53367000 personalisation through person centred planning
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DH INFORMATION
PolicyHR/Workforce
ManagementPlanningClinical
EstatesCommissioning
IM&TFinanceSocial care/Partnership working
Document purpose BestPracticeGuidance
Gateway reference 13345
Title Personalisationthroughpersoncentredplanning
Author DepartmentofHealth
Publication date 31March2010
Target audience PCTCEs,NHSTrustCEs,SHACEs,CareTrustCEs,FoundationTrustCEs,LocalAuthorityCEs,DirectorsofAdultSSs,DirectorsofHR,
DirectorsofChildrensSSsCirculation list MedicalDirectors,DirectorsofPH,Directors
ofNursing,DirectorsofFinance,AlliedHealthProfessionals,GPs,VoluntaryOrganisations/NDPBs
Description ThisguidanceseekstosharelearningabouthowpersoncentredthinkingandplanningcanmakeausefulcontributiontothedeliveryofPuttingPeopleFirstandValuingPeopleNow.Itisofferedasaresourcetopeoplewhouseservices,familycarers,managersandpractitioners.
Cross reference ValuingPeopleforpeoplewith
Now:anewthree-yearstrategylearningdisabilities(2009)
Superseded documents N/A
Action required N/A
Timing N/A
Contact details SocialCarePolicyandInnovationDepartmentofHealthRoom110WellingtonHouse133-155WaterlooRoadSE18UGwww.dh.gov.uk/en/Policyandguidance/Socialcare/Deliveringadultsocialcare/Learningdisabilities/index.htm
For recipients use
Crowncopyright2010
FirstpublishedMarch2010
ProducedbyCOIfortheDepartmentofHealth
Thetextofthisdocumentmaybereproducedwithoutformalpermission
orchargeforpersonalorin-houseuse.
www.dh.gov.uk/publications
http://www.dh.gov.uk/publicationshttp://www.dh.gov.uk/publications -
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Personalisation through
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Contents
Executive summary 3
1.PuttingPeopleFirstand person-centred planning and approaches 6
2. Person-centred planning a different kind of listening, a different kind of action 9
Approachestoperson-centredplanning 14
Person-centredthinkingtoolsthefoundationforperson-centredplanning 14
Deliveringpersonalisationthroughperson-centredthinkingandplanning 17
Gettingstartedwithperson-centredthinkingandplanning 18
Creatingaperson-centredsystemtodeliverpersonalisedservices 23
3. Delivering PuttingPeopleFirst and achieving the local government milestones using
person-centred thinking and planning 25
Whatworksandwhatdoesntworkinimplementingperson-centredplanning? 25
Supportingdeliveryofthemilestones 26
Whereareyounow? 26
Whatcanyoudonext? 26
Appendices
1.Backgroundonperson-centredplanning 27
2.WhatDHpoliciessayaboutperson-centredapproaches 28
3.Whatworksandwhatdoesntworkinimplementingperson-centredplanning? 32
4.Person-centredplanninganddeliveringthemilestones 37
5.Whereareyounow? 46
6.Whatcanyoudonext? 50
Links to useful resources 55
Acknowledgements 57
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Executive summary
1. Putting People Firstrecognisesthatperson-centredplanningandself-directedsupportarecentraltodeliveringpersonalisationandmaximisingchoiceandcontrol.1Thisguideoutlineswaystoachievethis.
2. Thisguide:
isnotcompulsoryguidanceforlocalauthorities.Ratheritseekstosharelearningabouthowperson-centredthinkingandplanningcanmakeausefulcontributiontothedeliveryofPutting People First.Itisofferedasaresourcetopeoplewhouseservices,familycarers,managersandpractitioners;
isoneofthePutting People Firstnationalplanproducts,offeringideasandapproachesbasedonlearningandexperiencefromaroundthecountry;
canhelpcouncilstomeetsomeofthemilestonesidentiedinthelettertocouncilsfromtheAssociationofDirectorsofAdultSocialServices
(ADASS)andtheLocalGovernmentAssociation(LGA).2Thesemilestones
havebeendevelopedasawayforcouncilstochecktheirprogressastheymovetowardstransformingtheirsystemsusingtheSocialCareReformGrant,whichendsin2011;
canalsohelptodeliverothercross-governmentstrategies,including
Valuing People NowandValuingEmployment Nowforpeoplewithlearningdisabilities.3
What is person-centred planning?
3. Putsimply,person-centredplanningisawayofdiscoveringwhatpeoplewant,thesupporttheyneedandhowtheycangetit.Itisevidence-basedpractice4that
assistspeopleinleadinganindependentandinclusivelife.Person-centredplanningisbothanempoweringphilosophyandasetoftoolsforchange,atanindividual,ateamandanorganisationallevel.Itshiftspowerfromprofessionalstopeoplewhouseservices.
4. Therearedifferentapproachestoperson-centredplanning.Thisguidancefocuses
mostlyonEssentialLifestylePlanning(ELP),whichisdesignedforusewithin
3
1 Putting People First: A shared vision and commitment to the transformation of Adult Social Care(2007),DepartmentofHealth.
2 Lettertocouncils(September2009),ADASSandLGA.
3 Valuing People Now: a new three-year strategy for people with learning disabilities(2009),DH;Valuing Employment Now: real jobs for people with Learning disabilities(June2009),DH.
4 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,The Impact of Person Centred Planningfor People with Intellectual Disabilities in England: A Summary of Findings(2005),LancasterUniversity:InstituteforHealthResearch.
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servicestodeliverself-directedsupport.Whenperson-centredplanningis
combinedwithanupfront(indicative)allocationofmoney(apersonalbudget),itiscalledsupport planning.
Key messages
5. Thekeymessagesinthisguidanceareasfollows:
Person-centredplanningandsupport
planningarepracticalwaystodeliverpersonalisedservicesandself-directedsupport.
Person-centredplanningandsupportplanningaresimplewaystoachieveco-production,enablingpeopletoshapeandcommissiontheirownservicesandtomakedecisionsabouthowtheywanttospendtheirpersonal
budgettolivetheirlives.
Person-centredplanningisnotintendedtoadd,norshoulditadd,unnecessarycomplexityorcoststoself-directedsupport.
How it works
Thefoundationofperson-centred
planningcomprisesarangeofsimple,practicalperson-centredthinkingtools.Thesecanbeusedtocreateday-to-daychangeforpeopleusingservices,aswellastobuildaperson-centredorasupportplan.
Waystogetstartedwiththisapproachacrossservicesinclude:
creatingone-pageprolesthatleadtoaction;
implementingperson-centredreviewsandperson-centred
thinking;and
usingperson-centredapproachesinsupportplanning.
Who will this benet?
Person-centredplanningisapracticalwayforpeopletohavechoiceandcontrolintheirlives.
Usingarangeofapproachestoplanning,andperson-centredthinking,willbenetanyoneassistinginsupportplanningforpeoplewhoaremakingdecisionsabouthowtheywanttoliveandusetheirpersonalbudget.Theseapproachesshouldalsobeavailabletopeoplewhowanttodeveloptheirownsupportplan,includingself-funders.
Informationfromperson-centredreviewsandoutcome-focusedreviewscanbeusedtoco-producecommissioningstrategiesandproviderdevelopment.
Suggested actions for councilsare to:
provideclearinformationandadviceaboutperson-centredplanningandsupportplanning.Peopleneedtounderstandwhatsupportplanningis,whattheycanspendtheirmoneyon,andwhocanhelpthemplaniftheywantassistance;
makesuretherearearangeofpeoplewhocanassistwithsupportplanning,
notjustcaremanagers.
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focusonprovidingguidesforpeopletoplanforthemselves,with
support,forexample,fromuser-ledorganisations;
implementperson-centredreviewsofservices,anduseoutcome-focusedreviewswherethepersonhasapersonalbudget;
deneleadershipforperson-centredthinking,planningandreviews;
investinperson-centredthinkingandsustainalocalresourceofpeoplechampioningperson-centredthinkingandplanning;and
adoptWorking together for change(DepartmentofHealth2009)orasimilarapproachtoco-producecommissioningandstrategicplanning.
There is only one way and that is the person-
centred way it is a journey worth taking.
Sally,memberoftheTransformingAdultSocialCareserviceuserreferencegroup
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CHAPTER 1
Person-centred planning and self-directed
support to become mainstream and dene
individually tailored support packages.
Putting People First5
1. Putting People Firstisapublicservicereformprogramme,whichisco-produced,co-developedandwillbeco-evaluated.
Itrecognisesthattoachieverealchange,usersandcarersmustparticipateateverystage.Thismarksachangeinstatusofpeoplewhouseservices,fromconsumerstoco-producers.
2. TheGovernmentsGreenPaperShapingthe Future of Care Together6statesthatitsvisionisfora system where people willbe able to live their lives in the way they
want, supported by the services that theychoose,andthatservicesshould respondto local conditions.Tomakethevisionareality,theGreenPapergoesontosaythatunderthenewsystem,organisationswill continue to have the same
responsibilities set out for them in PuttingPeopleFirst, but there will be implicationsfor the way in which local authorities
and other partners work together and
with people who need services.ThiswillbesetoutinaforthcomingWhitePaperexpectedinearly2010.
