personalisation & social work
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Personalisation & Social WorkDr Simon DuffyTalk for University of Huddersfield, 2011
1Monday, 23 January 12
Agenda
9.20 What is ‘Personalisation’10.30 Opportunities & Concerns - tables11.00 Break11.15 Debate12.00 Social Work Rescript12.45 Lunch2.15 Applications - tables3.00 Feedback3.30 Break4.00 Polling Questions4.30 Final Questions5.15 Finish
2Monday, 23 January 12
Dr Simon Duffy
• Invented Individual Budgets and Self-Directed Support
• Founded Inclusion Glasgow, In Control, Shop4Support and many other charities and social enterprises
• Honorary Senior Research Fellow at University of Birmingham’s Health Service Management Centre
• Director of The Centre for Welfare Reform
• Policy advisor to The Campaign for a Fair Society
• Based in Sheffield
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The Centre for Welfare Reform
• Research & development network
• Independent - no government or private backing
• Founded upon belief in human equality and diversity
• A community of 60 voluntary Fellows...
• ...people who created person centred planning, individual budgets, self-directed support, support planning etc...
• 200+ publications at www.centreforwelfarereform.org
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The welfare state is good
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The welfare state is good
it’s just designed wrong5Monday, 23 January 12
The welfare state is good
it’s just designed wrong5Monday, 23 January 12
• Personalisation is not defined by government
• Personalisation is about social justice
• Good ideas don’t just happen
• The challenge is to make it work for you
4 Thoughts
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What is the meaning of personalisation?
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Photos from “Christmas in Purgatory”
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Institutions don’t just come with walls...
They start in the mind...
And can be hidden in systems of power, education, funding and culture
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‘inclusion’ ‘normalisation’‘individualised’‘community’‘empowerment’
Great language...
...shame about reality
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44 women with complex needs
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Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t !nish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children have experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%
Of 44 women working with WomenCentre:
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Service label N Urgent problem N Real need N
Victim of domestic violence 55 Debt 50 Better self-esteem 64
Mentally Ill 39 Housing 48 To overcome past trauma
54
Criminal 35 Benefits 46 To manage current trauma
51
Poor Mother 33 Health 37 To stop being bullied
50
Misuses Alcohol 24 Rent 32 Guidance 50
Uses Drugs 22Criminal Justice Advocate 24 Relationship skills 45
Violent 19 Dentistry 8 Mothering skills 26
Chronic Health Condition
16 Others 3 Others 1
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is there a different way?
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is there a different way?
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in practice, this means
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personalisation in practice
• Smith family story
• Reforming care management
• Self-directed support
• Personalised support
• Personalised transition
• WomenCentre
• And many more innovations...
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individual (or personal) budgets
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7 steps of self-directed support
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Personalised Support flexible & creative
support
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Personalised Transition
control: health, education & support
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Jonathan’s health needs are complex.In the 3 years before leaving school Jonathan spent 150 days in hospital - responding to problems with breathing. In the 3 years since leaving hospital he has spent only 2 nights in hospital - for elective dental treatments.Jonathan’s family have overseen the development of a personalised package of support for Jonathan with flexibility, employment and learning - but not learning in college - but learning on the job. Over the last 3 years, Jonathan has acquired two City & Guilds Qualifications and is now learning new independent living skills. Over the last 3 years, the individual budget system has enabled Jonathan and his family to make significant efficiencies in the costs of his care and support and save the NHS:•Over £100,000 in hospital stays•Over £300,000 in residential care costs•Over £100,000 of funding contributed by the LSC
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A couple of weeks ago in Sheffield, I met a wonderful woman called Katrina. She's got three disabled sons. e oldest is Jonathan, a charming, warm hearted young man of 19. He can't walk or talk clearly, or feed himself alone. He's had a breathing tube in his neck since he was a toddler. Under a scheme the new Liberal Democrat council in Sheffield is extending, Jonathan's just got his own individual budget and care plan. Now he's doing work with a local charity, attending a music group, has his own personal assistant - a child whose potential seemed so limited. Finally as a young man, engaged in life in a way he and his mother never thought possible. Katrina told me with the biggest smile I've ever seen, she said: We've gone from having nothing to having everything. I wish every child's needs would be taken this seriously. (Nick Clegg, 17 September 2008).
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WomenCentre a creative and positive
community
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What are the opportunities?
•What benefits are in personalisation?
•What threats are in personalisation?
