An Evaluation of the Personalisation Agenda and the effect on Adults with Learning Disabilities - Literature review Example

? An Evaluation of the Personalisation Agenda and the Effect on Adults with Learning Disabilities: Personalisation, Empowerment or and end to Social Work Practice? Literature Review Personalisation is a concept that is transforming how social work is done in the UK. It is a new way of looking at people who need special services and social care. Personalisation is about putting the needs of the person ahead of the service needs. The purpose of personalisation is to take into consideration the skills that an individual brings into the need for service as well as putting the individual in the centre of identifying their needs for service. This is a different way of looking at social work practice in the UK because in the past, the person was left out of their individual needs. This was seen as an ineffective way of working with them because it often meant that the individual did not receive the right help for what they needed or it meant that they were totally left out of explaining the needs that they had for service. The new process of personalisation resolves several issues. Some of the issues it resolves include: 1. Tailoring support to people's individual needs 2. Making sure that people have access to information, advocacy, and advice so that they can make informed decisions about the care that they need. 3. Finding new ways to collaborate with individuals to make sure that they engage in the "design, delivery, and evaluation of services" (Carr 2010: 3) 4. Creates partnerships with a variety of services so that the individual has a choice in what they need so that they have opportunities for social inclusion and community development. 5. Ensures that people have a full range of service and they are able to have universal community services and resources (Carr 2010). These services are important to each individual and it is equally important that the individual has a say in what happens to them. This literature review will further provide information about personalisation and how it works or does not work for the adult with learning disabilities. 1. Medical and Social Model of Disability In order to understand personalisation, it is important to understand that there are two different models of disability that we are currently recognizing. The medical model of disability concentrates on the idea that if an individual's body is 'fixed' that they will be able to better fit into society. The medical model does not benefit the individual because there are many conditions that an individual is born with that cannot be 'fixed' in this way. The social model of disability is a more accurate depiction of the person with disability because it is concerned with the barriers that are in place to prevent a person with disabilities to access society. These barriers can be due to the environment, which keeps people from being able to access buildings and services because of physical barriers. The barrier can be due to people's attitudes when they stereotype certain abilities with people or discriminate against them. The barrier can also be due to organizations with inflexible policies, practices or procedures that exclude people with disabilities (Office for Disability Issues 2010). The Personalisation Agenda leans more towards the social model of disability because it emphasizes the challenges and/or barriers for people with disabilities. It was created in order to eliminate some of the barriers that individuals currently are exposed to when attempting to access services. 2. The Problem for Adults with Learning Disabilities According to the Learning Disability Coalition (2010) it is important for people with learning disabilities to have the same choices for care as other people have who do not have disabilities. This is one of the provisions that this new legislation has created. The challenge is that although this legislation has gone through and is attempting to be enforced, there are still challenges for some agencies in getting the resources needed for people with learning disabilities. The challenge for many agencies is that they have not had the resources and therefore have had to cut funding in certain areas which directly affects the services they provide to those with learning disabilities (Learning Disability Coalition 2011). In reality, many agencies have had to cut funding. The survey by the Learning Disability Coalition showed that: 1. 84% of the authorities surveyed stated that funding for adults with learning disabilities was difficult. 2. 20% of authorities were forced to cut services. 3. 64% stated that funding services was difficult but they were attempting to keep services going through efficiency savings. 4. Only 7% of authorities felt that learning disabilities was being funded well (Learning Disability Coalition 2011). Some of the authorities stated that costs were higher because of the change in demographics for adults with learning disabilities. As these authorities cut services, this decision impacts the individuals and their carers because they depend on their local authorities for access to services. Other changes such as the closing of the Independent Living Fund, changes to the Disability Living Allowance and reduction of funding for local authorities has created a difficult situation for carers who are afraid of what might happen in the future if funding is not provided (Learning Disability Coalition 2011). In other words, with out this local funding and other resources, these families are not able to afford care for their family members. One of the ways that local authorities are having to cut their services is to only provide service for those people who have severe problems, which limits funding to those adults with profound or multiple learning disabilities. This means that many people are left out, even though the new Agenda is supposed to be funding everyone. Lawton gives information regarding adults who have learning disabilities and who may not be able to make their own decisions. The Mental Capacity Act of 2005 (MCA) was instituted in order to