Realising thepersonalisation in health & social care                  Talk given by Dr Simon Duffy of e Centre for Welfare...
we’ve have come a long• see individual control as a right• see flexibility & creativity as a good thing• think block contra...
but we have much to learn,• forget why personalisation works• get lost in confusing process - eg.    the RAS•   burden and...
personalisation can be seenas a system
personalisation can be seenas a system
BUT personalisation did NOT • because of markets - although they can help • independent brokers (or other wonder workers) ...
BUT personalisation did NOT • because of markets - although they can help • independent brokers (or other wonder workers) ...
its true value is: we• respect each    other as fellow    citizens•   we enable people    to make better    decisions•   w...
its true value is: we• respect each    other as fellow    citizens•   we enable people    to make better    decisions•   w...
FROM pushing resources into things -and hoping they have valueTO pulling resources together - buildingon their real wealth...
FROM pushing resources into things -and hoping they have valueTO pulling resources together - buildingon their real wealth...
but control is not real, if • you chop out creative support from my plan - even     when I’m within budget! •   you tell m...
but control is not real, if • you chop out creative support from my plan - even     when I’m within budget! •   you tell m...
remember:•   I have a need if my health, independence (or ideally    citizenship) is at risk (unfortunately this subject t...
a couple of mistakes:
a couple of mistakes:• ere is a mistake in the 7  Steps of SDS - too much  focus on the money
a couple of mistakes:• ere is a mistake in the 7  Steps of SDS - too much  focus on the money• Evolution of the RAS has  ...
a couple of mistakes:• ere is a mistake in the 7  Steps of SDS - too much  focus on the money• Evolution of the RAS has  ...
RAS-we are goingdown aslippery slopeto ‘phoneyrationality’
• 1996 - RAS =                              RAS-  professional judgement  of ‘sufficiency’                           we are ...
• 1996 - RAS =                                 RAS-  professional judgement  of ‘sufficiency’• 2003 - RAS = one page  guide ...
• 1996 - RAS =                                 RAS-  professional judgement  of ‘sufficiency’• 2003 - RAS = one page  guide ...
• 1996 - RAS =                                 RAS-  professional judgement  of ‘sufficiency’• 2003 - RAS = one page  guide ...
• 1996 - RAS =                                 RAS-  professional judgement  of ‘sufficiency’• 2003 - RAS = one page  guide ...
Failure of Trust - we don’ttrust ourselves:• Razzle-dazzle = the RAS sounds ‘technical’• More rules = more control over so...
Failure of Trust - we don’ttrust ourselves:
Focus needs to shift from rules              to:   outcomes, resources and          principles
Need to return to social      ...and build on what is
Need to return to social      ...and build on what is
Need to use our
Need to use our
for example: families &
for example: families &
I want patients to have far more control over the care they get. So peoplewith long term conditions get to be part of desi...
what this might mean in• Focus on  supporting front-  line practice - make  personalisation  useful• Link RAS to current  ...
what this might mean in• Focus on  supporting front-  line practice - make  personalisation  useful• Link RAS to current  ...
headline possibilities...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
headline possibilities...•   End of life - if 40% of people who die in hospital could die at    home - saving of £450 mill...
managing amidst crisis
managing amidst crisis
managing amidst crisis• Discipline - implementing  without waste and delay
managing amidst crisis• Discipline - implementing  without waste and delay• Integrity - fulfilling our  obligations
managing amidst crisis• Discipline - implementing  without waste and delay• Integrity - fulfilling our  obligations• Wisdom...
managing amidst crisis• Discipline - implementing  without waste and delay• Integrity - fulfilling our  obligations• Wisdom...
The challenge for localgovernment
The challenge for localgovernment
The challenge for localgovernment    The rational     appeal and       Humpty-        Dumpty       dream of     Total Place
The reality is very different:
The reality is very different:
but the goal was never easy
but the goal was never easy
but the goal was never easy       and nothing is more
The Centre for Welfare ReformThe Quadrant, 99 Parkway Avenue,Parkway Business ParkSheffield, S9 4WGT +44 114 251 1790 | M ...