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time for debate
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good ideas don’t just happen
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social work is the art of helping people be active citizens
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social work is the art of helping people be active citizens
in practice citizenship means...43Monday, 23 January 12
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1. being in control
2. with direction
3. enough money
4. your own home
5. enough help, and
6. being active in community
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but citizenship isn’t easy
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poverty attacks citizenship
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and poverty comes in many forms
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and poverty comes in many forms
• loss of hope
• no power or control
• disadvantage
• exclusion & prejudice
• isolation & abuse
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challenge poverty
so social workers
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and social workers do this by
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★ inspiring - hope and recovery
and social workers do this by
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★ inspiring - hope and recovery
★ empowering - individuals & families
and social workers do this by
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★ inspiring - hope and recovery
★ empowering - individuals & families
★ strengthening - personal development
and social workers do this by
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★ inspiring - hope and recovery
★ empowering - individuals & families
★ strengthening - personal development
★ connecting - to community
and social workers do this by
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★ inspiring - hope and recovery
★ empowering - individuals & families
★ strengthening - personal development
★ connecting - to community
★ building - safer networks
and social workers do this by
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but social workers cannot do thison their own
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these are not things you can do for people
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these are things you have to do with people
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it is people themselves who make a changebuilding on their own
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resilience = hopeful human spirit
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resilience = hopeful human spirit
control = money and the power to use it
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resilience = hopeful human spirit
control = money and the power to use it
strengths = gifts, skills & knowledge
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resilience = hopeful human spirit
control = money and the power to use it
strengths = gifts, skills & knowledge
community = opportunities to join in
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resilience = hopeful human spirit
control = money and the power to use it
strengths = gifts, skills & knowledge
community = opportunities to join in
relationships = safe and loving networks
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personalisation = social work
so what’s the big problem?58Monday, 23 January 12
the big problem for social workers is...
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the old system
gets in the way
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the old care management system
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the old care management system
makes it hard to do social work61Monday, 23 January 12
it’s really hard to
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• empower people - without entitlements
it’s really hard to
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• empower people - without entitlements
• strengthen capacity - focusing only on needs
it’s really hard to
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• empower people - without entitlements
• strengthen capacity - focusing only on needs
• connect to community - inside segregated services
it’s really hard to
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• empower people - without entitlements
• strengthen capacity - focusing only on needs
• connect to community - inside segregated services
• build safe networks - without family, friends and love
it’s really hard to
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replace care management
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replace care management
with self-‐directed support63Monday, 23 January 12
this means social workers can
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this means social workers can1. empower people - tell people their budget
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this means social workers can1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes
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this means social workers can1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes
3. access community - use funding flexibly
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this means social workers can1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes
3. access community - use funding flexibly
4. build safe networks - work with family, friends & others
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systems sit on systems -‐ like sedimentary rock
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Protection/Safeguarding Responsibilities
Comprehensive Assessments
Annual ReviewsJoint Assessment Processes
Care PlanningEligibility Criteria & Resource Panels
Monitoring Systems
Social Care Law for Children and AdultsMental Capacity Law
Care ManagementPersonalisation
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We’re all still workingin the
old system 66Monday, 23 January 12
we’ve changed words
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added new complexities
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But thesystem is still the same
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social workerssometimes even feel
personalisation has made things
worse70Monday, 23 January 12
we must simplify
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and redesign
the whole system
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we need a New Script for social work
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the New Script looks like this...
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the New Script looks like this...
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Assess people’s ELIGIBILITY for:
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Assess people’s ELIGIBILITY for:
• guidance
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Assess people’s ELIGIBILITY for:
• guidance
• rehab or
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Assess people’s ELIGIBILITY for:
• guidance
• rehab or
• a budget
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Assess CAPACITY & clarify where the leadership is:
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Assess CAPACITY & clarify where the leadership is:
• the individual
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Assess CAPACITY & clarify where the leadership is:
• the individual• a representative
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Assess CAPACITY & clarify where the leadership is:
• the individual• a representative• or a professional
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Don’t plan for people -‐ instead ENABLE other people to plan
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Don’t plan for people -‐ instead ENABLE other people to plan
But always make sure that you...
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is is Community Brokerage
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OR79Monday, 23 January 12
Plan with people DIRECTLY yourself, especially when:
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Plan with people DIRECTLY yourself, especially when:
• it’s a critical situation
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Plan with people DIRECTLY yourself, especially when:
• it’s a critical situation• the solution is obvious, or
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Plan with people DIRECTLY yourself, especially when:
• it’s a critical situation• the solution is obvious, or•nobody else can help
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AGREE plans as soon as possible if they are:
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AGREE plans as soon as possible if they are:
• sensible
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AGREE plans as soon as possible if they are:
• sensible• safe
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AGREE plans as soon as possible if they are:
• sensible• safe• and in budget
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AGREE plans as soon as possible if they are:
• sensible• safe• and in budget
Plans should NOT be perfect!81Monday, 23 January 12
If people need help to set things up then DIRECT them to the right people and places
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It is the REVIEW that is central to really learning what is working and to helping people be in control of their own life.
