Putting the People into Personalisation June 15th 09

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Putting the People into PersonalisationJune 15th
09

• Co-production and Power

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Snapshot background

• Self Directed Support began after a sustained
  campaign by disabled people, with Direct Payments
  in 1996.Direct Payments have now been joined by
  in Controls system of Self Directed Support.
• Since 2003, when In Control created the concept
  of a personal budget, we have been working with
  our members to develop new and better ways for
  people to be in control of their lives.

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From institution to citizenship
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Snapshot background

• In Controls system of Self Directed Support is
  based on a clear set of values.
• The purpose of our work is to support improved
  decision making and a better relationship between
  people and the Welfare State, so that people get
  better lives.
• This means
• Influencing policy
• Focusing on practical solutions
• Being a source of mutual support and
• An exercise in citizenship

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Innovation from the ground up
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• The underlying system of power we know best
• Professionals work out what you need
• Which turns out to be what they are delivering
• Services stuck in their own past...
• People stuck in services...
• We have not rethought power

Provider Driven Care
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Citizenship Model

• Citizen at the centre
• Services negotiated
• Entitlements defined
• Community fully engaged
• Outcomes improved

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Universal citizenship?

• Our findings on how well people using mental
  health services are involved in the care that
  they receive remains of particular concern.
  Independence is as important for people who
  experience mental health problems as it is for
  cardiac or diabetes patients. Sadly however, many
  services still do not seem to realise this (No
  voice no choice CSCI and Health Care Commission
  July 2007.)

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Times are changing....

• ensuring older people, people with chronic
  conditions, disabled people and people with
  mental health problems have the best possible
  quality of life and the equality of independent
  living is fundamental to a socially just
  society...
• The time has now come to build on best practice
  and replace paternalistic, reactive care of
  variable quality with a mainstream system focused
  on prevention, early intervention, enablement and
  high quality personally tailored services. In the
  future we want people to have maximum choice,
  control and power over the support services they
  receive..
• (Putting people First Dh 2007)

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Evidence and examples....

• Self-direction is a concept in the recovery
  process which treats individuals as capable of
  determining their own purposes and achieving
  their own goals. Florida SDC Operational
  Policies Procedures, (2007).
• The Florida SDC program hinges on the belief
  that individuals are capable of choosing services
  and making purchases that will help them begin or
  remain on the road to recovery and to develop or
  regain a life of meaningful, productive
  activity. Florida SDC Operational Policies
  Procedures (2007).

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Evidence and examples....

• Personalisation can only be achieved by shifting
  the balance of control over the different
  dimensions of service deliveryfrom professionals
  and bureaucrats to individual services users..
• (Putting Patients in Control Social Market
  Foundation 2007 Vidhya Alakeson )

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Evidence and examples....

• The ideas underpinning Self Directed Support are
  also increasingly originating within the NHS,
  perhaps using slightly different words but
  following the same themes of shifting power and
  control closer to people
• For example the work on Rethinking long term
  conditions by the Centre for Clinical Management
  Development at Durham University, the
  Co-creating Health three year demonstration
  programme by the Health Foundation, the Expert
  Patient Programme and the latest Department of
  Health Personal Health Budget pilot programme.
• It seems that there is an emerging consensus that
  it is possible to successfully apply the
  principles of Self-Directed Support to some parts
  of the current health care system as well as to
  social care.

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Times are changing

• Traditional interactions
• Belief that knowledge creates behaviour change
• Goals are set by the clinician and success is
  measured by compliance with them
• Decisions are made by the clinician.

• Collaborative interactions
• Belief that ones confidence in the ability to
  change ,together with knowledge, leads to
  behaviour change
• Person is supported in defining their own goals.
  Success is measured by attaining those goals
• Decisions are made as a patient-clinician
  partnership

• Power with clinicians

• Co-production-power shared

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Co-production-theory

• Co production is useful since it supports the
  partnership that is necessary between people and
  public servants in order to achieve outcomes. It
  is about collaboration and encouraging people to
  take an active role.
• (Briefing 31 Co-production an emerging evidence
  base for adult social care transformation By Dr
  Catherine Needham, Queen Mary University of
  London and Sarah Carr, Social Care Institute for
  Excellence. Published March 2009)
• Co-production emphasises that people are not
  passive recipients of services and have assets
  and expertise which can help improve services.
• Co-production is a potentially transformative way
  of thinking about power, resources, partnerships,
  risks and outcomes, not an off-the-shelf model of
  service provision or a single magic solution.
• To act as partners, both users and providers
  must be empowered.
• Co-production means involving citizens in
  collaborative relationships with more empowered
  frontline staff who are able and confident to
  share power and accept user expertise.

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Co-production in practice

• Its about co-production and an improved
  relationship
•  Central focus is improving the dialogue between
  the citizen and the professional to create
• Greater mutual respect understanding
• Better quality decision-making
• Better outcomes
• This should produce a Personal Plan which is
  co-signed by the citizen and professional

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Co-production in practice

• In the 2006 Mental Health National Patient
  Survey Only 58 of service users reported
  definitely understanding their care plans, only
  53 had been offered a copy, and just 40
  reported being involved in deciding what was in
  their care plan.
• A Self Directed Support plan starts from a
  different place- from hopes and dreams rather
  than illness and problems. It is unique to the
  person and takes an active citizen
  approach-People are seen as equal citizens with
  skills to offer as well as support needs to be
  met. People in the Voice and a choice project
  spoke clearly of the value of being able to
  contribute as well as receive, to be seen as
  active participants, not passive recipients.

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Conclusion

• Its not just about getting hold of the money.
  Its permission to have a life again. Permission
  to dream.

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What do you think?