Social careEnabling self-directed adult careThe Putting People First framework for adult care announced in
December 2007 will lead to large changes in the provision of care in
England. Denise Harrison, Director at Liquidlogic outlines
the challenges facing all parties involved in the care process and
the role of technology as an enabler for delivering care.
With the roll out of pilot programmes for individual budgets and an increased emphasis on joined up working between local authorities and healthcare, it is becoming increasingly imperative that local authorities look to re-examine their IT strategies, facilitate greater inter-organisational working and get ready for future. There is undoubtedly a sea change underway in adult social care. The signing of the Putting People First concordat and the announcement on 10 December 2007 of £520 million over three years to local authorities to fund transformation in adult social care, will radically change the way that services are delivered. The idea of creating a system of self-directed care that supports the Government agenda of promoting citizenship and focuses on outcomes for individuals raises a number of challenges. The benefitsAt a recent business briefing in London, Janet Walden, The Department of Health’s (DH) Head of Personalisation & Innovation, made it clear that as part of the Government’s personalisation agenda, individual budgets would empower people to take control of their lives, by allowing them to plan and commission their own services. Individual budgets, Walden argues, will give adults greater independence and more control over their lives by being given the opportunity to choose and potentially commission services that are tailored to their needs: more choice and more control for everyone. For the Government, the personalisation agenda is seeking to create greater independence and less dependence for individuals. This will encourage and facilitate people to create and provide their own support structures to meet their individual needs, rather than depend on a one-size fits all approach. The Government concedes that personalisation is a radical agenda and will provide challenges for local councils and their partners. In recognition of this huge change in health and social care delivery, the Government has earmarked a pot of money to help councils finance all-important change-management programmes. It is inevitable that more agencies will need to work together if the personalisation agenda is to work. We have already seen how Single Assessment Process (SAP) implementations are positively impacting services across the country, eg by providing a more coherent approach to discharge planning and post-discharge care. However, more agencies working together carry with it the risk of more people carrying their own bank of information. If such an initiative is to work, then effective IT solutions need to enable greater sharing of information across organisational and professional boundaries. Health and social workers freely admit that most of the hard work they do is undertaken within the first six weeks of a case. The personalisation agenda, it is argued, frees up their time to effectively allow them to focus on critical cases, whilst long term cases that have established and agreed outcomes can be left in the hands of the clients’ own support team. The trialThough there are only 13 official Individual Budget pilot sites, the DH has recognised the number of authorities developing their own agendas around self-directed care is much greater. Despite the fact that the Individual Budgets Evaluation (IBSEN) report findings of these “official” trials are not scheduled for release until March 2008, the Government has already mandated that Councils must start delivering ‘personalisation’ by April 2008. This has led to some criticism within the industry, and despite positive outcomes for certain specific client groups, it is not universally accepted that self directed care is appropriate for all. Individual controlHanding over the responsibility of care to the individual has naturally raised a number of questions about whether the most appropriate care can or will be delivered. The most fundamental issue is the dichotomy between the need for health and social care agencies to relinquish control and hand this over to individuals, versus the need to ensure that outcomes are being adequately met by monitoring or regulating people or services. Whilst some individuals will certainly benefit from increased involvement and control over their own care; is it the ideal for all? A number of areas of concern have already been highlighted by local authorities: The self-assessment process
Risk to the individual
Certainly, legislation such as the Mental Capacity Act is designed to provide a clearer framework for practitioners to define capacity, and ensure that choice and dignity are maintained. There are clearly risks with the self-directed care agenda, but risks can be mitigated. If this is to be done successfully then the need to have a clear and well defined risk-assessment process delivered by an experienced and knowledgeable health and social care workforce collaborating and co-operating is fundamental. For this to happen successfully then effective IT systems to support this process are essential. For some, however, the self-directed care process may just not be appropriate and existing processes may still be the most effective. Technology as an enablerIT systems need to be able to effectively co-ordinate care despite the growing range of agencies, organisations and individuals who may be delivering that care. This needs to be allied to efficient risk management procedures which must be accessible to the client, their support team, as well as service providers and social care practitioners. The way in which systems are accessed and how access is controlled needs new thinking. How information and the process by which information is not only collected, but presented, also needs careful thought — especially in light of the range of people who may need to contribute to and view the information. The flexibility of systems is also key; as care and support processes become more tailored to an individual, so the systems designed to support and monitor must be able to adapt. It is clear that, at least in the short to medium term, the existing case management approach within social care will need to exist alongside the newer self-directed care process. Liquidlogic’s Protocol applications have been delivering co-ordinated multi-agency solutions to meet the emerging integrated working initiatives between health and social care for a number of years. The Protocol SAP solution has provided the means for all involved with a client irrespective of professional or organisational boundaries to effectively co-ordinate and monitor. Self directed care requires a multi-faceted interface tailored to the needs of the client groups involved. A “one size fits all” will simply not work effectively. John from Durham is 78 years old. For 30 years he has been a member at the Working Men’s Club three miles away. A stroke has made John vulnerable and wheelchair bound, leaving him unable to get the bus or drive to the Club. A weekly visit to a nearby Daycare Centre has been suggested so he can to meet people with similar disabilities; the new Personalisation Agenda will enable to John to use some of his Individual Budget on taxis with disabled access to transport him to and from the Club to meet old friends — if that is what he chooses. ConclusionChange is inevitable, and the Government is pushing forward its personalisation agenda to secure autonomy for the individual. Who knows whether this revolution in health and social care will ultimately benefit the outcomes of most individuals? Councils will no doubt encounter teething problems and inevitably the ability to overcome these problems could well dictate the outcome of the whole initiative. There are clearly numerous issues in terms of relinquishing control to individuals, Councils have been told that individual budgets are premised on providing maximum choice, and not ultimate choice. Perhaps councils can rest easy about meeting their responsibilities? It will be very interesting to watch how local authorities determine individual budget policies and requirements over the coming years. Denise Harrison, Director at Liquidlogic. Further information Department of Health Social Care Reform website Publication: Putting people first: a shared vision and commitment to the
transformation of adult social care Department of Health Personalisation website Individual Budgets pilot programme website (the pilots finished in
December 2007, but the site is still a useful resource) |
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Organisational changes and the introduction of the Integrated
Children’s System (ICS) initiative has seen a divergence in IT
requirements between children’s and adults' social care departments.
The specific IT requirements of the ICS has led in many cases to a
decoupling of adults' and children’s IT systems, with many local
authorities now re-assessing their IT systems required to support
the practice and procedures that will deliver quality services
across adult social care.