Personalisation and the Workforce

1. Personalisation and the Workforce The Emerging Evidence Base

2. Personalisation �Personalisation is not a set of policies but a general approach to public services and social care that puts the person at the centre as a participant in shaping the services they get, managing risk and providing resources, whether financial or in terms of their own effort� Demos report to Social Work Review (2005) Personalisation and Participation: The Future of Social Care in Scotland Demos report that informed Changing Lives: Demos report that informed Changing Lives:

3. A Paradigm Shift? �More of the same won�t work� (Changing Lives ) Transfer of Power Citizenship Demos report that informed Changing Lives: Social care in Scotland should be organised around the idea of personalisation: people as active participants in shaping, creating and delivering their care, in conjunction with their paid and unpaid carers, so that it meets their distinctive needs and their hopes for themselves. The main goal of personalisation is not to turn people into consumers of public services but to encourage them to become participants and investors in their own care. Choice, voice and support are all tools to this end. Whether people want to self-manage and live independently or if they are heavily dependent upon services they should feel in control of their lives Demos report that informed Changing Lives: Social care in Scotland should be organised around the idea of personalisation: people as active participants in shaping, creating and delivering their care, in conjunction with their paid and unpaid carers, so that it meets their distinctive needs and their hopes for themselves. The main goal of personalisation is not to turn people into consumers of public services but to encourage them to become participants and investors in their own care. Choice, voice and support are all tools to this end. Whether people want to self-manage and live independently or if they are heavily dependent upon services they should feel in control of their lives

4. Personalisation � Changing Lives? �It enables the individual alone, or in groups, to find the right solutions for them and to participate in the delivery of a service. From being a recipient of services, citizens can become actively involved in selecting and shaping the services they receive� Changing Lives, Service Development Group, �Personalisation: A Shared Understanding� Spring 2008

5. Tools Self Directed Support (successor to Direct Payments) Individualised Budgets In Control (Resource Allocation System) Person Centred Planning

6. England � Years Ahead of Us? Putting People First (HM Government, 2007) Commitment to Personal Budgets (Individual Budgets & Direct payments) Individual Budget Pilots (13 LAs by 2007) IBSEN Report (2008) In Control � Two pilot phases National Commission on Personalisation Joseph Rowntree Foundation project focusing on person-centred support Putting People First has asked all local authorities providing social care to engage with the process of transformation by 2010 There has been such political enthusiasm for individual budgets that they have run way ahead of the evidence. Or put another way, the government has committed itself to a whole new approach to social care policy and invested at least �0.5bn in making it happen before even its own research findings (Individual Budgets Evaluation Network Report 2008) were available to offer an adequate evidence base. Peter Beresford, writing in The Guardian Oct 08. Personal budgets abroad generally naturally align themselves with a private healthcare system, raising questions for their application to the UK (Help the Aged). The London Transformation ProgrammeJoint Improvement Partnership (2009 / 2010)Workforce and leadership programme Purpose: Delivering a programme of work to achieve culture change for transformation & personalisation in the workforce of both independent & statutory sectors. Example Projects: Design and disseminate content for culture change programme, to incorporate Personalisation, Dignity & Safeguarding & Common Core Principles for Self Care targeted at CQC registered employers and their staff Identify & disseminate information to support the skills required from the workforce to support new ways of working under Personalisation Skills for Health - report (of survey) on the workforce implications of personalisation in the health service will be published in New Year 2010. There has been such political enthusiasm for individual budgets that they have run way ahead of the evidence. Or put another way, the government has committed itself to a whole new approach to social care policy and invested at least �0.5bn in making it happen before even its own research findings (Individual Budgets Evaluation Network Report 2008) were available to offer an adequate evidence base. Peter Beresford, writing in The Guardian Oct 08. Personal budgets abroad generally naturally align themselves with a private healthcare system, raising questions for their application to the UK (Help the Aged). The London Transformation ProgrammeJoint Improvement Partnership (2009 / 2010)Workforce and leadership programme Purpose: Delivering a programme of work to achieve culture change for transformation & personalisation in the workforce of both independent & statutory sectors. Example Projects: Design and disseminate content for culture change programme, to incorporate Personalisation, Dignity & Safeguarding & Common Core Principles for Self Care targeted at CQC registered employers and their staff Identify & disseminate information to support the skills required from the workforce to support new ways of working under Personalisation Skills for Health - report (of survey) on the workforce implications of personalisation in the health service will be published in New Year 2010.

