Recently, the provision of social care and health services has increasingly shifted towards the adoption of person-centred operations. Personalisation can be defined as ‘efforts in service provision to ensure that users of given services are in a position to plan their futures and obtain their services of choice, as opposed to standardised services designed to fit all’ (Amado and McBride, 2002 p24). Through personalisation, users are directly empowered in terms of being offered independence, choice, equality and inclusion. This paper looks into personalization and how it acts as a fundamental driver in the contemporary health and social care policy.
In an effort to make a critical analysis on personalization and its effects on health and social care policy, this paper looks into the traditional services provision approaches and their shortcomings. From such a background, the paper will develop a foundation for further exploration into personalisation and the required direction of change. The paper places special emphasis on the potential benefits of personalisation to users and the overall health and social care service provision industry. At the same time, the paper acknowledges personalisation efforts encounter various challenges. It will go ahead and forge potential solutions to such challenges.
Evolution of personalisation
Health and social care services are meant to cater for the needs of people who use them. Paradoxically, these services have for long been without putting user’s needs at the forefront. This section is going to aspects of service provision as practised in the past and today and their implications on the current policy on health and social services provision.
Sanderson and Maudslay (2003, p18) observe that traditional service provision has been structured to fit people into existing services. Health and social care users have often been regarded as passive recipients. As such they are not involved in the planning and development of the services that they use. This can be identified through the parameter employed to gauge service provision in the health and social care industry. Stainton (2002, pg761) illustrates this quite effectively when he observes that inputs and predetermined ends have been long the focus of service provision reports. For example, service centres with the biggest bed space and longest hours of service are highly regarded. It is evident that services have traditionally been gauged quantitatively rather than through the quantitative examination from the users’ perception. Universal standards are adopted to cater for the diverse needs of different service uses. In this regard, users themselves have very limited control over the services they use.
Today, some sections of health and social care provision have shifted towards a more person-centred planning approach, although this shift has not been implemented across all social care providers (Sanderson and Maudslay, 2003, p57). Rose (2003, p60) observes that there has been a shift in the philosophical position to a state where service users are deemed as partners. According to Nolan (2001, p450), Client centeredness is emerging as the ‘watchword for social services in the twenty first century. There, however, has been slow progress in the implementation of person cantered planning. This is due to a number of factors discussed in a later section of this paper.
There have been concerted efforts by policymakers to make legislations that foster an inclusive and collaborative approach in the provision of health and social care services. Wistow (2004, p83), documents a speech by Stephen Ladyman, the then Parliamentary Under Secretary for Community in which he announced ‘a new vision for social care with services being delivered and in personal person-cantered, proactive and seamless means’. The consultation paper during the 2001 Community Care Live Conference bases social care taking on the principle that every individual has an important contribution to make the society and everyone should be given full control of their own lives.
Organisational structure and personalisation
The organisational structure surrounding social care provision in terms of; resource allocation, funding structures, organisation of care workers and multi-agency involvement impact on the successfulness of the person centred health and social care provision. This section focuses on identifying how various facets of the organisational structure effect the realization of the person-centred panning.
There is a need to change the traditional means of resource allocation and management if a new service delivery era is to be achieved. The current service delivery model is largely discredited and deemed inefficient. For contemporary social care services to achieve the required levels of reform, reorganisation of the resource allocation and management systems is necessary. Such a reorganisation should oversee a shift a smaller-scale community services that are more effective in addressing individualised needs as opposed to widespread and highly generalised health and social care programs (). Routledge and Gitsham (2004) advice that resource allocation and management should be aimed at matching resource avocation to people’s needs.
To make personalisation possible, staff features as one of the most important aspects. Considerations are made both on the level of staffing and the skill base of the staff team (Sanderson, 2000). Staffing levels should allow for individualised care as opposed to the tradition mode of service provision where services were offered to a group of service users. Lack of enough staff takes a toll on the available staff and on the service users themselves since they cannot access some services efficiently. In addition, family members who are forced to offer informal support due to lack of support staff are affected. It is therefore clear that personalisation efforts cannot only be successfully implemented once staffing needs have been effectively addressed.
Funding arrangements need to be restructured to enable the implementation of individualized panning. The funding structure should shift from one in which takes whole service requirements to a structure that takes the individual’s requirements into account. Such a restructured could employ the proposal developed by the Cabinet Office Strategy Unit (2005) report. The report indicated that linking funding arrangements to services limits health and social care providers to existing services and keeps individuals with special needs from accessing specialized services (Emerson and Stancliffe, 2004, p34). Currently, Direct Payments is a model that can potentially contribute to the successful implementation of person centred services. Though Direct Payments, people can buy their own support since they are provided with money instead of service. As such, they attain greater control of their lives, which is the central focus of personalisation. Direct Payments are however limited to some people hence cannot achieve universal individualisation. This is one of the policy goals to drive up personalisation across the board. Through the Direct Payments system, it is evident that cash systems ate better than care systems in the provision of person-centred services.
To realise person-centred planning, multi-agency collaboration is vital. Amado and McBride, (2002) identify three levels in which multi-agency collaboration should be manifested. At personal level, opportunities available to the individual should be increased. At the service level, adequate staff requirements should be met to offer personalised support to service users. Finally, the third stage involves community inclusion of services users through well-developed strategies (Nolan, 2001, p42). Such collaboration across the three levels will result in better personalised services and therefore the overall improvement of the health and social care service delivery.
