The citizen at the centre
People do not live their lives according to the categories we create in our welfare services, and concepts of health, social care, nursing care and personal care are all artificial constructs that we have developed over time to respond to the various political crises of the day.
You have seen that a combination of inter-related factors – professional cultures, organisational structures and how services are funded – has tended to maintain a focus on the service rather than on the service user . The priorities for change identified by The Christie Commission, established to explore and make recommendations on the future of public services in Scotland, included:
- Recognising that effective services must be designed with and for people and communities – not delivered ‘top-down’ for administrative convenience.
- Maximising scarce resources by utilising all available resources from the public, private and third sectors, individuals, groups and communities.
- Working closely with individuals and communities to understand their needs, maximise, talents and resources, support self-reliance and build resilience.
One way of achieving the shift that Christie proposed is to move towards a model of personalised services. Personalisation involves an attempt to fundamentally rethink how we work together – without at the same time losing what is and has been successful within the services we have come to depend on. Christie's recommendations seem hard to argue with. But are they really achievable in the 'real' world? The next activity invites you to see how a community care team in England has responded to the challenges that personalisation poses.
Activity 6.8 Making personalisation happen in practice
This shortexamines how the work of the personal budget team in Hull has changed since it started offering a personalised care service.
While you are watching the video reflect on:
- the challenges
- the benefits
for practitioners in moving towards a more personalised service.
We have started to record some of these challenges and benefits below from a practitioner's point of view - can you add to this list?
Use your learning log to note down any thoughts and ideas you have about the changes required to move towards a more personalised approach to working together.
The work of the Hull team offers an alternative to putting services first. Services are seen from the service user’s point of view; that is, not as a discrete set of services but as part of the person’s life. Working together may then cease to be an aspect of professional culture or organisational politics. Instead, service users become properly recognised as direct contributors to, and drivers of, their own care – and perhaps also to the welfare of their own communities. You will have heard the interviewed social workers describing the shift towards personalisation as challenging, but also very rewarding. For example, the social workers were drawing on their skills in relationship-building to work with families to enable them to achieve outcome s that are important to them. This increased professional job satisfaction as well improving service users' lives.
The figure above tries to represent this different way of thinking about services and citizens. Of course, once this change occurs, it implies that a professional assessment of need has to play ‘second fiddle’ to a citizen’s own assessment of their desired outcome. This is not an open-ended commitment to deliver whatever a citizen wants; it invites the citizen-user into a real discussion about what can be achieved within limited resources. It also means that the service user is brought into the discussion of any existing evidence base regarding ‘what works’.
It is also important to point out that although, culturally speaking, personalisation means that professional knowledge carries no automatic right to prescribe action, it does not undermine the relevance of professional knowledge. The doctor, nurse, home carer or social worker still possesses valuable knowledge or skills that the service user needs. What has changed is the status of having that knowledge or skill, and the power relationship between the service user and the professional. Treatment or care must always be negotiated from a position in which the service user or citizen is in the strongest position. This is radically different from what has happened in the past.