7. Personalisation and the Workforce �Public Service Reform has proceeded far more successfully where government has successfully articulated a story about reform�. that has engaged the workforce�. Brooks, 2007, quoted in SCIE Rough Guide Brooks, 2007, quoted in SCIE Rough Guide Brooks, 2007, quoted in SCIE Rough Guide

8. Workforce: The Dream Story Inspired by the goal of personalisation Able to �make a difference� unhindered by red tape and bureaucracy Skilled Recognised as collaborators in creating and delivering better care and support High sense of achievement High job satisfaction Properly rewarded

9. Workforce: The Nightmare Story No job security No regular hours/pay Poor terms and conditions No training Poor health and safety standards Minimum wage or� part of the black economy Multitude of maverick, individual employers Multiple jobs to make ends meet Unregistered & unregulated Who trains and support this workforce? How is the army of diverse PAs going to be recruited? IFF research into PAs for Skills for Care (July 2008)- Among PAs, a striking 95% declared themselves happy with their role, and 90% felt appreciated either most of the time or frequently. Two-thirds had previous experience of working in health and social care and, of them, 66% said they had chosen to work as a PA because of the convenient or flexible hours involved. Hours were variable in 56% of cases surveyed. One in five PAs thought they were required to work too many hours, and one in three considered themselves underpaid. The average hourly wage was �7.60, with 11% of roles paying more than �10 and 8% paying less than �6. The typical PA would take home about �165 a week. For Skills for Care, the main worry thrown up by the research is a general reluctance on the part of employers to arrange or fund training for their PAs In Scotland ongoing research (commissioned by Scottish Government Adult Care and Support Division) is looking at two important questions about self-directed support: What training and support do people who employ PAs need? What training and support do PAs themselves need? Who trains and support this workforce? How is the army of diverse PAs going to be recruited? IFF research into PAs for Skills for Care (July 2008)- Among PAs, a striking 95% declared themselves happy with their role, and 90% felt appreciated either most of the time or frequently. Two-thirds had previous experience of working in health and social care and, of them, 66% said they had chosen to work as a PA because of the convenient or flexible hours involved. Hours were variable in 56% of cases surveyed. One in five PAs thought they were required to work too many hours, and one in three considered themselves underpaid. The average hourly wage was �7.60, with 11% of roles paying more than �10 and 8% paying less than �6. The typical PA would take home about �165 a week. For Skills for Care, the main worry thrown up by the research is a general reluctance on the part of employers to arrange or fund training for their PAs In Scotland ongoing research (commissioned by Scottish Government Adult Care and Support Division) is looking at two important questions about self-directed support: What training and support do people who employ PAs need? What training and support do PAs themselves need?

10. What does it mean for voluntary sector managers? Critical leadership role � vision, implementation, outcomes Manage resources (including staff) flexibly Grow a learning, person centred culture and listening mind-set Support staff to think about their roles in new ways Build co-productive, problem solving relationships Harness everyone�s energies, goodwill and talents to� Create networks of support and shared approaches to providing support and opportunities for social inclusion. SCIE Briefing 13 (Sept 09) SCIE Briefing 13 (Sept 09) The managers of voluntary/third sector service providers have a critical leadership role to play in ensuring a personalised approach to service delivery and in monitoring person centred outcomes for the individuals using the services. As for all service providers, developing and delivering personalised services fundamentally means: the individual is the primary focus there is a vision and strategy for continuously improving services based on the experiences of people who use the service resources are used flexibly, including staff staff are supported to think about their roles in new ways a learning, person centred culture and listening mind-set is encouraged to flourish at every level ways of working, particularly policy and planning systems, and governance arrangements promote cultural change building co-productive, problem solving relationships with people who use the service, carers, care managers and commissioners, and the wider community. This requires being prepared to think radically about what support is available to people who use the service currently, how it is delivered and what difference it makes to their lives. It means harnessing the energies, goodwill and talents of everyone involved, particularly individuals who use the service, staff, families, friends and carers, volunteers, care managers and the wider community, in order to create vibrant networks of support and a shared approach to providing support and opportunities for social inclusion. SCIE Briefing 13 (Sept 09) The managers of voluntary/third sector service providers have a critical leadership role to play in ensuring a personalised approach to service delivery and in monitoring person centred outcomes for the individuals using the services. As for all service providers, developing and delivering personalised services fundamentally means: the individual is the primary focus there is a vision and strategy for continuously improving services based on the experiences of people who use the service resources are used flexibly, including staff staff are supported to think about their roles in new ways a learning, person centred culture and listening mind-set is encouraged to flourish at every level ways of working, particularly policy and planning systems, and governance arrangements promote cultural change building co-productive, problem solving relationships with people who use the service, carers, care managers and commissioners, and the wider community. This requires being prepared to think radically about what support is available to people who use the service currently, how it is delivered and what difference it makes to their lives. It means harnessing the energies, goodwill and talents of everyone involved, particularly individuals who use the service, staff, families, friends and carers, volunteers, care managers and the wider community, in order to create vibrant networks of support and a shared approach to providing support and opportunities for social inclusion.