3. Person-centredplanningandsupportplanningarewaystosupporttheachievementofco-production.
Co-productionmeansworkingtogetherwithpeopletodeliverapolicyorservice.Listeningtohowpeoplewanttolivetheirlivesiscrucial.Itmeanspeopleareincreasinglyabletoshapeandcommissiontheirownservices.Throughsupportplanning,peoplewithpersonalbudgetscanmakedecisionsabouthowtheywant
tospendtheirmoneyinordertomovetowardsthelifetheywanttolead.
4. Supportplanningisanimportantpartoftheself-directedsupportprocess.Itrequiressimpleandproportionatesystemssothateveryonereceivesenoughinformationaboutthetypeofsupporttheycouldbeentitledto,withouthavingtogothroughcomplexorburdensome
processes.
People want better quality services that are
personal to them and more control over
decisions that affect them.
Putting People First the whole story7
5. DeliveringPutting People Firstrequiresorganisationalandsystemtransformationtodeliverperson-centredsupport.Thiswill
helppeoplemovefrommarginalisationtoinclusion;andfrombeingtheobjectsofcaretoactingascontributingcitizens.Thisrequiresfarmorethanperson-centredthinkingandplanningitrequiresavisionofinclusionandindependentliving.Person-centredthinking,person-centred
PuttingPeopleFirstand person-centredplanning and approaches
5 Putting People First(2007),DH,p.3.
6 Shaping the Future of Care Together(2009),DH.
7 Putting People First the whole story(2008),DH.
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planningandperson-centredteamsarewaysofachievingthisvision.Inaddition
toPutting People First,person-centredapproachesareeitherrecommendedorexpectedinawiderangeofpolicies.AsummaryofthesecanbefoundinAppendix 2.
6. Inthediagramoverleaf,werecommendanumberofperson-centredthinkingtoolsthatcanhelppersonaliseadultsocialcareacrossthefourelementsofPutting People
First.
Putting People First the whole story8setoutfourareasonwhichcouncilsandtheirpartnersshouldfocusinordertopersonaliseservices.Theseareasare:
universalservicestransport,leisure,health,education,housingandaccesstoinformationandadvice;
choiceandcontrolshapingservicestomeetpeoplesneeds,ratherthanshapingpeopletotinwiththeservicesonoffer;
socialcapitalcareandsupportthatindividualsandtheircarerscangetfromtheirlocalcommunity(friends,family,neighboursorcommunity
groups);and
earlyinterventionandpreventionsupportthatisavailableforpeople
whoneedhelptostayindependentforaslongaspossible,tokeeptheirhomeorgardentidy,ortostarttakingregularexercise.
Thediagramoverleafshowsexamplesofhowperson-centredthinkingcanhelpdeliverPutting People First.
8 TransformingAdultSocialCareProgrammeBoard, Putting People First the whole story (2008),DH.
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Unive
rsal
servic
es Early
intervention
andprevention
Soc
ial
capi
tal
Choice
and
control
Universal services
Introducing MaureenMaureen has a learning disability and difculty
communicating with people, made worse by a hearingimpairment. She became gravely ill and was admittedto her local hospital. The hospital sta struggled tocommunicate with Maureen, and this had a dramaticimpact on the way she responded to her treatment.Maureens key worker went straight to the hospitaland explained to nursing sta how to speak with herby getting up close to her right ear and using a loudvoice, while at the same time, using body language thatMaureen was used to. Her key worker wrote a one-page prole, and this helped hospital sta understandwho Maureen was, what she liked and the kind osupport she needed. When there was a change o shit,the profle enabled the new nurses to communicate with
Maureen and continue with her treatment, meaning hercondition improved dramatically and she was ventuallyable to return home.
Early intervention and prevention
Introducing PatPat has Reynauds condition, chronic obstructive
pulmonary disease (COPD) and type 2 diabetes. Sheis supported by her daughter Su. Together, they used theimportant to/important for tool to work out what Patneeded or peace o mind without eeling like she wasbothering her daughter. They also used the workingand not working tool to fnd ways o easily improvingPats home. They rearranged her bedroom so she couldmove about more easily and reach the mattress variatorcontrols to help her get in and out o bed. Pat also saidshe would like to go to the supermarket hersel and topick her own ood so that she could be more creativewith her diet. They bought a reezer so she could stockup on the basics and manage her anxiety about beinglet in the house without anything to eat. The decision-
making agreement helped Pat explain that shesometimes elt Su made too many decisions onher behal. Pat now goes to all her medical
appointments on her own. When she wasrecently admitted to hospital, she said
she elt much more inormed abouther condition, and much more
in control.
Social capital
Introducing IanParish plans encouragecommunities to come together toidentiy their needs, prioritise theissues raised and address them with anagreed action plan. Although parish plansare not statutory documents, best practiceshows that local authorities can incorporate theminto community strategies, service delivery and localdevelopment rameworks.
The idea o a parish plan excited members o a villagecouncil in Suolk. This resulted in the largest turn-out or a parish meeting or many years. There wasconcern that the agency presenting the idea seemedto ocus more on the cost to the village to train peopleto carry out the process, rather than the real beneftso a local action plan. Residents elt the process couldengage with a wide range o people, rom the veryyoungest to the most senior. Ian, a person-centredplanning coordinator who lived in the village, was awarethat these issues existed, but they were difcult toclariy and address. Ian wanted to get people togetherto think about what they could do and thought theperson-centred review process could be useul. Thismeant that as a group, the village was able to pose anddiscuss a number o questions: What do we appreciate
about our village?, What is important to us about it?,What do we want or the uture? and What is workingand not working now?
Choice and control
Introducing KevinKevin experienced major
episodes o paranoia and wasdiagnosed with schizoaective
disorder. This has had a big impacton his working lie, leading to cycles
o joblessness, homelessness and hospitalstays. He and his social worker started
developing a support plan using the important to/important for and working/not working tools. ForKevin, its important he keeps well and only usesmental health services i he is unwell. He described
his love o cycling and said that social interactionand a work routine to keep him occupied helped tostabilise his mood. They talked about what could beachieved with his personal budget and explored theidea o sel-employment providing training or cyclingmechanics and the things Kevin would need to setup in business. Kevins personal budget now coverssome o his business costs and allows him to do a tradequalifcation as a cycle mechanic. There is also moneyset aside or respite i things get too much.
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CHAPTER 2
1. Arthursstory(seebelow)showshowunderstandingwhatisimportanttosomeoneandthenndingoutandactinginawaythatisexactlyhowtheywanttobesupportedcanmakeahugedifferencetotheirlife.Thisinformationwasrecordedonasinglesideofpaper(calledaone-pageprole)afterGillspent
acoupleofhourstalkingtoArthurandmeetingwithhisstaffandfamily(ataperson-centredreview).Togethertheycameupwithaplanthataddressedwhatwasnotworkingforeveryone,andwhichmeantthathisstaffworkedwithhiminadifferentwaytoachievethechangeshewanted.Changingwaysofworking,basedonhowArthurwantedtobesupported,representedashiftinpowerandachange
ofculture.
2. Thisapproachiscalledperson-centredplanning.
IntroducingArthur
Arthur, 86, is a charming man. Peopledescribe him as the salt of the earth; a true
character and a real gent. He has lived in
his own at in an inner-city area for 35years. He lost his wife Madge 20 years ago
and treasures her wedding ring that he
wears on his little nger. He loves talking
to people and is an amazing storyteller.
Sometimes, he likes to talk about his time
driving tanks during the war, but only
when he is in the mood. He also likes
to talk about the old boxers, especially
Cassius Clay, but would not know him as
Muhammad Ali.
Arthur is supported by the local domiciliary
care services. His district nurse, Marie, was
concerned Arthur may need residential
care. Arthur is terried of being put in a
home, so Marie spoke with Gill, the local
person-centred planning coordinator. Gill
spent an hour with Arthur. She asked him
about things like his past and what makes
up a good or bad day. She found out howhed like to be supported and what kind of
routine he enjoys. She used this to develop
a one-page prole, which contained all this
information. Gill then organised a person-
centred review with Arthur, his nephew
Stephen and wife Sally, the manager of the
domiciliary service and a staff member.
Together they looked at the one-page
prole and talked about what was working
and not working in Arthurs life from eachof their perspectives.
From Arthurs perspective, the highlight
of his week was spending Friday evenings
with Stephen, Sally, and their three
children, whom he loves dearly. Stephen
also phoned him at 5pm every day. Arthur
felt both of these actions worked well for
him. He also said it was important to have
someone to talk to, especially at mealtimes. His staff spent their time making his
evening meal and left it with him, but did
not have time to sit and chat. He also said
it was important his meals were served
piping hot. It didnt work for him when
the staff gave him his dinner lukewarm
and left him just a sandwich for lunch.
Arthur usually threw both meals into his
back yard. This caused problems with his
neighbours and a rat infestation.
Person-centred planning a differentkind of listening, a different kind of
action
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Arthur also said he was sick and tired of
people telling him to take off his wool bob
hat.
