Opinion

Managing the risk of self-directed support

There is undoubtedly a sea of change underway in adult social care in the UK as local authorities gear themselves up for the implementation of a comprehensive Self-Directed Support (SDS) programme, as part of the Government’s 'personalisation agenda'.

Direct payments and Individual Budgets will play a vital role in personalising adult social care services around the needs of users. The idea is that these initiatives will ultimately facilitate greater independence as citizens will be able to choose and purchase services and products for themselves to meet their specific needs.

However, there is still some scepticism among practitioners and social care leaders about the impact of personalisation on social workers’ roles and on the levels of risk carried by service users.

Even the Government concedes that there certainly are challenges ahead. Not least, because a number of local authorities will need to transform their entire IT systems to embrace these new ways of working; but also because the admirable objective to improve outcomes, whilst at the same time not compromising safeguarding will be challenging.

Local authorities have to get their Planning for Transformation frameworks in place. There is certainly no prescriptive national template for implementation and local authorities are all at different stages of the game.

Nonetheless, because 'personalisation' is such a radical agenda and will require huge cultural change across both health and social care, it is imperative that local authorities take due care at the planning stage to ensure that they get their strategies absolutely right — as well as achieving buy-in from practitioners from the offset.

Many social workers feel that the personalisation agenda is at the heart of helping those who are most vulnerable and in need of support, something which has played a major role for many in their decision to enter into a career in social care.

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 by, for example, providing a more coherent approach to discharge planning and post-discharge care.

However, more agencies working together will carry with it the risk of more people carrying their own bank of information and one of the possible disadvantages of this is that information could fall through organisational cracks. Key to the success of the personalisation agenda is the communication between these organisations.

IT systems will need to be allied to effective risk management procedures which must be accessible to the client, their support team, service providers and social care practitioners. The way in which systems are accessed and how access is controlled requires 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.

Self-Directed Support is also relevant for younger disabled people. Providing a communications method appropriate to their generation is imperative. One such obvious approach would be via the Internet, where younger people could search for providers of required services like they would search for products on websites such as Amazon or Money Supermarket.

They could provide a review of the services they have used and create a social networking environment with likeminded people with similar experiences. Finally they could use this online portal to manage their Individual Budget in the same way as they would manage their bank account on line.

Other technologies, such as pre-loaded payment cards will also help to manage risk by ring-fencing funds for the benefit of those users without bank accounts, to enable practitioners to monitor user spend activity effectively so that outcomes can be adequately assessed and to separate finances for those with overdraft or debt problems.

The Self-Directed Support agenda aims to assist a broad spectrum of people. With this comes the challenge of satisfying a number of needs via a variety of methods.

There are clearly risks with SDS, 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 all working together, is fundamental.

Effective IT systems will undoubtedly underpin this process.

More information

The UK Department of Health website covering the personalisation of social services, the Putting People First framework, Common Assessment Framework and individual budgets: www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/

More on the personalisation agenda: the Department of Health's personal health budgets web pages
www.dh.gov.uk/en/Healthcare/Highqualitycareforall/DH_090018

The Personalisation Network, which is "a place where people involved in changing the Adult Social Care system can get guidance and examples from across the country": http://networks.csip.org.uk/personalisation/