11. Flexibility is the key Very few full time posts Recruited for specific person or people Employment contracts with/for named individuals Split shifts the norm Local � part of same community Able to respond at short notice Irregular weekly hours (banking of hours by person in receipt of service) Greater self management � opportunities for self-employed staff teams Working in collaboration with person and unpaid carers (Help the Aged, Personalisation in Social Care) Example of France, where care work is seen as an attractive, skilled occupation which offers flexibility to fit around family responsibilities. We must also take heed of what experience abroad shows about the tendency for people to use their budgets within families and grapple with the issues arising from this. Family and informal carers have been crucial to the success of individual experiences of personal budgets abroad, and to the system as a whole. All countries rely on the willingness and availability of family members to help organise the payment of the budget, as well as, in some cases, being the final recipient of the money and becoming a paid carer for their family member. Care services provided include many regarded as low-level in the UK � help with cleaning, shopping, food preparation, etc. Many are bought from individuals, rather than agencies. Professional social care staff have been freed up to spend more time assessing and visiting people, and less arranging care. A minority of individuals use service providers because they prefer the flexibility of employing PAs. Providing more flexible, responsive, personalised services for individuals would be a way that service providers could deliver more support through SDS e.g. being able to provide support at times and in locations that enable a person to go to work. Continuity of staff is vital. The SDS relationship goes beyond helping someone with intimate tasks such as showering to longer term relationship-building. Also a change of mind set is needed away from fixed approaches to set tasks that may have developed through previous agency work, towards providing a more flexible support according to what the individual wants within home and outside settings. (A Review of Self Directed Support in Scotland, 2008) (Help the Aged, Personalisation in Social Care) Example of France, where care work is seen as an attractive, skilled occupation which offers flexibility to fit around family responsibilities. We must also take heed of what experience abroad shows about the tendency for people to use their budgets within families and grapple with the issues arising from this. Family and informal carers have been crucial to the success of individual experiences of personal budgets abroad, and to the system as a whole. All countries rely on the willingness and availability of family members to help organise the payment of the budget, as well as, in some cases, being the final recipient of the money and becoming a paid carer for their family member. Care services provided include many regarded as low-level in the UK � help with cleaning, shopping, food preparation, etc. Many are bought from individuals, rather than agencies. Professional social care staff have been freed up to spend more time assessing and visiting people, and less arranging care. A minority of individuals use service providers because they prefer the flexibility of employing PAs. Providing more flexible, responsive, personalised services for individuals would be a way that service providers could deliver more support through SDS e.g. being able to provide support at times and in locations that enable a person to go to work. Continuity of staff is vital. The SDS relationship goes beyond helping someone with intimate tasks such as showering to longer term relationship-building. Also a change of mind set is needed away from fixed approaches to set tasks that may have developed through previous agency work, towards providing a more flexible support according to what the individual wants within home and outside settings. (A Review of Self Directed Support in Scotland, 2008)