From the staffs perspective, it did not work
when Arthur sometimes hit out with his
walking stick when they came to wake him
in the morning. As he cant see well, he had
assumed they were burglars. Arthurs poor
eyesight means that good support would
be for staff to call him from the bedroom
door to wake him up and never to approach
him and shake him while he slept. Staffwere also concerned that he sometimes
wandered out late at night, which was not
safe. They say Arthur makes sense of his
days by sticking to his routines. He needs
to be reminded daily if something out of
the ordinary is happening; otherwise, he
becomes disoriented, confused and is likely
to go outdoors in search of help.
Stephen said that something that did notwork for him was Arthurs late night phone
calls when he couldnt nd the 10 note he
usually kept in his pocket in case he needs
it. Some of the staff had taken this out for
safekeeping and put it away in a drawer,
but Arthur would become distressed
looking for it, sometimes struggling on his
hands and knees for hours.
Together, Arthur, his family and staff agreed
some simple actions that meant that Arthur
could stay living in his own home, andaddressed what was not working for him.
Staff agreed to use the one-page prole as
the way to support Arthur particularly
around how to help him wake up in the
morning (by calling from the door) and
never taking his 10 out of his pocket. The
family suggested that Sally provide frozen
meals for Arthur, so that the staff simply
heated these until they were piping hot.
They could then use their time to stay andtalk to Arthur while he ate. This made life
better for Arthur; he started to eat well,
had company and no longer had problems
with his neighbours. They treated the rat
infestation, and Arthur agreed to a mat
sensor, which can be activated at night in
case he wanders out of the house confused.
These small, but signicant changes mean
that Arthurs life improved. He avoided hisnightmare of going into residential care,
and staff could support him in the way that
he wanted.
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Whatisperson-centredplanning?
3. Putsimply,person-centredplanningis
awayofaskingwhatpeoplewant,thesupporttheyneedandhowtheycangetit.Itassistspeopleinleadinganindependentandinclusivelife.Whenperson-centredplanningiscombinedwithanupfrontallocationofmoney(apersonalbudget),itiscalledsupport planning.Together,person-centredplanningandsupportplanningarepracticalwaystodeliverpersonalisedservicesandself-
directedsupport.
The purpose of person-centred planning is to
inform action that makes life better for people
with disabilities and the people who know
and love them.
JohnOBrienandConnieLyleOBrien(co-developersofperson-centredplanning)
Person-centred planning is our label for
learning how people want to live, to learnwhat is important to them in everyday life
and to discover how they might want to live
in the future. However, a plan is not an
outcome. The only reason to do the planning
is to help people move toward the life that
they want and person-centred planning is
only the rst part of the process.
MichaelSmull(co-developerofperson-centredthinkingandplanning)
4. Person-centredplanningisapracticalwayforpeopletohavechoiceandcontrol
intheirlives.Itisnotamagicbulletforeverythingthatneedstobechangedinpeopleslivesorinservices,norisitjustanewsetoftoolsandtechniques.Person-centredplanningisaphilosophyandanapproachthatisrootedincitizenshipandempowerment.
5. Person-centredplanningfocusesimmediatelyonthepositiveaspects
ofapersonsliferatherthanassessingwhattheycannotdo.Thedeciency-ledassessmentissodeeplyentrenchedinpolicies,proceduresandresource-allocatingmodelsinhealthandsocialcarethatitcanbothdiminishthehumanityofitsclientsandunderminetheirabilitytomakeacontributionbothtotheirownwelfareandtothewidercommunity.Oftenfamiliesandindividualsfeel
assessedtodeath,yetdiscoverthatthisleadstonopracticalhelpatallortotheallocationofaservicewhichatbestapproximatesthehelprequired.Thiscanbeprofoundlydisempowering.9
6. Focusingonthepersonsstrengths,passions,interestsandthethingsthatotherslikeandadmireaboutthemprovidesatremendousstartingpointfor
aco-productiverelationship.10
9 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley
Publishers.10 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley
Publishers.
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Background
7. Thiswayofworkinghasevolvedoverthe
last25years,mainlyinNorthAmericaandtheUK.Itstartedwithpeoplewhohavelearningdisabilitiesandinrecentyearshasextendedtoincludeeveryoneusingadultsocialcare,focusingonindependentlivingaswellasinclusion.Thousandsofpeople,likeArthur,andtheirfamilies,haveusedperson-centredplanningtohelpthemmakedecisionsandchangesintheirlives.Itisstartingtobeusedinhealth,too.For
example,thereisnowawebsitecalledThink about your life,11wherecancersurvivorscanuseperson-centredplanningtohelpmanagetheirtreatmentandsupport.
8. Valuing People12andPlanning withPeople Towards Person-centred
Approaches13weretherstgovernmentpolicyandguidancedocumentstobe
basedontheprinciplesofperson-centredplanning.Theysetoutexpectationsforlocallearningdisabilitypartnershipboardstodevelopframeworksfordeliveringperson-centredplanning.
Doesperson-centredplanningwork?
9. In2005,theDepartmentofHealth(DH)publishedresearch14intotheimpactofthis
wayofworkingonpeoplewithlearningdisabilities.Itfoundthat:
Very little change was apparent in peoples
lives priorto the introduction of person-
centred planning. Afterthe introduction ofperson-centred planning, signicant positivechanges were found in the areas of: social
networks; contact with family; contact with
friends; community based activities;
scheduled day activities; and levels of
choice The research supports the current
emphasis within health and social care policy
on using person-centred planning to improve
the life chances of people with learning
disabilities.
10. Notonlydidperson-centredplanningresultinsignicantpositivechange,itwasachievedatnoextracosttocouncilsotherthananinitialinvestmentintrainingandsupport.
11. Person-centredplanningenablesindependentlivingandrealchoiceand
controlfordisabledpeople.
Person-centred planning has given us hope
and a vision for a better future for
Mohammed. We feel now we can have a say
in how and what service support he receives.
We no longer believe that only professionals
know best for our son. Mohammeds faith
and cultural needs are recognised and
responded to.
Joynab,Mohammedsmother
11 www.thinkaboutyourlife.org
12 Valuing People(2001),DH.
13 Planning with People Towards Person-centred Approaches(2002),DH.
14 Valuing people and research: the Learning Disability Research Initiative overview report(2007),DH.
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Approaches to person-centredplanning
12. Therearefourmainapproachestoperson-centredplanning,eachdevelopedforaparticularcontextandeachexertingapowerfulinuenceincreatingchange.Theyreectadifferentwayoflistening,askdifferentquestionsandfundamentallyresultindifferentactions.
Thefourmainapproachesare:
essentialLifestylePlanning;
PATH(planningalternativetomorrowswithhope);
MAPS(makingactionplans);and
PersonalFuturesPlanning.
13. ThisguidancedealswithEssentialLifestyle Planning(ELP)asawaytoachievethePutting People Firstrequirementofmainstreamingperson-centredplanning.Theapproachcanbeusedwithinservicesthatpeopleuse.AnEssentialLifestylePlan15isadescriptionofhowsomeonewantstolive(whatpeopleappreciateabouttheperson,whatisimportanttothemandhowbest
tosupportthem)andactionstomovetowardsthis.Usingthisapproach,person-centredplanscanbegrownovertime,beginningwithinformationononepage
(aone-pageprole);thenthinkingaboutwhatisworkingandnotworkingfor
thepersonandthencreatingactionsforchange.ThisiswhatGillusedwithArthur,hisfamilyandstaffinthestoryatthebeginningofthischapter.
14. Theotherthreemainstylesofperson-centredplanningarecalledPath,16Maps17andPersonalFuturesPlanning.18Theyfocusonthefutureandhavebeendesignedforuseoutsideorattheedgesof
services.
15. Appendix 1providesamoredetailedcomparisonoftheotherthreeapproachestoperson-centredplanning.ThisguidancefocusesprimarilyonELP.
Person-centred thinkingtools the foundation forperson-centred planning
16. Thefoundationforperson-centredplanningisarangeofsimple,practicalperson-centredthinkingskillsandtools.
17. Usingthesetoolscanbringimmediatechangestopeopleslivesandtothewayprofessionalsandstaffsupportingpeoplework.Onthefollowingpagesisasummaryofsomeoftheperson-centred
thinkingtoolsandhowtheycanbeuseful.
15 SmullM,SandersonH,SweeneyC,SkelhornL,GeorgeA,SteinbruckM,Essential Lifestyle Planningfor Everyone(2005).
16 OBrienJ,PearpointJandKahnL,The PATH and MAPS Handbook: Person-centered Ways to BuildCommunity(inpress),Toronto:InclusionPress.
17 FalveyM,ForestM,PearpointJ,RosenbergR,All my Life is a circle(1994).
18 MountB,Capacity Works: Finding Windows for Change Using Personal Future Planning(1995).
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what it does how this tool a quick glimpse
sorting Sorts whats important TO
helps
As a way to think through aimportant TO important FOR
important
to/for
(what makes us happy,
content, fulfilled) from
whats important FOR us
situation before deciding what
should happen next.
As an everyday tool. need to learn/know
(health and safety, being As part of reviews.
valued) while working As the beginning of an
towards a good balance. individual, family or team plan.
the Identifies specific Helps you know where you
doughnutresponsibilities:
core responsibilities
can be creative without fear.
It clarifies the roles of the
sort using judgement and dierent professionals andcreativity agencies supporting people
not a paid responsibility. and families.