Flexible support is one of the factors that are enhanced by personalised services. People themselves are involved in formulation of service delivery plans that factors in their individual needs, desires, gaols and abilities. This strengthens principles of choice, empowerment and inclusion (Routledge and Gitsham, 2004, p23). This sees a shift from the traditional perceived needs of many to the individual needs of service users. To enhance better service delivery, service providers should adhere to regulations and rigorous standards of care provision. Each service user’s background attributes and personal experiences should be taken into account to enable individualised care. Campbell (2001, p88) lists the following aspects to be captured in a personalised system: history and experiences, health and wellbeing, community life, relationships and social contacts, personal preferences and habits communication strategies, fears, aspirations and reputation.
In addition to individual change, culture change as a whole is vital if person-centred services are to be realised. Most agencies that have been operating in the traditional models will need to adopt significant operational changes to achieve person centred operations. Many writers emphasize on the importance of person centred planning with most of them expressing that a change in the culture that governs services is necessary for the success of person-centred planning (Wistow, 2004; Routledge and Gitsham, 2004; Sanderson, 2000; Emerson and Stancliffe, 2004; Amado and McBride, 2002). To increase the power of service users over the services they receive, a number of strategies would be suitable. For example, policy should be formulated to encourage, rather than prohibit, the use of Direct Payments which enhances the user’s control. Policy formulation should ensure that service users can hold service providers legally liable for their failure to provide personalised services. Personalisation should be taken as a life philosophy that encourages independence, respects individuality, values equality, celebrates uniqueness and faces threats, anxieties and guilt positively (Emerson and Stancliffe, 2004, p35).
Personalisation and front line staff
The previous sections point to the importance of the role played by frontline staff and managers in providing quality services to service users. However, this role is not as straightforward as it seems. Managers and frontline staff encounter numerous obstacles in the course of providing personalised care to service users. This section looks at the challenges of personalisation in the context of frontline staff and managers.
Front line workers have crucial views and needs that can aid in the overall success of implementation of person-centred planning. Managers, on the other hand, have a direct impact on the way a service is delivered through their supervisory capacity. The performance of frontline workers will always be subject to the management of the service and associated constraints in terms of resources, insufficient training and lack of flexible approaches to service delivery (Mansell and Beadle-Brown, 2004, p34).
Mansell and Beadle-Brown (2004, p34), identify limited staff training as a factor that exposes them to skill deficit especially in dealing with care users who are need of specialised attention. This is a major obstacle to the implementation of person-centred services. The authors point to evidence showing that people with learning difficulties derive little support from the frontline staff involved in health and social service care centres. Such people need support to help them engage in meaningful activity in their homes and in the wider society (Emerson and Stancliffe, 2004, p36). Lack of such activities hinders affected individuals from engaging in the community. Further, affected persons cannot forge a circle of support to help in facilitating learning.
Training for personalisation
Considering all that is involved in the offering of personalised services, it is clear that staff have a lot to cope with, hence the necessity of equipping them with necessary skills. These skills will help in insight development and utilisation of their skills in effective care giving. Stainton (2002, p752) identifies a serious lack of training for frontline staff hampering effective provision of person-centred services. Staff training should focus on empowering them and encouraging them to be proud of what they do and realize the value of their input. This way, they will develop confidence to deal with various situations in the course of their careers. In addition, such a realization helps staff deal effectively with the challenges of adapting to new procedures, a characteristic feature of their occupation.
Training programs should be tailored to embrace the ‘new culture’ of person-centred service provision with new attitudes and practices. Staffs have the opportunity to reflect on the new approach and their role in the provision of services in an effective manner. Training that makes use of direct experience to make staff understand the new approach is most effective. Recent efforts by government to increase the training opportunities are proof of the importance of training in the successful implementation of person-centred service provision.
Challenges to personalisation
One of the biggest challenges to the successful adoption of personalised care is the traditional notion of universal services that classifies service users into predetermined service categories. This notion is directly contrary to the principles of person-centred planning. Resource constraint is another challenge that impedes the implementation of person-centred planning. Bureaucratic management of resources locks out service users from involvement in the decision making process. Higher management may not always be accurate in identifying the needs of service users. The nature of funding is currently based on whole service requirements making it hard to deliver individualised services. Frontline staff is not well skilled to adopt a person-centred approach and hence offer a considerable challenge to the implementation of person-centred planning. Current management styles are top down in nature impeding effective implementation of individualised services.
Conclusion and recommendations
From the considerations made in this paper, it is clear that person-centred planning is the way forward in health and social care provision. Policy reform should therefore be structured to ensure that personalization is not hampered by bureaucracy and management systems that are out of touch with the service users. Extensive literature has indicated that the perspective of health and social care workers has not been properly considered in the process of personalizing services. Adequate training should be offered for these workers to derive maximum benefits offered by their unique position as the people who have first-hand interaction with the service care users.
It is recommended that policy should be implemented to ensure that the opinions of end service users are taken into account while planning, refining and developing, and implementing health and social care plans. Person-centred planning should take into consideration the differing needs of each individual service-user. The key to a successful implementation of personalised services lies in identifying and addressing the needs of each individual service user. Funding management should take into consideration the need to involve service users in the decision-making process.