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This is a New Script for Social Work
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What the New Script means is
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★ things speed up
What the New Script means is
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★ things speed up
★ bureaucracy goes down
What the New Script means is
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★ things speed up
★ bureaucracy goes down
★ social workers use their best skills
What the New Script means is
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★ things speed up
★ bureaucracy goes down
★ social workers use their best skills
★ people connect to community
What the New Script means is
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★ things speed up
★ bureaucracy goes down
★ social workers use their best skills
★ people connect to community
★ but most importantly...
What the New Script means is
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lives are transformed
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e New Script helps us to...
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1. empower people - people and families in control of their own lives
e New Script helps us to...
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1. empower people - people and families in control of their own lives
2. strengthen capacity - people living positive lives, achieving, growing
e New Script helps us to...
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1. empower people - people and families in control of their own lives
2. strengthen capacity - people living positive lives, achieving, growing
3. access community - people as active citizens
e New Script helps us to...
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1. empower people - people and families in control of their own lives
2. strengthen capacity - people living positive lives, achieving, growing
3. access community - people as active citizens
4. build safe networks - reducing abuse and isolation
e New Script helps us to...
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Share Expenditure Cost PP Hours PP
1. First point of contact - initial sign-posting 9.5% £414,437 £63 2.6
2. Overview assessment 13.7% £599,514 £91 3.7
3. Comprehensive/full assessment 19.0% £831,038 £126 5.2
4. Basic planning 13.7% £597,272 £91 3.7
5. Intensive planning, service design or support planning 16.3% £713,343 £108 4.4
6. Problem solving & responding to crises 16.0% £700,749 £107 4.4
7. Short reviews - basic 7.5% £327,924 £50 2.0
8. Long reviews - intensive 4.3% £189,200 £29 1.2
Total £4,373,478 £665 27.288Monday, 23 January 12
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17%
12%
13%34%
23%
Indiv idualFamily/Fr iendsProviderBrokerCare Manager
Who is the best planner?
N = 801
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16%
17%
28%
31%
9%
Indiv idualFamily/Fr iendsProviderBrokerSocial Worker
Who is the best organiser?
N = 774
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Personalisation should be efficient
but it can easily be made wasteful94Monday, 23 January 12
Number of care managers (WTE) 111.55
Cost of care management £4,373,477.75
Number now served by authority 6465
Ratio (number of people to 1 care manager) 68.73
Total hours of care management available 185507.18
Hours available per person 27.24
Average cost per person £664.87
Time on slimmed down core functions 81623.1592 44%
Time on crisis management 44521.7232 24%
Residual time to reinvest 59362.2976 32%
Share of residual time 32%
Residual time expressed as money £1,399,512.88
Residual time per person 8.7168
Residual money per person £212.76
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how do you make a ‘good idea’ really useful
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Know how to take things. Never against the grain, though they’re handed to you that way. There are two sides to everything. If you grab the blade, the best thing will do you harm; the most harmful will defend you if you seize it by the hilt. Many things that caused pain could have caused pleasure if only their advantages had been considered. There are always pros and cons; the trick lies in knowing how to turn things to your advantage. Things look different when seen in a different light. So look at them in the light of happiness. Don’t confuse good and bad. This is why some people find contentment in everything, and others sorrow. This is a sure defence against the reversals of fortune, and a great rule for living, at all times and in every pursuit - Baltasar Gracian
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What are the opportunities
• safeguarding children and adults from abuse?• empowering disabled people?• helping people manage long-term conditions,
dementia or end of life care?• allocating resources more fairly?• improving the quality of planning and support?• strengthening communities and improving
connectedness?• improved family work?
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www.campaignforafairsociety.org100Monday, 23 January 12
© Simon Duffy 2011. Rights Reserved. Full copyright details at www.centreforwelfarereform.org 101Monday, 23 January 12
Agenda
9.20 What is ‘Personalisation’10.30 Opportunities & Concerns - tables11.00 Break11.15 Debate12.00 Social Work Rescript12.45 Lunch2.15 Applications - tables3.00 Feedback3.30 Break4.00 Polling Questions4.30 Final Questions5.15 Finish
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