Personalisation / citizen or self directed support

The drive to adopt person centred approaches in health and social care across the UK has come from disabled people and their families and progressive allies in public services.

across the UK has come from disabled people and their families and progressive allies in public services. They have consistently argued for a shift in the balance of power to give greater choice and control for disabled people in decision making. (see H Sanderson and J Lewis (2012) A practical guide to delivering Personalisation. Chapters 1 & 2. London: Jessica Kingsley). England, Northern Ireland Scotland and Wales have adopted slightly different terminology to describe this topic, using the terms: personalisation, self directed support and citizen directed support. NB In some sections the term Personalisation has been used for brevity but it should be noted that this is intended to encapsulate all country specific terminology, i.e. to include self directed and citizen directed support.

What is personalisation / self or citizen directed support?

'Personalisation means thinking about care and support services in an entirely different way. This means starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives.'
 
(Quoted from Social Care Institute for Excellence (SCIE) A rough guide to personalisation)
 
Personalisation and self directed support put people who need care and support and their carers at the centre of making choices about how that care and support is delivered. It engages people in considering the outcomes they want to achieve and the approach they want to take to manage their lives. It changes the relationship between the practitioner and the person in need of care and support to a more equal partnership, recognising that better outcomes can be achieved when people are involved in self-management of their health and well-being.
 
Personalisation and self directed support are not just about personal budgets, but about achieving choice and control in many ways and in different settings, wherever the person may live. It’s about ensuring that everyone has access to public services and includes strengthening communities by encouraging inclusion. It is about the dignity and wellbeing of the individual.
 
A short video from Social Care Institute for Excellence (SCIE) provides further information.

Delivering personalisation through personal budgets

Personal budgets (social care) and personal health budgets (NHS) are ways of delivering personalisation. Letting people know how much money is available to meet their needs, leads to greater transparency and allows individuals, in partnership with professionals and others, to make decisions about the best way to use this money to meet those needs.
 
In social care:
Throughout the UK, government administrations have made it clear that personalisation and citizen/self directed support are a priority.
More information on personal budgets in social care can be found on the Think Local Act Personal (TLAP) website.
In the NHS:
In England and Scotland personal health budgets are being piloted for people with long-term health conditions. Personal health budgets are part of the wider drive to personalise the services and support that people receive and give greater choice and control. They complement and build on other programmes of work that focus on patient involvement in decision-making and person centred planning.
 
More information on personal health budgets can be found on the Department of Health personal health budgets website.
 
In Wales, the policy focuses on developing robust citizen focused services and strong communities. More on the sustainable social services programme can be found here:
http://wales.gov.uk/topics/health/publications/socialcare/guidance1/services/?lang=en
 
In Wales a significant reconfiguration and modernization programme is underway which will fundamentally change the provision of services and the relationship of citizens with the NHS. There is no internal market or choice based provision and no intention to develop personal health care budgets.
More information can be found here: http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en
 

What does personalisation* mean for Occupational Therapists?

Occupational Therapists’ core values, beliefs and skills make them ideally placed to help people make choices, take control of their health and well-being and achieve personally meaningful outcomes.
 
Personalisation for Occupational Therapists means:
 

• understanding and embracing the social model of disability; providing choice, control and a person-centred approach to assessment/review and delivery of support and service
• considering environmental barriers as disabling factors in people’s lives and seeking to remove these barriers through inclusive and flexible building design and strategic planning
• optimising potential for independence through the use of adaptive techniques and assistive technology
• emphasising the promotion of self-reliance and personal and community resources (universal services)
• enabling people to optimise independence in daily living activities through outcome-focused re-ablement programmes
• promoting vocational and employment support to enable disabled people to enter the employment market
• ensuring that people have access to information and advice to make informed decisions about the support they need, however this is funded
• finding new, creative and collaborative ways of working that may be outside normal statutory provision and actively engaging with service users to co-produce, design, deliver and evaluate the support/ services received.

 
More information on what personalisation means for for occupational therapists in social care can be found in the SCIE At a glance: Personalisation briefing: Implications for Occupational Therapists
 
Occupational Therapists can support personalisation through all of the above and through:

• Taking a shared decision making approach to assessment, care planning and review
• Working with people to establish the outcomes they want to achieve and exploring options to achieve these. This can include goal setting, identifying graded activities, developing personal coping strategies and methods of self management and engagement with work leisure and community activity that is meaningful for the individual.
• Providing professional advice and information to help people make informed decisions eg adaptive techniques, how to improve functional ability, use of assistive technology, environmental adaptations.
• Getting involved locally: finding out what’s happening and ensuring that Occupational Therapy plays a central part in developments