create a framework for working with those individuals who may not be able to understand how to make decisions for themselves. Under this act, people cannot be seen as unable to make decisions for themselves only because of their age, a medical diagnosis, their appearance or because they act in a certain way. Because of this, the Act says that anyone working with an individual who has difficulty making decisions should do everything possible to help them. When someone is making decisions for this individual, they must be sure to create the "least restrictive option" and make sure that they respect the individual's "rights and freedoms" (11). The individual working with them must also be able to show that the individual with disability was active in the decision for their needs. The act also created a independent mental capacity advocate (IMCA) who can work with the individual. A caveat was made to the MCA called The Deprivation of Liberty Safeguards (DOLS) which was added in 2009 and it increased the role of the IMCA by allowing them to assess whether their best interest would include depriving them of their liberty and whether the safeguards are there to protect the individual. These acts and safeguards were brought in to make sure that the individual with disabilities was able to gain the information they needed in order to create the life they wanted (Lawson 12). Lawson also sets out the effects of person centred approach to helping people with disabilities which is what the personalisation act is supposed to do. In these approaches, the individual is looked at as the most important aspect of the relationship and the people working with the individual should take into consideration those things that the individual likes, in what environments they feel most comfortable and their chosen method of communication (18). If these things can be kept in mind, any meetings that are held will have more meaning for the disabled individual. The Valuing People agenda set a framework for working with people with learning disabilities specifically. Some of the ways that this agenda and other legislation has stated to include people with learning disabilities include: 1. Involving the learning disabled person from the beginning of the development process so that they are not simply answering questions that someone else has devised for them. 2. Making sure that venues, time and timings, resources, information and carer support are developed in such a way that all of the people working with the individual can be present. 3. Making sure that everyone understands and accepts that a person with learning disabilities can understand services that they need, that they have skills and expertise to help themselves. This will call on social workers and other providers to create "flexible and creative" ways for people with learning disabilities to contribute to these meetings in meaningful ways (Lewis 19). All of these safeguards should help to make sure that the personalisation agenda goes further in insuring that people with learning disabilities are taken care of in positive ways, and that they have an opportunity to speak for themselves about their needs. 3. The Putting People First Agenda The Putting People First Agenda was instituted in 2007 and was supposed to create more opportunity for those with disability. Each individual was supposed to be able to fill out a questionnaire that would describe for the authorities the challenges an individual had (and their carers needs) and be able to show what specifically they needed. After this questionnaire was answered, a care plan was to be created which would provide an amount of funding for these needs (Beint 2009). The Agenda was to provide early intervention for people, that may grow to preventive services and accessibility to 'good quality public information' (Beint 2009: 3) that would assist people in arranging their own services according to the care plan. These services could include help at home, short-term assessment and rehabilitation services, extra care housing, and services provided by a third sector (to include things like meals on wheels, day centres for older people or transportation and benefits advice). Unfortunately, there are still people who do not have access to these services because of funding. 3. Social Workers Commitment to Personalisation Social workers have always had the individual in mind when they began service, so the Personalisation Agenda will not be a new feature for them. The Social Care Institute for Excellence (2010) reiterates this fact and suggests that social workers are in a very good position to continue care for their clients. Some of the contributions for social work in this area include: 1. Building professional relationships with their clients and empowering them to access services for themselves and their families. 2. Helping clients work through conflicts and supporting their clients to manage risk and safety issues. 3. Knowing legislation and being able to apply it in the best interest of their clients. 4. Helping clients access services and support where necessary. 5. Working with other professionals to make sure that the best outcomes happen for their clients (Social Care Institute for Excellence 2010). This means that social workers will stay a very important part of the Personalisation Agenda because they will be the ones that must make sure that clients receive the care that they need. Leadbeater suggests that social workers would have more time to work with clients under personalisation. He gives an example of one office where social workers were out of the office visiting clients so much that an answering machine was used to pick up calls. When people returned to the office, the answering machine was so over loaded that some calls were missed and it was difficult to know who should be seen, when they had called and so forth. With personalisation, an individual would be manning a call line and a social worker would sit with the person answering the phone so that decisions could be made on the spot (39). In this way, a social worker could be assigned to a case almost immediately instead of a user having to wait several days for service. In the example that Leadbeater gave, the user was able to speak with a social worker within an hour. Of course this may not work in every situation, but it would be something for social workers to strive for. In this instance, a social worker would still be needed because they had the expertise that was needed in order to help clients. Although some controversy about personalisation suggests that social workers may not be needed, there are many areas that social workers would still need to be available. Some of the ways that social workers would be needed include: 1. They would be needed to help people get the information needed about services and how to obtain them. 2. The social worker will need to make sure that money is distributed equally and fairly as well as for people who really need the services. 