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In this easy, I will be discussing personalisation in considering its key elements. Looking at the impact of Fair Access to Care Services (FACS) in meeting service user needs. How it contradict in particular the notion of choice, control and independence for old people. I will also the implications for social work practice, and my own personal practice in an anti-discriminatory point of view.
The adult transforming agenda is focused on the development of personalisation of support. The 2006 Community Services White Paper, Our Health, Our Care, Our Say, announced the piloting of Individual Budgets. Personalisation had its beginnings in Direct Payment which was introduced in 1987, were people who are eligible for social care can choose to receive a cash sum in lieu of services (Henwood &Nigel, 2007).
The development of Transforming Social Care is driven by the demographic pressures and changes to public expectations. According to Chandler (2009, p2) “by 2022 20% of English population will be over 65 and the number of those over 85 will have increased by 60%”. The development of better housing options and extra care housing will be crucial for the future. Majority of older people will expect to live in their own homes for as long as they possibly can. And with more people living longer and requiring support, an increasing number of families will feel the impact of these demographic changes (Chandler,2009) [online]. One of the objectives of Putting People First was to champion the rights and needs of older people in their local authority and public services within a policy, which will involve them as active citizens who may or may not need support. However, these expectations cannot be met through traditional approaches to delivering of social care services.
A fundamental change in Adult Social care is required in order to ensure that the needs of each person can be met in a way that suits their personal individual circumstances. Putting people first (DOH 2009), laid out the vision for change in social careâ€¦ “this vision is of a new social care system that helps people stay healthyâ€¦â€¦ through a focus on prevention, early intervention and enablement, and high quality personally tailored services for those who need ongoing care social care support This new policy is referred to as “personalisation”.
According to Lloyd (2010, p 189), “the term personalisation is very contentious” she further cited Boxall et al (2009) distinguishing between personalisation which focuses on the particular needs of individuals to the preference of one size-fits-all approach of services. The self directed support is about the control that service users can exert over the definition of their needs and the ways in which these should be met. In policy terms, personalisation is both “the way in which services are tailored to the needs and preferences of citizens” and how the state empowers citizens “to shape their own lives and the services they receive” (according to the Department of Health, document Transform Social Care, Local Authority Circular 2008, p4).
Personalisation was introduced in government policy in 2007 when the Putting People First: A shared vision and commitment to transformation of adult care (DOH, 2007) Concordat was published. This outlined the reforms for social care. The key elements in the document where;
Choice, Control, Independence.
However, because personalisation is only a policy it is implemented differently across social care services. Proponents of personalisation argue that the need to personalise services arise because, services were institutionalised and driven by professional, managerial and economic agendas, rather than those of service users (Lloyd, 2010).
Historically and currently, a person in need of social care services is assessed by a social worker and other agencies. Then they decide the type of support the service user will receive, who from, where and when. For a couple of years now the government has been moving towards changing that system to one which the person in need of social care gets to decide the type of support they need and how, and this is now known as personalisation.
The drivers behind personalisation are found in the Our Health, Our Care, and Our Say White Paper (DOH). It suggests that people will be happier, healthier, and have better prospects for the future if they are put in control of their social care support.
According to Harris & White () a “milestone in the pronounced shift by new labour towards personalisation was the Adult Social Care Green Paper, Independence, Wellbeing and Choice. This saw the introduction of individual budgets as the principle route to personalisation (Harris & White).
The Department of Health describes personalisation as an approach in which “every person who receives support, whether provided by statutory services or funded by themselves, will have a choice and control over the shape of that support in all care settings” Brody(2009) [online]. One key issue identified by Griffiths (2009, p3) is that “individual budgets offers a â€¦ a chance to empower ‘service users’ in their dealings with public services and it puts the service user at the heart of public service reform. This is one of the key values of Putting People First (2007), to ensure people in need of social care have the best possible quality of life and the equality of independence living. Griffiths (20009, p2) further argues that individual’s budget will give “service users a greater choiceâ€¦. by giving money to the service user to purchase services from a plurality of providers”.
However, Forster (2002.p, 85) identified that there is “little or no choice for elderly people. They can only have choice if the cost of their care is within the amount allocated by local Authority (LA) or if social workers agreed that it is suitable”. This was also highlighted by Hudson& Henwood (2008), in the CSCI document Prevention, Personalisation, and Prioritisation in social Care, that the “coexistence â€¦ of self directed support alongside the Fair Access to Care (FACS) criteria have create some tensions” while personalisation is concerned about promoting and maximising the choice and control of service users.” it fails to determine how the eligibility of those groups is defined (Dodd, 2009) [online]
The FACS policy guidance was publish in 2002 as a Local Authority Circular LAC (2002) 13. That Provides local authority with an eligibility framework for setting and applying their local criteria with the aim of ensuring fairer and more consistent eligibility decisions across the country (DOH).
As Crawford & Walker (2004), points out this system is failing to distribute resources to people who will benefit from early intervention. For example there are a growing number of old people with lower level needs who are likely to develop higher needs in the absence of responsive support. According to Dodd (2010), “using one of the four levels within the Fair Access to Care services (FACS) banding as a threshold for rationing resources is too rigid an instrument for fairly and responsively allocate social care budget”. He goes on to argue that currently, “people with proven care needs are not receiving the services they need”. Therefore as long as the FACS criteria remains in place as a rationing mechanism, it will be impossible to realise the universal model of self directed support envisaged within the personalisation agenda(Dodd,2010)[online]
The CSCI report argues that as the government is concerned to hold down public spending “eligibility criteria are a key mechanism, serving to regulate service provision in line with available resources and identified priorities”. In the current financial climate were resources are tight, these criteria can be adjusted by the local authority in order to narrow access to care support. Lloyd (2010), policy makers are more focused on the economic challenges than the needs of older people.
The implications for social workers according to Adams (2009, p145) is the amount of time they will have to spend with service users and carers who have individual budgets “to help them gain the necessary knowledge and skills they may need to manage their budgets”. Also, another limitation to personalization and individual budget has been identified by Griffiths (2009) that the current economic climate may pose a threat for individual budgets and may not survive the planned government spending cuts for the next few years.
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