It can inform a family
support plan.
It clarifies roles and
expectations in a team plan.
matching sta A structure to look at both Helps people think about
what skills/supports and what kind of paid support
what people/characteristics they want and need.
make for good matches. Helps in recruiting team members.Gives the information for
the characteristics section
of a plan.
relationship Identify who is important to Learn who is important to
circlea person or family. people.
See if there are any
important issues around
relationships.
Helps identify who to talk to
when developing a plan.
Identify relationships that
can be strengthened or
supported.
communication Helps us focus on peoples A quick snapshot of how
chartscommunication whether they someone communicates.
use words to speak or not. A way of enriching the level of
To be used whenever a persons information available about
action communicates a message people who use words to
more clearly than their words. speak and particularly about
people who dont.
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what it does how this tool a quick glimpse
helps
learning log Directs people to look for Provides a way for peopleto record ongoing learning
ongoing learning.(focused on what worked
A structure that captures details well, what didnt work well)of learning within specific for any event or activity.
activities and experiences. Tells us what is important to
and for individuals, familiesProvides a way of recording
and team plans.information on what needs to Can replace traditional
stay the same and what notes or records to help
us focus more clearly onneeds to be dierent aboutcritical information about the
how we support people. person.
Can be used to focus on
someones whole life or
specific areas of their life,
e.g. someones health, or how
they like to spend their
time.
sorting Clarifies what to build on Analyses an issue/situation
whats (maintain or enhance) and across dierent perspectives.what to change. Provides a picture of how
working/notHelps in looking at how: things are right now.
working any part of a persons life
is working
medications are working people providing paid
support are doing in their
work
any eort, activity or project
is working.
Helps with mediation where
there are disagreements.
a quick glimpse
perspective 1
perspective 2
perspective 3
whats whatsworking not
working
IntroducingGraham
Graham uses a wheelchair, has profoundlearning disabilities and doesnt
communicate verbally. For years, the most
signicant part of his life was attending
a day service where there was an over-
reliance on repetitive activities like jigsaws.
By using person-centred thinking tools to
work out Grahams abilities and what was
important to him, staff members realisedhe suited ofce work. He consequently
attended a job centre interview and
now works at the Derbyshire Centre for
Integrated Living. He has thrived there,
is happier, more engaged and more
communicative. Using person-centred
thinking made that happen.
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Delivering personalisationthrough person-centred thinking
and planning
18. Inorderforpeopletohaverealchoiceandcontrolovertheirlifeandservices,thepeoplewhosupportthemwillwanttoconsiderthefollowingquestions(seealsothetablebelow):
Whatisimportanttotheperson,sothatservicesandsupportsarebuilt
aroundwhatmatterstothemasanindividualinsteadofpeoplebeinglabelledaccordingtoacondition,animpairmentorastereotype.
How,whenandwherethepersonwantssupportorservicesdeliveredratherthanastandardonesizetsallapproach.
Howthepersoncommunicatesthewayinwhichtheywanttheirservices
personalised.IfthepersondoesnotusewordsorifsomeoneelseismaingdecisionsontheirbehalfundertheMentalCapacityAct,thereneedtobeclearwaystomakeandrecorddecisionsandjudgementsaroundtheirsupportchoices.
Howwellprofessionalsandstaffaredeliveringpersonalisedservices.What
doindividualsthinkoftheservicestheyreceive?Whatworksanddoesnotworkforthem?Whatdopeoplesaytheywantinthefuturesothatpeopleresponsiblefortheservicescanrespondanddeveloptheservicesaccordingly?
a well dened understanding of important
to and for and a regular review of whats
working/not working that actually guides
Person-centredthinkingandplanningprovidespracticalwaystoaddressthesequestions:
What we need to know to deliver
personalised services
Person-centred thinking tools or processes
that can help
Whatisimportanttotheperson?Theimportantto/fortool,inone-pageproles,person-centredplansandsupportplans.
Whatisthebestwaytosupporttheperson? Bestsupportdescribedinone-pageproles,person-centredplansandsupportplans.
Howdoesthepersoncommunicateandmakedecisions?
Communicationcharts.Decision-makingproles.
Howarewedoingindeliveringpersonalisedservices?
Whatisworkingandnotworkingaspartofaperson-centredreview.UsingthistoinformchangeinserviceprovisionandcommissioningusingWorkingtogether for change.
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action is a necessary condition for any form of
service provision.
JohnOBrien
Getting started with person-centred thinking and planning
19. Thereareanumberofwaystostartusingperson-centredplanswithinorganisations,andtomakethisapproachstandardpracticeinservicedelivery.Optionsincludeto:
createone-pageprolesforindividualsthatleadtoaction;
implementperson-centredreviews19;and
useperson-centredplanningandthinkinginsupportplanning.
One-pageproles
20. Aone-pageproleisawaytosetoutinformationaboutwhatpeopleappreciateinanindividual,whatisimportanttothemandhowtheywanttobesupported.Itcanbecreatedbylookingatwhatisworkingandnotworkingforthepersonandwhatneedstohappentochangewhatisnotworking.Thiscanresultinbig,
smalloreverydaychanges,forexamplerearranginganolderpersonssupportsoshecangotothetheatreonceamonth.
19 BaileyG,SandersonH,SweeneyC,HeaneyB,Person Centred Reviews in Adult Services(2009).
Personalisation
Person-centred thinking
Person-
centred
reviews
Supportplan
Person-
centred
planning
Every person who receives support,whether provided by statutory
services or funded by themselves,
will be empowered to shape theirown lives and the services theyreceive in all care settings.
A range of practical toolsthat form the basis of person-centred planning. They helpfocus on the person, their gifts
and skills, what is important tothem, and how best to support
them.
A review process that can be used as a
statutory review. The review looks at apersons life and supports whats workingand not working, whats important to theperson now and in the future and agrees
outcomes for change. When the person has apersonal budget, the person-centred reviewis called an Outcome Focused Review.
A plan that shows howthe persons personalbudget will be spent to
achieve their outcomes.
A continual processof listening and
learning about what
is important to andfor the person nowand in the future, and
in alliance with familyand friends and makingchanges based on this.
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Caseexample
Onewoman lives in a residential setting.
To keep her memories and experiences of
working in a pub alive, she started having
a glass of red wine and a bag of crisps each
evening and now goes to bed at 11.30pm.
She says this has made her much happier.
21. Person-centredthinkingisawayofhelpingpeopletoworkoutwhatthey
wantandthesupporttheyneed.Itthenshowshowtheycangetthatsupport.Thisiscentraltoself-directedsupport.
One sheet of information on what matters to
me as a person and how best to support me
would be very useful.
Farzana,memberoftheTransformingAdultSocialCareserviceuserreferencegroup
22. Aone-pageproleisthebeginningofaperson-centredplan.InthediagrambelowyoucanseePatsone-pageprole.Pathaschronicobstructivepulmonarydisease(COPD)andtype2diabetesandyoucanreadherstoryinthediagramonpage8.
Important to Pat: Speaking and being in the company of her
family (daughter Su and granddaughterJessica) every day and enjoying her sleepovers with them.
Seeing friends and neighbours and beinginvolved with her local community.
Being part of other peoples lives.
Having a nice home and having the gardenlooked after by the gardener.
Looking her best in nice clothes andjewellery, being pampered and having herhair done at the local hairdressers onsenior day.
Always having enough food in the house!
Getting out and about with her scooter todo some shopping locally.
Going on holiday and sitting on the beachin the sun at least once a year.
Always having some money in her purse.
Having a weekly TV magazine.
Keeping busy and enjoying her manyinterests such as good food, gardening,drawing, watching TV (Big Brother andStrictly fan).
Enjoying the odd glass of Liebfraumilch.
Being busy, pottering around can take up alarge part of Pats day.
Making decisions and being organised.
Riding a Harley Davidson for her 70thbirthday.
Enjoying life!
How best tosupport Pat:
Share your day withher she loves beingin the company offriends and family.
Dont talk to her abouther illness.
Pat will worry if shethinks that Su ishaving to cope withtoo much.
Always give Pat plentyof time to get ready inthe mornings.
Dont rush her if goingout.
Dont fuss over her if
she is out of breath. Be aware that the
winter weather doeshave an effect on herhealth and she will needmore support at thistime.
Going with Su to thesupermarket oncea week and using ascooter trolley to do abig shop.
Pat enjoys going outat least once a week.
What those who know Patsay they like and admireabout her:
Bubbly lady.
Confident.
Independent.
Classy chick and always lookslovely.
Never lets her illness get her down.
A good friend and listener.
Cracking sense of humour.
Selfless.
Lives life to the full!
Pats one-page profile
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Person-centredreviews
23. Aperson-centredreviewisaperson-
centredapproachtotheannualreviewsrequiredinallservices.
24. Aperson-centredreviewisaspecicprocessthattakesbetweenanhourandaquarter,andanhourandahalf.Itrequiresatrainedfacilitator,whohelpsthemeetingalongbyusingthefollowingquestions:
Whatdoweappreciateaboutthe
person(thismaybecalledlikeandadmire)?
Whatisimportanttothepersonnow?
Whatisimportanttothepersoninthefuture?
Whatisthebestsupportfortheperson,tostayhealthyandwell?
