Personalisation requires a fundamental culture shift across the whole system, new skills and knowledge, new roles and responsibilities and a different way of working, thinking and behaving. There are already some good building blocks for this change, such as the development of personal budgets, person-centred thinking and planning and recovery approaches, innovative commissioning and community projects, but much remains to be done. Skilled and experienced specialist professionals, who are valued and have a vital role in helping people recover and stay healthy, are facing the challenge of changes in their approaches and practice, and in overcoming barriers to making partnership right across the system work. At the same time professionals and staff in universal services (e.g. libraries, sports and leisure, culture, education, employment) have the challenge of making services accessible and available to all citizens and working in partnership to encourage innovation.
Some of the challenges are:
- Individual citizens are developing a different relationship with public services that empowers them to have more say and control
- For social workers there is a shift to be more focused on ‘advocacy and brokerage rather than assessment and gatekeeping' (DH, 2008) and an increased drive to improve partnership working
- In the health service personal health budgets and the shift to more choice and control has significant implications
- As experts by experience become more commonplace in all areas their influence increases and brings about changes in attitude, relationships and approaches
- As former service users become employers of care staff (to varying degrees) or are involved in the development and running of user led organisations, there is a major shift in roles and relationships and in personal and skills development needs
- The growth of personal assistants raises issues and challenges, for example, about supply, training, qualifications and quality monitoring, isolation, risk, terms and conditions and career development
- Staff involved in commissioning and contracting will need to re-think current ways of operating to accommodate a personalised approach, with more effective and dynamic consultation and user involvement, and a diverse market with more micro commissioning
- Health, education, housing and social care providers have to address the challenge of flexibility in providing personal services through more individualised approaches and contracts
- Communities and community groups have a new challenge for inclusivity, innovation and leadership
- Senior and local managers have the challenge of inspiring, leading change and encouraging leadership in others throughout the system
- Board members and trustees, elected members, local authorities and local health authorities, regional government offices and national government need to embrace the full range and impact of these changes and provide clear leadership and action for change
All of these changes have a system wide impact on workforce and organisation development and rely on good leadership to inspire and guide change.
I have a good and positive experience of people involved in my treatment and support.
Staff I come into contact with in organisations are helpful, treat me with respect and help me take control.
Examples of things that help with this:
- Active promotion of personalisation and training that inspires staff
- Good leadership that ensures staff are clear about their job and how it should be done and are supported to take calculated risks
- Removal of unnecessarily complicated bureaucratic systems and processes
- Staff that have been given the time, space and expert input to acquire the right skills and are themselves respected, valued and empowered
- Staff who have been encouraged see themselves as partners in better care and support
- Staff who are respected, encouraged, praised and properly rewarded when they get things right
- Staff with high expectations of what people can achieve and contribute
- Experts by experience employed in all areas to influence and inspire new ways of working
- Staff across the system who have terms of employment that are reasonable, legal and fair
- Staff and unions involved in the process of developing personal budgets and of associated training programmes
- Job satisfaction as a result of these approaches
I can get all the different treatment, information, advice and support I need smoothly and easily, no matter how complex my needs and situation are.
People I rely on and respect for their specialist knowledge, skills and expertise are there for me when I need them
Examples of things that help with this:
- Clear terms of reference for partnership working and partnership arrangements that all concerned have been involved in drawing up
- Training, job descriptions, policies, systems and performance management overhauled and revitalised so that they reflect new roles and responsibilities and new ways of working
- Addressing fears of losing specialisation and professional identity by recognising people's specialist skills and expertise and giving time and space for people to use them but also
- Being clear about the need for willingness and openness to cross professional boundaries and act and collaborate beyond specialisms to solve problems together and achieve the right outcomes for people (rather than passing people around the system)
- Collaboration and partnership beyond health and social care
- Good information systems that can provide information and advice for all aspects of people's lives, and for people who may not be eligible for publicly funded support and services
- Investment in active development work with communities and community groups
- Central and local government leaders and policy makers willing to address differences in eligibility criteria, priorities, performance indicators, referral systems, professional and organizational cultures
- A positive approach to risk taking and risk management
(For more information see Partnership section)
I am trusted to make good decisions.
