Personalisation in cases of abuse and vulnerability
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Personalisation is a new government strategy which has been set up to support service users who need support or care from adult social care. This policy is a new approach in supporting disabled people to enable them to lead more independent lives and exercise choice and control over the services they receive (Social Care Institute for Excellence, 2010). The overall aim is for service users to have control over how money is allocated to their care is spent, this includes direct payments, individual budgets, personal budgets, user led services, self directed support. As well as, support brokerage which would involve professionals from the wider fields of healthcare, including occupational therapists, and non professionals to provide advice and support for them (Mandelstam, 2010).
A personal health budget will enable a service user to decide how to use the money that the National Health Service has allocated to them for their care needs. It could just be a discussion with a doctor or other health care professionals, such as a care manager about the different ways the money could be spent on a care plan, or alternatively patients will be able to receive a cash payment to allow them to buy the care which has been agreed in the plan themselves (Stobbs, 2010).
The Department of Health (2007a) also state that this is a move away from the traditional welfare system to a more consumer type model of service provision which in turn will improve the quality of people's lives. Although elements of this new policy are not legally defined, service users will be fully involved in accessing their own needs by having a personal budget by means of a direct payment, which in turn gives them control of the money.
Lymbery (2010) argues that there appears to be little recognition of the complexities and contradictions which characterize some areas of the policy, as well as having in inadequate resources bases for adult social care.
However, Dunning (2009) suggests that as the personalisation agenda advances the role of advocacy and support brokerage will be of increasing importance. However as Mandlestam (2010) argues that brokers need not be local authority employees or even professionals, which can place individuals at risk. If personalisation is to achieve its core aims, it will be essential that those accessing individual budgets can refer to sources of advice and support. Councils will also have to strike the right balance between giving people the freedom to choose their own care and protecting clients and their budgets from abuse. In addition, Mandelstam (2010) also believes that professionals will benefit from moving away from financial 'gate-keeping' to that of brokerage and advocacy.
Duffy & Gillespie (2009) discuss in their report that there appears to be some conflict between personalisation and safeguarding. The conflict has arisen through people thinking that that the ideas linked to the term 'personalisation' and those linked to the term 'safeguarding' is that this conflict is more likely to be a deep misunderstanding about both ideas rather than conflict. They have identified these misunderstandings around personalisation and safeguarding as; the goal for personalisation is freedom from control, not safety; the practice of personalisation is less concerned with the reduction of risk; and the rules and systems required for personalisation will increase risk. Although Pitt (2010) states that safeguarding and personalisation are seen as two sides of the same coin.
Also, they discuss the procedure with regard to the complex cases of vulnerability and abuse where careful risk management and person centred practice is required. Self-Directed Support is enshrined within the personalisation policy and states that before any individual receives any support services, six vital checks for risk are to be completed which are; First Contact, Assessment, Capacity Test, Support Planning, Plan Review and Sign-Off Outcome Review. As well as this, Self-directed support is very flexible and holds a number of tools which make it easier to solve complex cases. Resources are targeted at outcomes as this identifies the right level of funding applicable to the particular situation and needs of the individual. High quality planning; which commands that the social worker/occupational therapist identifies the best approach for the individual. Risk assessment; especially where abuse is suspected or criminal measures might become necessary, police may play an integral part to the final decision on the balance of risk. Appropriate control,; self directed support puts control of the funding into the hands of the appropriate person, such as a carer or a professional. Appropriate support; local authorities have to ensure that individuals can receive the help to manage their support that being traditional services, new or systems of peer support. Flexible resources; should be used creatively to support individuals and finally Outcome review; is essential which plays an integral part of the risk management process for the local authority.
However, as Mandelstam (2010) points out personalisation may not always work for vulnerable adults who are unable to express choices, unless they are adequately supported. Shortages of resources in some local authorities could threaten the availability of the vital support which is needed for individuals, and therefore for this system to work it is not to be seen as a cost cutting measure.