Whatarethequestionstoanswer/issuestoresolveforthisperson?
Whatisworkingandnotworkingfromthepersonsperspective?
Whatisworkingandnotworkingfromthefamily/carersperspectives?
Whatisworkingandnotworkingfromthestaffandmanagersperspectives?
Whatisworkingandnotworkingfromtheothersperspectives(e.g.healthprofessionals,caremanagers)?
25. Thereviewinvolvestheperson,keypeoplewhohavetobetheretomeet
statutoryrequirements,andotherpeoplethatthepersonwantstoinvite.Themeetinggeneratesperson-centredinformationwhichcanbeusedtocreateaone-pageproleandbeginaperson-centredplan.Moreimportantly,itcaninitiateactionsthatwillpositivelychangethepersonslifeanddeliveramoreperson-centredservice.
26. Thequestionsposedareimportant,astheyareusedbycommissionerstoinformstrategiccommissioningandproviderbusinessplanning.ThisapproachisdescribedinrecentlypublishedDHguidanceWorking together for change:using person-centred information for
commissioning.20
A person-centred review can create
signicant change in how people live theirlives, based on what people want to achieve
it makes a difference.
Wendy,memberoftheTransformingAdultSocialCareserviceuserreferencegroup
27. Person-centredreviewsgenerateinformationforperson-centredplanningwhilemeetingstatutoryrequirementsandwithouttakingmoretime.Theyare
effectivelydirectedbythepersonandaddresstheirpriorityissuesbecausetheyarebasedonwhatpeoplesayisimportanttothem;theyshowwhatgoodsupportlookslikeanddiscoverwhatisworkingandnotworking.
20 Working Together for Change(2009),DH.
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In Wigan, the commissioner,aproviderandWiganPeopleFirst, a self-advocacy
group, came together to look at 20 person-centred reviews as part of the DH PuttingPeopleFirst co-producing commissioningwork programme. The group looked at what
people said in their person-centred reviews
about:
what is working;
what is not working; and
what is important for the future.
The group clustered the information into
themes. Together, they thought about
the underlying reasons for what was not
working for people and what the outcome
would be if each of these were addressed.
The group then decided what they would
do to move towards a successful outcome.
Person-centredplanningandsupportplanning
Using person-centred tools helped
it amazed me how everything came
together when I was developing Hannahs
support plan.
Alan,familycarer
28. Asupportplanisarecordofthedecisionsapersonhasmadeabouthowtheywanttospendtheirpersonalbudgettoachievetheoutcomesthathavebeendened.Person-centredthinkingandplanningareexcellentwaysofhelpingpeoplethinkaboutwhatisimportantintheirlife,what
theywanttochangeinthefutureandhowtheywanttousetheirresourcesand
money.Thisistruewhetherthemoneycomesfromexternalsources(thelocalauthorityforexample),oristhepersonsown.Everyonewhoassistspeoplewithsupportplanningneedstoknowhowtouseperson-centredthinkingandplanning.Juliadescribesbelowhowtheperson-centredthinkingtoolsimportanttoandworking/notworkingwereusefulwhenshedevelopedhersupportplan.
IntroducingJulia
My name is Julia and I am married with
an 11-year-old son. I have been disabled
for 13 years and I have been using social
services for ten years.
For the rst two years I had direct services.
This meant that I had carers who came
when they could, did what was written on
my care plan and then left.
I moved to direct payments in 1998 and
enjoyed the new freedom of being able to
choose who came through my door and
what they did when. I must admit when
personal budgets came along I was quite
sceptical. How could things get better than
this? But I decided to investigate more.
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The rst major difference was that I was
in control of my support planning and I
decided what the priorities for me were.This was a bit like having a life coach. The
types of questions asked were:
What is important to you?
What is working?
What isnt?
What needs to change?
They were very different to the usual social
services assessments. These questions
threw up some interesting answers for me
and as a result I have changed my care
radically.
I was given a budgetary gure for the whole
year and together with a support planner
(this can be someone outside of social
services, or you can do it on your own)
we wrote a plan of how I would spend
the money to meet my eligible, assessed
needs. The plan we came up with included
buying lightweight modular ramps to nally
make my house wheelchair accessible; air
conditioning to help my breathing andreduce my admissions to hospital; and an
accessible patio to enable me to access my
garden.
BUDGET:
WHAT DO I
WANT TO
CHANGE?
SUPPORT PLAN GRAPHIC for
NOT WORKING WORKING
NOW
WHAT DO I BRING?
WHATS
IMPORTANTTOME?
BOTTOM LINE
SUPPORT
SUPPORT
HOW CAN I
KEEP GOING
AND STAY IN
CONTROL?
HOW DO I WANT
MY LIFE TO BE?
ACTION PLAN
2006 Helen Sanderson Associates
Created by The Grove Consultants International
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Creating a person-centred systemto deliver personalised services
29. Person-centredthinkingtoolsareversatileandcanbeusedwithindividuals,teamsandorganisationstothinkdifferentlyandcreatedifferentkindsofactions.
30. Todeliverpersonalisedservices,peopleneedtobeabletouseperson-centred
thinkingtoolsandapproachesintheirday-to-daylivesandwork.Person-centredplansdescribehowpeoplewanttoliveandbesupported.Plansshouldbethebasisofthejobroleandtasksforthe
staffwhosupportpeople.Theprocessofusingperson-centredplanstoguidewaysofworkingforsupportstaffneedstobecentraltohowteamsworkanduseresources.Arthurssupportstaffusedtoapproachhimwhenhewasinbed,althoughhethoughttheywereburglarsandusedtohitoutwithhiswalkingstick.Creatingaone-pageprolehelpedthemrealisethattheyneededtowork
differently.Staffnowrespectthatwhenheisinbed,theycallhisnamefromthebedroomdoor.
All these were achieved with the same
amount of money I had had as a direct
payment. And I was able to do it becausethe process let me make more use of my
informal networks of support, like my
husband and friends. They were happy to
help me more as they beneted from less
lugging of wheelchairs and fewer hospital
visits. I also vowed to spend less time
working and more time with my family!
I would say that direct services allow you to
survive at home, direct payments give you
more choice and control over your life but
personal budgets allow you to live!
IntroducingMichael
Michael, who has a learning disability anddoes not use words to communicate, will
periodically yell and pound on the tray
attached to his wheelchair. One of the
people supporting him noticed that while
he was yelling, he was also staring. She
picked up the pea that he was starting at on
the oor and the yelling stopped.
It seemed that he felt strongly that
everything has a place and could not
tolerate mess. Now, every time he startsto yell, people ask him if something is
out of place and look where he is staring.
Together, he and the person supporting
him, work it out and the yelling stops. This
is recorded on his communication chart.
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Workbookstosupportperson-centredplanning
31. Person-centredplansaremorelikelytomakeadifferencewherethereisaperson-centredculture.Tocreatepersonalisedservices,managersneedtoembedperson-centredthinkingandapproachesintoalloftheirmanagementpractices.Researchhasshowedthatperson-centredplanningwasmostsuccessfulwhenmanagerswereactivelyinvolvedinplanning.21Person-centredthinkingiscentralto
deliveringIndividualServiceFunds,whichisdescribedintheAdviceforProviders(workbook1).
32. Healthprofessionalsandcaremanagershaveanimportantroletoplayindevelopingperson-centredpracticesacrossorganisations.Practitionerscanuseone-pageprolesorperson-centredplanstosupportpeopleintakingmorecontrolovertheirhealthandtheirlives.Professionalscanensurethereviewstheydoareperson-centred,outcome-focusedandleadtochangingwhatisnotworkingforpeople.Professionalsmayalsocontributetoindividualsperson-centredplans.Whenitcomestopersonalbudgets,professionalsplayanimportantroleinensuringeveryonehastheinformationtheyneedforsupportplanning.Finally,caremanagersandhealthprofessionalscanuseperson-centredthinkingtoolsintheirday-to-daypracticeandteamworktoenhanceeffectiveness.Therolesofhealthprofessionalscaremanagers,practitionersandotherprofessionalsaredescribedinmoredetailintheAdviceforProfessionals(workbook2).
33. Thereneedtobeconsistentmessagesfromcommissioners,procurementstaff
andregulatorsaboutperson-centredthinkingandplanning.Commissionersneedtoknowhowtocommissionperson-centredpracticeandbasecommissioningonperson-centredplans.Theythenneedtoworkinpartnershipwithproviderstodeliverchanges.Procurementstaffmaytenderandestablishcontractsbasedonperson-centredinformation;evaluatetendersontheirabilitytodeliveraperson-
centredserviceandreviewcontractsusingperson-centredreviews.Regulatorsneedtolookforperson-centredpracticeandrecognisebestpractice.TheseissuesarecoveredintheAdviceforCommissioners(workbook3).
