment users in mental health is relatively low as a result of poor level of mental capacity, lack of awareness and non proactive attitude of managers towards the implementation of direct payment. This has been evidently noticed in my placement setting. Research studies indicate that, when offered with sufficient support people with the mental health condition will start to use direct payment option effectively and imaginatively (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008). In a National Pilot Study of direct payments in mental health (2001 to 2003), around more than half of the people used a personal assistant in obtaining social, personal and mental support and they assisted the impaired ones in carrying out their daily activities and helping them in accessing community and leisure facilities (Spander, Vick 2004; 2006). Many barriers do exist for these direct payments in all the impairment groups and out of which many of them also apply within the mental field. They include lack of awareness, risk aversion and protectionism (Pearson, 2004; Fernandez et al, 2007; Hasler, Stewart 2004; Spandler, Vick 2005), potential difficulties in undertaking decisions pertaining to social care needs and other eligibility issues for the people whose condition changes within less time (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008).
Personal Budgets: The cornerstone of the Government’s approach in creating transformations within social care especially mental health residential home care and relative support through personalisation is the allocation of Personal Budget (PB). My placement setting is a mental health residential home accommodating people with enduring mental health problems. I think individuals should be supported and assessed in conjunction with other agencies in order to meet users own needs, and by doing so a care provider can ultimately determine whether they are eligible for providing any social care funding. If individuals were found to be eligible, care providers can explain the amount of money they expected to receive in order to meet the needs (Department of Health 2006; Duffy, 2007).
Individual Budgets: On the other hand, individual budgets are quite similar to the Personal Budgets and these incorporate various other funding schemes along with social care funding (Glendinning et al., 2008). The funding schemes include: access to work, supporting people, living independently, disabled facilities and grants as well as integrated community equipment services. A National Pilot Study on Individual Budgets took place in the year of 2007- 2008, it was observed that around 14% of the people were found to be with mental health condition (Glendinning et al., 2008). The pilot study concluded that people who receive individual budgets experienced much higher levels of independence and were more likely to commission their valuable support from the main stream community services instead of specialist ones (Bamber, Flanagan 2008). This application offered a better mental health support need along with the flexibility in comparison to other conventional services or direct payments (Glendining et al., 2008; Manthrope et al., 2008). Many barriers were observed with Personal and Individual budgets in relation to the mental health field. The difference between the funding in relation to health and social care can also form a major barrier to the developing individual budgets in mental health (Glendinning et al., 2008). In addition, the following points need to be implemented within Residential care Homes in offering a personalised approach:
Person and relationship centered care and support at the heart of the service offered.
As the care home setting is considered to be as a community, the residents or the staff actively searches the various available opportunities to develop an effective relationship (Carey 2003; Bradley 2005).
The managers working in care homes need to be sure that the existing services respond to the needs and should look for the opportunities to diversify the offered services.
Staff should ensure that people has a live and breathe culture which is actively involved in promoting personalised services in a way by offering maximum choice and control for the people who are living in care homes (Cestari et al., 2006).
Residents need to possess the accessibility to all the information and advices as they need to make certain informed decisions including those pertaining to advocacy matters (Cestari et al., 2006).Team work and effective communication is needed with the people in care homes.
Staff development programs and the quality assurance systems must be introduced as they are considered to be crucial in offering a positive outcome.
Care home managers should be nicely placed in order to understand the potential needs of the local communities. Effective leadership work should be carried out in a collaborative manner with the people who are using these services along with their families and carers involved in design and delivery of services (Spandler 2004).
Assessing self directed approaches along with allocation of budgets (Cestari et al., 2006).
If a disabled person lacks capacity in choosing a direct payment or any other option, the local authorities must help them in undertaking a best interested solution and decisions (Ridley, Jones 2002).
The applications of principles of personalisation with the mental care residential homes share a lot of core values (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008) The Mental Capacity Act (MCA) laid down in 2005 supports the practices and principles of personalisation by empowering many people in undertaking their own decisions. It also helps the mentally disabled people in taking their own decisions as much as possible (Spandler, Vick 2004). But in principle, this may not seem to be possible as the people lack mental ability and the individuals need play a very big role in decision making processes that can only directly detect them. The first research study underpinning this approach was carried out by Norah Fry Research Centre at the Bristol University in 2008-2009 (Philips, Waterson 2002). The study suggested that people experiencing mental health problems and distress need to possess a better choice and control over their care (Carey 2003; Bradley 2005).
The Personalisation Agenda in United Kingdom has more to offer in the field of mental health as it challenges the way through which health condition is perceived (Payne 2000). To implement the principles, the country need to support a social model in understanding the mental health condition and must recognize the important social factors that play a key role in contributing to that condition (Beresford, Wallcraft, 1997; Brewis, 2007).
Thus effective and proactive leadership from the managers in senior position along with the direct payment support agencies could help in creating awareness within the general public and thereby aid in developing expertise (Newbigging, Lowe 2005). Therefore, in the context of mental health, it can be understood that a move towards the direction of personalisation indicates a move towards a feeling of independent living philosophy (Vick, Spandler 2006). Various projects need to be developed to support that move and various practical tools must be designed to effectively meet the challenges associated to the mental health field. In particular we need to aim in developing strategies that encourage champions amongst various other service users, forums for discussions and networking in a way that progress can be made in overcoming the challenges to personalisation in mental health field. In addition issues of negligence pertaining to poverty and inequality, its weak conception regarding individuals utilizing social care work services, its view on welfare dependency and its potential for promotion as an alternative of challenging the depersonalisation in relation to social work, need to be tackled effectively in order to meet its future aims and objectives.
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