Duffy & Gillespie (2010) report that there is a misconceived idea that personalisation is simply about 'freedom' and treating safeguarding as it is simply about 'control' is wrong and to enable a person to have a good life balance you have to balance between freedom and control. Safety is one of the key goals in personalisation as control can be personalised because designing support arrangements need to be tailored to fit the person and need be justified with regard for their capacity, effectiveness and proportionality.
They also state that control does not guarantee safety, for example the current community care system is poor in providing individuals to exercise freedom and control. Individuals who need support often find they have little or no choice over the support they can receive as most social care services struggle to provide personalised support due to bureaucracy that surrounds them. This in turn can create dependency or frustration which can easily place individuals at greater risk.
The idea that personalisation may increase the risk of abuse in some way has been suggested by many professionals (Lymbery,2010. Duffy & Gillespie (2009) argue that personalisation is committed to improving safety as integral part of promoting well-being and enhancing citizenship along with offering techniques and approaches such as self-directed support which provides the framework for minimising the risk of harm and protecting vulnerable people from abuse. Personalisation is about designing support arrangements so they are more personal to the service user.
McGauran (2010) points out in her report that occupational therapists are placed well within the personalisation agenda as they are the only allied health professional who are widely employed throughout social and health care sectors. Personalisation is congruent to the philosophy of occupational therapy as the heart of its practice is to be client centred, and therefore occupational therapists need to seize these opportunities to pilot new ways of delivering this service which would be of benefit to the clients and enhance professional practice.
An example of this can be seen when an individual is given choice and control of a personal budget to purchase personal or nursing care for an older adult, then it would give the individual personal control over how, when and by whom the care or equipment should be provided. This philosophy is embraced with the College of Occupational Therapists Code of Ethics that 'occupational therapists shall at all times recognise, respect and uphold the autonomy of clients, and advocate client choice.' (College of Occupational Therapists 2005, p.2.1).
Social Care Institute for Excellence (2010) agree that occupational therapists are skilled in finding and tailoring individual solutions for people in different care settings and aim to improve the quality of life, as well as a facilitator of learning needs and can work collaboratively with people who use services, their carers, families, friends and other social care and health professionals to co-design and co-produce care and support.
Social Care Institute for Excellence (2010) believes also that by introducing this new agenda it will allow service users to become empowered and enable them to design the support packages for themselves or choose how they want to live. This in turn will enable service users to feel that are being supported in staying well and ensure that they have access to public services. This approach undoubtedly has the potential to improve the quality of people's lives and give occupational therapists the opportunity to use their skills and expertise.
Over 70 health projects have been chosen by the Department of Health across England to pilot personal health budgets and a formal evaluation has been carried out by the Department of Health (Department of Health, 2009). Evidence suggests that although it was popular with younger disabled people, many of the older age service users found they were put off by the complexities of the scheme, especially around issues of becoming an employer if they needed to appoint paying carers (McGauran, 2010).
As Mandelstem (2010) points out there is some confusion in the legislation in the personalisation agenda as there is no new legislation or detailed statutory guidance to support this. The Department of Health have set up a 'toolkit' that fits personalisation into legislation but it is inadequate and contains errors. Therefore suggesting that there could be risks involved in the transformation of social care.
What is apparent from evidence on pilot studies is very early to say what the full impact of personal budgets will be on occupational therapy staff and other professionals, and that it is most likely that developments of personal health budgets need to significantly change cultural values throughout the National Health Service (Stobbs, 2010).
Personalisation in social care does have potential benefits in giving service users choice and control over their care services. Although there is no doubt that it does have some potential pitfalls. What can be recognised from this new approach is that safeguarding is essential to all service users especially complex cases where careful risk management and person centred practice are essential.
However, personalisation is in its infancy stage and a lot more debate is needed around this new policy for service users to feel confident in new transformation of our healthcare system. Equally, this can be seen as an excellent opportunity for occupational therapists to demonstrate that they are well equipped to take the lead in this personalised agenda as it sits well in the role of their profession.
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