34. Schoolsandchildrensserviceshaveanimportantroletoplayinraisingyoungpeoplesexpectationsthattheywillgointo
workandleadfulllives.Youngpeopleandtheirfamiliesneedaccessibleinformationfromthestartofthetransitionprocessaboutwhatispossibleintermsofcareers,employmentandindependentlivingandwhatsupportisavailabletoachievetheiraspirations.Usingaperson-centredapproachintransitionplanningresultsinbetteractionplansandhelpspeopletomakedecisionsabouttheirfuture.We
arenowlearninghowtobringtogethertransitionplanningandsupportplanningsothatresourcesareusedeffectivelytohelpyoungpeoplegetthesupporttheywant.TheseissuesarecoveredintheAdviceforUsingPerson-centredThinking,PlanningandReviewsinSchoolsandTransition(workbook4).
21 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,The Impact of Person Centred Planningfor People with Intellectual Disabilities in England: A Summary of Findings(2005),LancasterUniversity:InstituteforHealthResearch.
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CHAPTER 3
In the future we want people to have
maximum choice, control and power over the
support services they receive.
Putting People First22
1. SincetheintroductionofValuing Peoplein2001,importantlessonshavebeenlearntfromtheimplementationofperson-centredplanninginlearningdisabilityservices.Thischapter:
setsoutsomeofthelearninggatheredthroughresearch,consultationandpractitionerexperience;
setsoutthecontributionthatperson-centredthinkingandplanningcanmaketodeliveringonthepersonalisationagendaagainstlocalgovernmentmilestones;
providesquestionstohelpreviewprogress;and
suggestssomenextsteps.
What works and what doesntwork in implementing person-centred planning?
2. Whatactionsworkinimplementingperson-centredplanning?
Effectiveleadership.
Investinginlocalcapacity.
Trainingandsupportingstafftouseaperson-centredapproachwhatevertheirrole,throughuseofperson-
centredthinkingtools.
Havingastrategicfocusoncreatingaperson-centredculture,byusingperson-centredthinkingatalllevelsofanorganisationandnotjustimplementingplanning.
Embeddingperson-centredapproaches,byndingopportunities
touseperson-centredthinkinginallaspectsofthesystem.
3. Whatdoesntworkinimplementingperson-centredplanning?
Expectingfacilitatorstodevelopperson-centredplansandtoensurethattheyareimplementedorhandedovertomanagers.
Relyingonexternal,independentperson-centredplanningfacilitatorstoberesponsibleforcreatingperson-centredplans.
Appendix 3setsouttheseareasinmoredetail.
Delivering PuttingPeopleFirstandachieving the local government
milestones using person-centredthinking and planning
22 Putting People First(2007),DH,p.2.
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Supporting delivery of themilestones
4. ThelessonslearnedfromimplementingtheValuing Peopleperson-centredplanningguidance23informhowperson-centredplanningcancontributetothedeliveryofPutting People FirstandthelocalgovernmentmilestonessetoutbyADASSandtheLGA.24
5. Theappendicesfocusonthemilestones
thatrelateto:
self-directedsupportandpersonalbudgets;
effectivepartnershipswithpeopleusingservices,carersandotherlocalcitizens;
preventionandcost-effectiveservices;
informationandadvice;and
localcommissioning.
6. Appendix 4looksat:
whathasbeentriedandlearnedthatisrelevanttoeachofthesemilestones;
somequestionstoevaluatewhereyouarenow;and
suggestionsfornextstepswithlinkstotoolsandresources.
Where are you now?
7. Appendix 5setsoutsomequestionstohelpyoustartthinkingaboutyourprogressinusingperson-centredthinkingandplanningtodeliverPutting PeopleFirstandtomeetthelocalgovernmentmilestones.
What can you do next?
8. Appendix 6suggestspriorityactions:
Providingclearinformationandadviceaboutsupportplanningandperson-centredreviews.
Makingsuretherearearangeofpeoplewhocanassistwithsupportplanning,notjustcaremanagers.
Implementingperson-centredreviews
inservices.
Deningleadershipforperson-centredthinking,planningandreviews.
Investinginperson-centredthinkingandcreatingalocalresourceofpeoplechampioningperson-centredthinkingandplanning.
AdoptingWorking together for changeorasimilarapproachtoco-producecommissioningandstrategicplanning.
9. Appendix 7listsadditionalusefultoolsandresources.
23 Planning with People Towards Person Centred Approaches(2002),DH.
24 Lettertocouncil(September2009),ADASSandLGA.
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27
Theotherthreemainstylesofperson-centredplanningarecalledPATH,25MAPS26andPersonalFuturesPlanning.27Theyfocusonthefutureandhavebeendesignedforuseoutside,orattheedgesof,services.Theyinvolveonepersonatatimeandfollowameetingformat.Thesestylesofplanningrequireanindependentfacilitator
andacommittedgroupofpeoplewhomeetregularlytoimplementtheplans.JohnOBrien,oneoftheco-developersofPATH,MAPSandPersonalFuturesPlanning,describesthesestylesasanartorcraftandtalksofthedangersofseekingtoassimilatethesestylesofperson-centredplanningintotheservicesystem.PATH,MAPSandPersonalFuturesPlanningareveryhelpfulininformingsupportplanningbycreatingasharedimage
ofadesirablefuture.JohnOBriensuggeststhatPATHandMAPSaremostlikelytoresultin:
people making satisfying community
contributions
when a circle that continues to support the
person holds the plan than when a group
gathers to plan and then disperses.
when a person who requires assistance and
the circle plan alongside an organisation
committed to person centred work.
Typically the person involved people who
know and like them to come to a meeting.
One or two facilitators guide and record the
discussions and decisions. After the meeting
people do what has been agreed. This hardlysounds revolutionary. But the frame which is
put around the meeting, the questions the
meeting asks and the way the meeting is
organised often mean that new possibilities
emerge, new understandings develop, new
alliances are formed and peoples lives take a
denite turn for the better.
PeteRitchie28
Appendix 1
Background on person-centred
planning
25 OBrienJ,PearpointJandKahnL,The PATH and MAPS Handbook: Person-centered Ways to BuildCommunity (inpress),Toronto:InclusionPress.
26 FalveyM,ForestM,PearpointJandRosenbergR,All My Life is a Circle(1994).
27 MountB,Capacity Works: Finding Windows for Change Using Personal Future Planning(1995).28 HunterSandRitchieP(eds),Co-Production and Personalisation in Social Care(2008),JessicaKingsley
Publishers.
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Appendix 2
What DH policies say about
person-centred approachesPerson centred approaches in current policy
Policy What it says about personalisation and person centred approaches
1. Valuing People Now and Key Priorities
Valuing Employment For 2009 -10 the key priorities include: to ensure that the Personalisation agenda is embedded within
Now all local authority services and developments for people with learning disabilities and their family carers,and is underpinned by person centred planning.Regional Action and SupportThe Deputy Regional Directors and the Valuing People Regional Leads will establish a regional deliveryplan to respond to the national delivery plan and the key priorities. For 2009-2010, these are: ..to ensurethat the Personalisation agenda is embedded within local authority services and developments forpeople with learning disabilities, and is underpinned by person centred planning and support.Education, work and getting a lifeToo few people with learning disabilities have opportunities to work and study after leaving school, orto enjoy a full range of leisure and social activities in their local communities. The policy objective is toincrease the number of people in employment and who have access to post-16 education. The followingaction will be taken: ...The Transition Lead in the office of the national Director, with support from theValuing People Regional Leads, will continue to oversee a programme to embed Person CentredTransition Planning in the statutory Transition process nationally (2009-10) (p35)Making it happen - commissioningGood commissioning, based on sound information from Joint Strategic Needs Assessments and collationof information from person centred plans, is the key to improving outcomes for people with learningdisabilities. It enables Local Authorities and Primary Care Trusts to identify gaps in services, developnew models of service provision, working with providers, and decommission inappropriate models.
Valuing Employment NowJoint working to create employment paths for individuals. Where people with moderate and severelearning disabilities have jobs, it is achieved through very close partnership working between statutory,voluntary and private agencies, with funding streams brought together. Starting from a person centredapproach, this joint working needs to map out a clear employment pathway for people with learningdisabilities. (p15)Making it happen regionally and locally - recommended actions ...Social care staff to embed employmentin the person centred support plans of working-age adults, including bringing together funding forsupported employment. (p37)Person centred employment planning...social care services should use person centred planning to help individuals to explore theirinterests and aspirations, and specifically to think about the implications of these for work. Getting a
job should be a priority for all working-age adults. DH will issue guidance on this. (p46)Key actions for government departments...DHs forthcoming person centred planning guidance will emphasise that the individual supportplanning process for all adults of working age should prioritise employment as an outcome.