People who are involved in giving treatment, information, advice and support and in commissioning and managing services are trusted to make good decisions.
Examples of things that help with this:
- Senior managers, boards and elected members who rise to the challenge of personalisation and support an organisational approach based on trust - of staff in their judgments and of citizens in their choices and decisions
- Leadership styles based on trust and collaboration that empower people and allow them to learn from mistakes
- Recognising and supporting professionals as leaders and innovators, not as a barrier to progress
- Supporting people to identify their own learning and training needs
- The development of a different, more open and trusting, relationship between central and local government, between managers and professionals and between professionals and individual citizens
- People who are involved in my treatment and support in health and social care services have the right approaches and skills
- People I come into contact with in the community as part of my support plan have the right attitudes and approaches
Examples of things that help with this:
- Professional and work based skills training that builds on person-centred approaches, respect, flexibility, enabling and empowering and cultural competence
- Access to knowledge of new ways of working
- Shared practice networks that give people an opportunity to tap into ideas and information
- Organisation development programmes that encourage and support culture change
- Information and training that is available in different forms and at different times (e.g e-learning courses)
- Leadership from health and social care organisations in community development and positive promotion of inclusion
- Access to a structured programme of continuous development and support that builds on existing knowledge and expertise
- Service users and carers involved throughout the design, delivery and evaluation of all relevant education and training
It is easy for me to find or purchase all the things I need in my personal support plan
Examples of things that help with this:
Creative, outcomes based, commissioning and contracting (See Creative Commissioning section)
Employing Expert by Experience Commissioners • Excellent partnership working (See Partnership section)
• Good, accessible information (See Information section)
SIGNPOSTS
Policy guidance
1. Working to put people first: The strategy for the adult social care workforce in England, Department of Health, 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/ dH_098481
2. Options for Excellence: Building the Social Care Workforce of the Future, DH/DfES, 2006. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_4139958
training and consultancy
3. Working to Recovery offer training and consultancy to deliver recovery- based services. www.workingtorecovery.co.uk/default.aspx?tabid=1128
4. City university scoping exercise for a mental health carer support curriculum.
www.city.ac.uk/sonm/research/projects/Mental%20health%20and%20learning%20disabilities/alan%20simpson%201.html
5. An example of personalised e-learning can be found on: www.embrace-learning.co.uk
6. Training to support closer work between voluntary and statutory sectors CSIP esvsproject@gymind.org.uk
7. The ten essential shared capabilities: A framework for the whole of the mental health workforce, Hope R, Department of Health 2004. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_4087169
research
8. Personalisation of Health and Social Services: Leadership challenges and workforce development needs of the mental health voluntary sector in Leeds Loul B, Crawshaw G, Volition 2008. www.volition.org.uk/documents/ volitionsummaryreportpersonalisationandworkforcedevSept08.pdf
9. Service user and carer led research. http://hesas.glam.ac.uk/news/en/2009/ apr/08/first-all-wales-mental-health-research-group-estab/
Partnership working
10. Luton Centre of Excellence A resource with an integrated team of social care staff and Community Psychiatric Nurses offering a range of services and therapies, information and advice. www.dhcarenetworks.org.uk/Prevention/ MakingItHappen/PracticeExamples/communitySupport/?parent=3942χ ld=4043
recognition and accreditation
11. Practice development is a person-centred framework that enables the development of creativity and innovation in practice. It facilitates practice that is leading edge and evidence based, and harbours a "bottom up" approach to improving care where any individual, regardless of their place in the organisation, can be instrumental in taking good ideas forward. The university of Leeds have an accreditation scheme. www.cdhpp.leeds.ac.uk/services/practice2.php
12. Recognition and reward for innovation www.hee.org.uk
building capability
13. Capabilities for Inclusive Practice, CSIP/NSIP/DH, 2007 Builds on The 10 Essential Shared Capabilities to look at values, characteristics and skills needed in a workforce capable of delivering inclusive opportunities for people with mental health needs. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/ dH_078095
14. Personal health budgets: understanding the implications for staff Department of Health 2010 http://www.dhcarenetworks.org.uk/PHBLN/Topics/latest/Resource/?cid=7346