3. To help those people with limited organisational or limited communication skills would still be represented. 4. To insure that people who need protection are protected 5. To insure that services are of good quality and that they are cost effective. 6. That someone will take a strategic view of services and see them from a large perspective (The Scottish Government 31). Lelkes suggests that the role of social workers has not been directly identified by the literature on personalisation. Some researchers suggest that the role of social workers is to go back to the traditional ways of doing things when social workers were involved with the values of 'interpersonal communication, negotiation, mediation and appreciation of organisations and procedures' (Lelkes Slide 9). Also, it is important for social workers to be involved with helping users with disabilities to understand the risks that are involved and help them make decisions about those risks to enable them to take part in personal care needs. Lelkes states research promotes specific messages for social workers that state: 1. Risk enablement should become a core part of the transformation of adult social care. It cannot be a ‘bolt-on’solution. 2. Organisation must have a positive risk enablement culture and policies. With social work skills and relationship-based working promoting risk enablement and detecting and prevent abuse as part of safeguarding. 3. A supportive system is one which clearly incorporates self-directed support with safeguarding policy and practice, abuse detection and prevention (slide 21). These points suggest that social workers will still be in need to advocate for the rights of people with disabilities. 4. Users and Personalisation Leadbeater suggests that personalisation will provide a more positive way for people to access services and for social workers to continue to be carers. The agenda will create an availability of booked services, guaranteed faster response times, and better customer service (21). This would allow people to receive the services they needed when they needed them instead of having to wait until they could get in to see someone. Leadbeater states that this would also provide a way for people to learn to navigate through services once they begin to take part in them. This would give users a way to become more particular about the types of services they received and learn to choose from several courses of action because they were more informed about their choices. One other suggestion that Leadbeater suggests is that personalisation could give users a better understanding of how money will be spent for services and provide them with "more direct say" (22) over how the money is spent. Users would be able to talk about how they could use money for education or operating expenses. This would give them more freedom to use the money in their care plans, which would make users co-designers of their needs. Eost-Telling (2010) provided information about a pilot program for users using the personalization format. The aim of the study was to find 60 service users who would work with the Personal Budget system in the first year. They were able to find 94 service users instead which showed the popularity of the program. The study found that users were very involved in the process and felt that their needs were being met. The service providers found that there was a need to make a clearer communication effort with social workers and with users so that the service users would be clearer on what they could expect from the information and how they could use the program (Eost-Telling 7). Service practitioners stated that the program was very positive and that users had benefitted from the process. Several social workers saw that there was still a need to define how a 'citizenship model' would work because there are still areas where it is difficult to know exactly how much they should depend on the user to be able to do (Eost-Telling 8). It is clear that there is more information that is needed for social workers so that they can understand exactly how to put personalization into practice. References Beint, V. (2009). 'Putting people first: The personalisation Agenda'. Shropshire County Council. Available from . [11 May 2011]. Carr, S. (2010). 'Personalisation: A rough guide. (revised edition)'. Available from [10 May 2011]. Eost-Telling, C. (2010). 'Final Report of the Evaluation of the Self-Directed Support Pilot'. University of Chester. 1-124. Available from http://www.stockport.gov.uk/2013/2996/41105/ stockselfdiretsupportpilotmentalhealth[12 May 2011]. Lawton, A. (2009). ' SCIE Report 24: Personalisation and learning disabilities: A review of evidence on advocacy and its practice for people with learning disabilities and high support needs' Available from . [11 May 2011] Social Care Institute for Excellence. (2010). 'At a glance 29: Personalisation briefing-implications for social workers in adult services'. Available from < http://www.scie.org.uk/publications/ataglance/ataglance29.asp>. [11 May 2011]. The Scottish Government. (2009). 'Personalisation: A Shared Understanding A Personalised Commissioning Approach to Support and Care Services'. Commissioning for Personalisation. Available from http://www.socialworkscotland.org.uk/resources/pub/PersonalisationPapers.pdf [11 May 2011]. Read More