Making it happen regionally and locally - recommended actions...Social care staff to use person centred planning to change peoples work expectations andidentify their path to employment, using personal budgets for this where appropriate. (P48)
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Policy What it says about personalisation and person centred approaches
2 Living well with
dementia: a national
strategy 2009
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058
Case for Change... Emerging research-based evidence shows considerable benefits to both people with dementia andtheir carers from specialist dementia home care when compared with standard home care services.Improved outcomes include reduced stress and risk of crises for carers, and extended capacity for
independent living for people with dementia. Some examples of innovative practice are emergingfrom dedicated home care dementia teams. They ensure the provision of additional time prior to thecommencement of the care package, to build a rapport, learn about the person with dementia, theirfamily, their preferences and their life as a whole so that the service is truly person-centred. (p47)Community Personal Support ServicesObjective 6: Improved community personal support services. Provision of an appropriate range ofservices to support people with dementia living at home and their carers. Access to flexible andreliable services, ranging from early intervention to specialist home care services, which are responsiveto the personal needs and preferences of each individual and take account of their broader familycircumstances. Accessible to people living alone or with carers, people who pay for their care privately,through personal budgets, or through local authority-arranged services.A comprehensive community personal support service would provide: home care that is reliable, withstaff who have basic training in dementia care; flexibility to respond to changing needs, not determinedby rigid time slots that prevent staff from working alongside people rather than doing things for them;access to personalised social activity, short breaks and day services; access to peer support networks;access to expert patient and carer programmes; responsiveness to crisis services; access to supported
housing that is inclusive of people with dementia; respite care/breaks that provide valued and enjoyableexperiences for people with dementia as well as their family carers; flexible and responsive respite care/breaks that can be provided in a variety of settings including the home of the person with dementia;independent advocacy services; and assistive technologies such as telecare. (p 48)Carers - the most valuable resource for people with dementia - The Case for Change... Often, insufficient information is sought from relatives and carers. This means that person-centredcare is not delivered and it can lead to under-recognition of delirium and dementia.Objective 7: Implementing the Carers Strategy for people with dementia... Carers have a right to anassessment of their needs and can be supported through an agreed plan to support the importantrole they play in the care of the person with dementia. This will include good-quality personalisedbreaks...Improving care for people with dementia in care homes - The Case for ChangeThere is no doubt that residential care may be the most appropriate and effective way of meeting theneeds of someone with dementia and a service of choice. There are care homes that provide excellentcare for people with dementia. Such homes generally pay close attention to leadership and staffmanagement, staff training and development, and person-centred care planning. They also provide a
physical environment that enables people with dementia to move around the home safely. They providepurposeful activities that relate to individual preferences rather than general entertainment; activelyinvolve relatives and friends in the care of residents; and develop strong links with and involvement inlocal communities. There is a growing interest in Life Story work which provides an effective vehiclefor care home staff to communicate and develop relationships with residents, based on their unique lifeexperiences. Equally the provision of therapeutic activities within care homes, such as art therapy, musictherapy or dramatherapy, may have a useful role in enabling a good-quality social environment and thepossibility for self-expression where the individuality of the residents is respected. (p 58)
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Policy What it says about personalisation and person centred approaches
2 Living well with
dementia: a national
strategy 2009
Commissioning a trained and competent workforceObjective 14: A joint commissioning strategy for dementia. Local commissioning and planningmechanisms to be established to determine the services needed for people with dementia and theircarers, and how best to meet these needs. Joint commissioning strategies will need to take accountof peoples needs for both mainstream and specific services. They will need: a community focus, linking
into Local Area Agreements and the development of sustainable communities; and an individual focus,drawing on the use of personal budgets and the commissioning of self-directed support...The strategiesshould inform the operational plans and budget cycles of PCTs and local authorities, and demonstratehow they plan to improve services for people with dementia. They should be informed by guidance onWorld Class Commissioning and ... as well as the Putting People First guidance. (p 67)
3 New Horizons Vision By 2020, we hope that: Mental health services will make special plans that give people a bigger say inNew Horizons (July what their treatment is and how they get treatment. This will be underpinned by:
2009), the emerging Guiding values (p 26)
national policy
framework for mental
We are aiming for a model of care in which service users can determine their own route to recoveryand the role of the professional is to support them in achieving this.
health, which replaces
the National Service
Framework for Mental
Health (2000), providesa further impetus
for personalisation in
mental health, calling
for a move from
something which should
Better mental health care for adults (p 61)Key message: People with mental health problems should receive high-quality, personalised care basedon recovery principles, whether in hospital or in the community.The foundations for mental health care services include: high-quality clinical services providing evidence-based interventions along a care pathway tailored
to individual needs, choices and preferences. a recovery philosophy focusing on building on individual strengths and improving quality of life as
defined by the service user.Assessment (p56)Timely, comprehensive assessment that considers the needs of both the individual and their family or
be done to service users carers is central to care planning and to the delivery of multi-disciplinary care. One such approach isby the system, towards a the 3 Keys method. (p126) This outlines three keys to a multi-disciplinary assessment that supports
system of support built
by the person and their
advocates...
National Mental Health
Delivery Unit (NMHDU)
Kevin Lewis
recovery and the development of self-management skills: active participation of the service user and where appropriate their carer in a shared understanding
with service providers. input from different provider perspectives within a multidisciplinary approach. a person centred ethos that builds on the strengths, resilience and aspirations of the individual
service user as well as identifying his or her needs and challenges.
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Policy What it says about personalisation and person centred approaches
4 High Quality Care For
All - Final report of the http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
Next Stage Review 2008...Providing personalised care should also help us to reduce health inequalities, as the households withthe lowest incomes are most likely to contain a member with a long-term condition. (p34)
Over the next two years, every one of the 15 million people with one or more long-term conditionsshould be offered a personalised care plan, developed, agreed and regularly reviewed with a named leadprofessional from among the team of staff who help manage their care. (p47)
Pilot personal health budgets. Learning from experience in social care and other health systems,personal health budgets will be piloted, giving individuals and families greater control over their owncare, with clear safeguards.
5 Carers at the heart of http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085338.pdf
21st century families
and communities 2008By 2018: carers will be respected as expert care partners and will have access to the integrated andpersonalised services they need to support them in their caring role... (p13)Personal BudgetsPersonal budgets signal the move towards a system where person-centred planning is at theheart of the services provided by central and local government, and services are tailored to meet theneeds of individuals and families...over the next few years, we are committed to giving every person
using social services, including carers, a personal budget. Personal budgets will enable carers to live alife outside their caring role while still ensuring that the people they care for receive the high-qualitysupport they need. (p79)Partners in careInformation prescriptions are part of the person-centred care approach which is a consistenttheme running through the department of healths vision for everyone who uses health services andsocial care. They should enable people with long-term conditions and their carers, from the pointof diagnosis, to make better informed choices when planning care and getting on with their lives.Information prescriptions will also support professionals in sharing information with those who useservices and assist them in their role of navigating people around the system. (p122)
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What works in implementingperson-centred planning?
Effectiveleadership
Researchhasstressedtheimportanceofleadershipforperson-centredplanning,particularlyfromindividualswhouseservices,families,managersandimplementationgroups.29Powerful,effectiveleadershipbypeoplewhouseservicesandfamilycarershasoccurredwhentheyhavehadsupporttodeveloptheirownperson-centredplans,andhaveseenthedifferencethishasmadetotheirlivesandhavewantedtosharethiswithothers.PartnersinPolicymakingandothercitizenleadershipcoursesareexcellentopportunitiesforpeopletodeveloptheirownperson-centredplansandseethemmakeadifference.
Mostlearningdisabilitypartnershipboardsandsomeprovidershaveestablishedgroupstoleadthedevelopmentofperson-centredplanning.Thesehavebeencalledimplementationgroups,taskgroupsorsteeringgroups.LeadershipexpertJohnKottercallsthistypeofgroup,whoformacriticalmassforchangeintheorganisation,aguidingcoalition.30Thisisnotjustanotherbureaucratictaskgroup;thisgroupneeds
todemonstrateperson-centredvaluesandinclusion.
Manyimplementationgroupsusethesefourgoalstodenetheirpurpose:
Workingtoensurethatperson-centredthinkingandplanningishappening.
Makingsurethatthisplanningisgoodquality.
Makingsurethatthatperson-centredthinkingandplanningchangespeopleslives.
Makingsurethatplanningischangingtheservices,sothatmorepeopleareworking,livingintheirownhomesanddirectingtheirownsupport.
Implementationgroupshavebeenmostpowerfulinmakingchangewhentheyhave:
theactiveinvolvementofpeoplewhouseservicesandfamilycarerswhohave
personalexperienceofperson-centredplanning;
committedleadershipatasenior,strategiclevel;
Appendix 3
What works and what doesnt work
in implementing person-centredplanning?
29 RobertsonJ,EmersonE,HattonC,ElliottJ,McIntoshB,etal,Research Health The Impact of PersonCentred Planning for People with Intellectual Disabilities in England: A Summary of Findings (2005),
LancasterUniversity:InstituteforHealthResearch.30 RitchieP,SandersonH,KilbaneJandRoutledgeM,People, Plans and Practicalities: Achieving Change
through Person Centred Planning(2003).
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aclear,sharedsenseofpurposedrawnfromavisionbasedoncitizenshipand
inclusion;
aclearlydenedwayofworkingtogethertoachievethischange;and
decidedwhatsuccesslookslikeandhowtheywillknowtheyarebeingsuccessful
thisincludeswhattheywillsee,hearandfeel.
DerbyCityPartnershipBoard
commissioned a programme of
development based on person-centred
thinking for its services. Neil, the person-
centred planning coordinator, explained
that these programmes are based around
one provider organisation: We cover the
city councils provider and commissioning
arms, three external providers and the
learning disability services of the mental
health trust. Family members, self-
advocates, board members and provider
representatives were part of the leadership
team. They thought about what success
would look like in three years, as theorganisations became more person-centred
and developed specic outcomes and
success indicators. The programme included
training in person-centred thinking and how
it could be applied to running meetings,
enabling risk, supervision and recruitment.