12. Variety: New Roles � Just for Social Workers? Navigator Advocate Broker Counsellor Risk Assessor Designer Changing Lives, Service Development Group, �Personalisation: A Shared Understanding� (2008) What about community development and the community animator role? Demos report (2005) A new division of labour within the social care workforce, with the growth of para-professional assistants, support workers and managers, that will in turn allow a revival in social work based around the roles of navigator, advocate, broker, counsellor, risk assessor and designer. Making it personal (Leadbetter and others, 2008 p 61) suggests that in a context of increasing self-directed support, social work roles will adapt accordingly and social workers could enjoy more creative, person-centred roles as: Advisers � helping clients to self-assess their needs and plan for future care Navigators � helping clients find their way to the service they want Brokers � helping clients assemble the right ingredients for their care package from a variety of sources Service providers � deploying the therapeutic and counselling skills directly with clients Risk assessors and auditors � especially in complex cases and with vulnerable people deemed to be a risk to themselves and other people Designers of social care systems as a whole: to help draw together formal, informal, voluntary and private sector providers. Local Area Co-ordinators, Voluntary Sector development roles e.g. Practice Development/ Development Managers etc. Aren�t we already doing a lot of this? Statutory settings � are these roles possible? What would it take to overcome the control function? Community development? Not identified by Leadbetter or in Changing Lives serevice Development GroupDemos report (2005) A new division of labour within the social care workforce, with the growth of para-professional assistants, support workers and managers, that will in turn allow a revival in social work based around the roles of navigator, advocate, broker, counsellor, risk assessor and designer. Making it personal (Leadbetter and others, 2008 p 61) suggests that in a context of increasing self-directed support, social work roles will adapt accordingly and social workers could enjoy more creative, person-centred roles as: Advisers � helping clients to self-assess their needs and plan for future care Navigators � helping clients find their way to the service they want Brokers � helping clients assemble the right ingredients for their care package from a variety of sources Service providers � deploying the therapeutic and counselling skills directly with clients Risk assessors and auditors � especially in complex cases and with vulnerable people deemed to be a risk to themselves and other people Designers of social care systems as a whole: to help draw together formal, informal, voluntary and private sector providers. Local Area Co-ordinators, Voluntary Sector development roles e.g. Practice Development/ Development Managers etc. Aren�t we already doing a lot of this? Statutory settings � are these roles possible? What would it take to overcome the control function? Community development? Not identified by Leadbetter or in Changing Lives serevice Development Group

13. Skills Gaps �Key to all this is likely to be new training and education for a new culture in social care, crucially involving service user trainers at the centre.� Peter Beresford (2008) Person centred approaches Person centred planning Advocacy Commissioning for personalised services Leadership � emotional intelligence, self management Community development

14. �Experts by Experience� People who have experience of using care services Recruiting and training social care workers Assessing quality Commissioning services SCIE Rough Guide to Personalisation (2008) Unpaid carers Recognition of contribution as vital part of service provision Support for them as partners Changing Lives, Service Development Group, �Personalisation: A Shared Understanding� (2008) �And, most urgently of all, it is time for non-disabled professionals to recognise the right of disabled persons to self control, and therefore to gracefully step to one side, into a role where they, as professionals, are no longer on top but rather on tap - as allies. Being on tap rather than on top requires significant attitudinal and cultural change. It requires a reshaping of the way social workers relate and interact with disabled people. This will take courage and commitment and a willingness to allow people to make their own decisions, even if you don�t agree with them.� Extract from Anne Pridmore�s presentation (giving a personal perspective of being a direct employer) delivered to the All Party Parliamentary Group on Social Care at the House of Commons. �And, most urgently of all, it is time for non-disabled professionals to recognise the right of disabled persons to self control, and therefore to gracefully step to one side, into a role where they, as professionals, are no longer on top but rather on tap - as allies. Being on tap rather than on top requires significant attitudinal and cultural change. It requires a reshaping of the way social workers relate and interact with disabled people. This will take courage and commitment and a willingness to allow people to make their own decisions, even if you don�t agree with them.� Extract from Anne Pridmore�s presentation (giving a personal perspective of being a direct employer) delivered to the All Party Parliamentary Group on Social Care at the House of Commons.

15. Personalisation and the Workforce Research 2009/10 An exploratory study to assess the current capacity of the voluntary sector workforce to deliver on the aspirations of the personalisation agenda and to identify the functions, skills and behaviours (demonstrating underpinning ethos/values) required of the workforce to meet these aspirations.

16. Research Implications The research will highlight implications for national workforce policy and planning, including: the contribution the voluntary sector workforce can and is already making towards driving forward the personalisation agenda, and workforce issues that may need to be addressed in redesigning services for personalisation.