Managers were given direct support and
coaching from the person-centred planning
coordinator to help them implement what
they had learned. Providers shared thesechanges with the leadership team and
identied those that needed to be shared
with the partnership board.
Listen2Me is a group of service-user leaders
who offer training to help other service
users understand what is important to
them now and what will be important to
them in the future. This gives people the
choice and control to be in charge of what
happens in their own lives. The course is
co-facilitated by service users who have
been through the training themselves and
have used person-centred planning in
their own lives. Through their experiences,
they can offer direction to other service
users. A Listen2Me course can also help
people write their own one-page prole
and prepare for their own person-centred
review. Listen2me helps service users
understand how to get practitioners to
listen to them and their wishes.
Listen2me is brilliant it has helped me to
tell people what I want in my life.
Neil
Sally attended a PartnersinPolicymaking
course in 2003: It was like a light bulbswitching on, she said of her rst contact
with person-centred planning. I was told
on the rst day of the course that it would
probably change my life and of course I
thought, Oh yeah. It did though. The
very rst sessions were about person-
centred approaches and person-centred
planning. Sally now organises person-
centred planning meetings for her son and
other local people.
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31 Planning with People Towards Person Centred Approaches(2002),DH.
Investinginlocalcapacity
Havinglocalperson-centredplanning
coordinatorswhocouldtrainandsupportothershasworkedtocreatelocalcapacity.Localchampionswhocoachandsupportothersinusingperson-centredthinkingcanalsohelpwithfacilitatingperson-centredreviewsandplanning.
A nationalproviderhas invested inidentifying, training and supporting
champions throughout the organisation.
The champions undertaking person-centred
thinking and coaching skills training are
mainly rstline managers. They receive
regular support from an internal group of
person-centred thinking trainers. A local
leadership team supports the champions.
The leadership team functions like an
implementation team. They have a vision
of what success would look like if person-
centred thinking and planning were reallymaking a difference in the organisation.
From that vision, they have identied
annual targets and success indicators. At
each meeting, they examine how they are
progressing with their targets and hear from
the champions about what is working and
not working. Once a year, members from
all the leadership teams and the champions
meet together, to share what they are
learning. This informs the work of thedirectors. The organisation won a National
Training Award for how this work has made
a difference to people who use the service
and their staff.
Trainingandsupportingstafftouseaperson-centredapproachinarange
ofrolesusingperson-centredthinkingtools
ThisapproachwasdescribedasadepthandbreadthapproachintheoriginalDHperson-centredplanningguidance.31Thismeansallstaffhavingabreadthofexperienceinperson-centredthinkingandapproacheswhilealsoprovidingmorein-depthtrainingandsupporttoacoreteam(seeabove).Itisimportant
caremanagersandprofessionalshaveopportunitiestolearnaboutanduseperson-centredthinkingintheirrolestoenhancetheirexistingpractices.
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Findingopportunitiestouseperson-centredthinkinginallaspectsofthe
system
Usingperson-centredthinkingandapproachesneedstoextendbeyondrstlinemanagers,sothateveryoneinanorganisationisclearabouthowtheycanworkinperson-centredways.Insteadofjustimplementingperson-centredplans,thefocusneedstobeonhoworganisationscanbecomemoreperson-centred,creatingaperson-centredculture
inwhichpersonalisationcanourish.Itiseasyforpeopletothinkthatperson-centredthinkingandplanningisjustsomethingthatneedstohappenwithpeoplewhoaresupported.Manyorganisationsarendingperson-centredthinkingskillsbenecialinotherareasforexampleinhumanresources,meetingsandwithinqualityassurance.
What does not work in
implementing person-centredplanning?
Expectingfacilitatorstodevelopperson-centredplansandtoensurethattheyareimplementedorhandedovertomanagers
Inmanyplaces,person-centredplanning
facilitatorsandcoordinatorsaresolelyresponsibleforthedevelopmentofperson-centredplanning.Thishasledtothedevelopmentofcriteriagoverningwhocangetaplan,withinevitablewaitinglistsandinequalities.Managerscantakeresponsibilityforensuringthatstaffmemberssupportingpeopleknowwhatmatterstoaperson,howbesttosupportthemandhowtoactonthis.Facilitatorscouldplayaroleincoaching
andsupportingmanagersandstaffinusingperson-centredthinkingtodevelopplans.
Relyingonexternal,independentperson-centredplanningfacilitators
toberesponsibleforcreatingperson-centredplans
Somelocalauthoritiescreatedindependentteamstoofferperson-centredplans.Oneauthorityinvested100,000peryearoverthreeyearsandtheoutcomewas90person-centredplans.Thereweresomegreatoutcomesforafewpeople,butnotalloftheseplanswereimplementedoreffectiveincreatingchange.Outsourcingtheperson-centredplanningresourcealsomeantthatperson-centredthinkingandplanningwasseenassomeoneelsesjob.Itwasanotherservicetoreferpeopleto,ratherthananapproachforeveryonetouseintheirday-to-daywork.
Aninternalteamofchampionsforperson-centredthinking,planningandperson-centredreviewscancoach,trainandsupportpeopleinusingthesetoolsandbefacilitatorsoflastresortwhenthereisnooneelsewhocantakethatrole.Theoutcomeshouldbeaperson-centredculturewhereeveryoneworkstoensurethatchoiceandcontrolisinthehandsofpeoplewhousetheservice.Aninternalteamcanhaveasignicantimpactoncoachingandsupportingculturalchangethroughperson-centredthinking,fargreater
thananarmslengthservicethatdeliversperson-centredplans.Itcanbevaluabletohavepaidindependentfacilitatorsavailabletopeopleandfamilies;however,localauthoritieswillwanttoinvestincreatinglocalcapacityforchangeandnotrelyonexternalfacilitatorstoachieveculturalchangeandtodeliveronperson-centredplans.
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33 Operating Models: Learning From the Early Adopters(2009),ADASS.
34 Evaluation of the Individual Budgets Pilot Programme: Final Report(2008),IndividualBudgetsEvaluationNetwork.
35 Operating Models: Learning From the Early Adopters(2009),ADASS.36 Putting People First: Support planning and brokerage with older people and people with mental
health difculties(2010),DH.
Appendix 4
Person-centred planning anddelivering the milestones
Self-directed support andpersonal budgets
Assuggestedearlier,tobeabletodeliverself-directedsupportrequiresknowledgeofwhatisimportanttotheperson,howtheywanttobesupportedandthesupportthey
requiretomakedecisions.Adultsocialcarestaffmembersneedtoactuponup-to-dateinformation.Thisinformationcanbethebeginningofaperson-centredplan,whichisfundamentaltosupportplanning.
LearningfromEarlyAdopters33andtheevaluationoftheIndividualBudgetsPilot34showsthatsupportplanningprocessescantakelonger,buttheoutcomesarebetterand
peoplefeelmoreempowered.
Newthinkingisrequiredforsupportplanning
Thereisacautionaboutsomesupportplansbeingcomposedusingtraditionalcareplanningtechniquesandthinking,forexample,wherepractitionersusetheoldworldtimeandtaskmodeltotranslate
peoplesneedsintohoursofcare.35
Olderpeopleandpeoplewhousementalhealthserviceswhohavepioneeredsupport
planning,36suggestthefollowingbestpracticetohelppeopledevelopsupportplans:
Payattentiontohistoryandhearthepersonsstory.
Lettheindividualsetthepaceofthe
planningprocessandchoosewhoelsetoinvolve.
Planforcontingenciesandbeexible.
Trydifferentwaysoflisteningtopeople.
Focusonwhatisimportanttotheperson(notwhatisimportanttostaff).
Peopledonotneedtohaveaperson-centredplanbeforetheystarttheirsupportplan,buttheprinciplesandtoolsusedinperson-centredthinkingwillbefoundinallgoodsupportplanningapproaches.Ifpeopledohaveaperson-centredplan,theyhaveaheadstartontheinformationneededforasupportplan.
Athoroughgroundinginperson-centredthinkingandplanningforanyoneundertakingsupportplanningwillavoidtheoldworldtimeandtaskmodelmentionedearlier.Greatsupportplanningisanopportunityforpeopletothinkafreshabouthowtheywanttheirlife
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tobe.Itshouldnotbeaproceduredriven,formllingexerciseledbystaff.
Co-producingsupportplansandpeersupport
Co-producingsupportplanswithotherpeoplehasemergedasapowerfulwaytoplan.37Aco-productionapproachsupportsanddevelopspeer-to-peersupportandoffersthisinasmallgroupsetting,aswellasonaone-to-onebasis.Ascouncilslooktodevelopnewandmoreempoweringrelationshipswith
peoplewhousetheirservices,itisincreasinglyimportanttondeffectivewaysofteachingpeopletheskillstodesignandmanagetheirownsupportarrangements.Engagingpeopleasactiveparticipantsinsupportplanningisessentialindirectingtheirownsupport.Itgivespeopletheopportunitytodesignandbuildtheirownsolutionstotheirsupportneeds,basedonwhatisimportanttothem.38
ADHprojectthatprovidedeightcouncilswithasmallamountofseedfundinghasdevelopedinnovativewaystotransfersupportplanningskillstopeopleusin