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
(172) realising the benefits (may 2011)
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(172) realising the benefits (may 2011)

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  • (172) realising the benefits (may 2011)

    1. 1. Realising thepersonalisation in health & social care Talk given by Dr Simon Duffy of e Centre for Welfare Reform, for Adult Health and Social Care in Yorkshire and Humber Joint Improvement Partnership, Doncaster, England 12th May 2011
    2. 2. we’ve have come a long• see individual control as a right• see flexibility & creativity as a good thing• think block contracts are problematic• understand the phrase “life not services”• have a little more humility about our own role5 years ago these were thebeliefs of a smallminority, 10 years agothey were met withbewilderment - today
    3. 3. but we have much to learn,• forget why personalisation works• get lost in confusing process - eg. the RAS• burden and blame front-line workers• fail to trust communities and services• pretend things don’t really need to change - e.g the health-social care divide
    4. 4. personalisation can be seenas a system
    5. 5. personalisation can be seenas a system
    6. 6. BUT personalisation did NOT • because of markets - although they can help • independent brokers (or other wonder workers) • clever Resource Allocation Systems • following the 7 steps of self-directed support • having an individual budgetSome of these systems do help to setup new patterns of positive behaviour -but they also present grave danger:
    7. 7. BUT personalisation did NOT • because of markets - although they can help • independent brokers (or other wonder workers) • clever Resource Allocation Systems • following the 7 steps of self-directed support • having an individual budgetSome of these systems do help to setup new patterns of positive behaviour -but they also present grave danger: Means ≠ Ends
    8. 8. its true value is: we• respect each other as fellow citizens• we enable people to make better decisions• we enter into a more equal partnership• learn - we get better at our job
    9. 9. its true value is: we• respect each other as fellow citizens• we enable people to make better decisions• we enter into a more equal partnership• learn - we get better at our job
    10. 10. FROM pushing resources into things -and hoping they have valueTO pulling resources together - buildingon their real wealth - increased value
    11. 11. FROM pushing resources into things -and hoping they have valueTO pulling resources together - buildingon their real wealth - increased value
    12. 12. but control is not real, if • you chop out creative support from my plan - even when I’m within budget! • you tell me it’s too difficult & offer to plan for me • you don’t give me enough support • you create burdensome rules, undue monitoring or just make everything too vague • you confuse needs, outcomes and support
    13. 13. but control is not real, if • you chop out creative support from my plan - even when I’m within budget! • you tell me it’s too difficult & offer to plan for me • you don’t give me enough support • you create burdensome rules, undue monitoring or just make everything too vague • you confuse needs, outcomes and support
    14. 14. remember:• I have a need if my health, independence (or ideally citizenship) is at risk (unfortunately this subject to crude eligibility thresholds in England) - undue risk creates a NEED for help - it does NOT determine what kind of help (or its cost!)• You have a duty to help me meet my needs (reduce risk) in a way that is consistent with my own goals or OUTCOMES - you must NOT frustrate my goals - that is an abuse of human rights.• An entitlement - my BUDGET - must be sufficient to meet my needs - you must NOT give me too little to meet my needs.even when times are tough our legaland moral responsibilities remain
    15. 15. a couple of mistakes:
    16. 16. a couple of mistakes:• ere is a mistake in the 7 Steps of SDS - too much focus on the money
    17. 17. a couple of mistakes:• ere is a mistake in the 7 Steps of SDS - too much focus on the money• Evolution of the RAS has become damaging
    18. 18. a couple of mistakes:• ere is a mistake in the 7 Steps of SDS - too much focus on the money• Evolution of the RAS has become damaging sorry
    19. 19. RAS-we are goingdown aslippery slopeto ‘phoneyrationality’
    20. 20. • 1996 - RAS = RAS- professional judgement of ‘sufficiency’ we are going down a slippery slope to ‘phoney rationality’
    21. 21. • 1996 - RAS = RAS- professional judgement of ‘sufficiency’• 2003 - RAS = one page guide to practitioners on an indicative budget we are going down a slippery slope to ‘phoney rationality’
    22. 22. • 1996 - RAS = RAS- professional judgement of ‘sufficiency’• 2003 - RAS = one page guide to practitioners on an indicative budget• 2006 - RAS = 10 page questionnaire - but easy questions we are going down a slippery slope to ‘phoney rationality’
    23. 23. • 1996 - RAS = RAS- professional judgement of ‘sufficiency’• 2003 - RAS = one page guide to practitioners on an indicative budget• 2006 - RAS = 10 page questionnaire - but easy questions we are going down a• 2011 - RAS = 40 page slippery slope questionnaire and to ‘phoney increasing ambiguity rationality’
    24. 24. • 1996 - RAS = RAS- professional judgement of ‘sufficiency’• 2003 - RAS = one page guide to practitioners on an indicative budget• 2006 - RAS = 10 page questionnaire - but easy questions we are going down a• 2011 - RAS = 40 page slippery slope questionnaire and to ‘phoney increasing ambiguity rationality’
    25. 25. Failure of Trust - we don’ttrust ourselves:• Razzle-dazzle = the RAS sounds ‘technical’• More rules = more control over social workers• Panels and RAS working groups = control dris upwards• Months and years to calculate = confusion and disempowerment• Lots of process ≠ guarantee of sufficiency
    26. 26. Failure of Trust - we don’ttrust ourselves:
    27. 27. Focus needs to shift from rules to: outcomes, resources and principles
    28. 28. Need to return to social ...and build on what is
    29. 29. Need to return to social ...and build on what is
    30. 30. Need to use our
    31. 31. Need to use our
    32. 32. for example: families &
    33. 33. for example: families &
    34. 34. I want patients to have far more control over the care they get. So peoplewith long term conditions get to be part of designing the care they need.Choosing what suits them - and making it work. For mental healthpatients. For pensioners in need of care. For people with disabilities. Itworks.A couple of weeks ago in Sheffield, I met a wonderful woman calledKatrina. Shes got three disabled sons. e oldest is Jonathan, a charming,warm hearted young man of 19. He cant walk or talk clearly, or feedhimself alone. Hes had a breathing tube in his neck since he was atoddler.... Jonathans just got his own individual budget and care plan.Now hes doing work with a local charity, attending a music group, has hisown personal assistant. A child whose potential seemed so limited. Finallyas a young man, engaged in life in a way he and his mother never thoughtpossible. Katrina told me with the biggest smile Ive ever seen. She said:Weve gone from having nothing to having everything. I wish every childsneeds would be taken this seriously.Nick Clegg 2008 Lib Dem Conference - now Deputy Prime Minister
    35. 35. what this might mean in• Focus on supporting front- line practice - make personalisation useful• Link RAS to current practice - simplify!!• Dare to integrate - the health/social care divide won’t hold
    36. 36. what this might mean in• Focus on supporting front- line practice - make personalisation useful• Link RAS to current practice - simplify!!• Dare to integrate - the health/social care divide won’t hold
    37. 37. headline possibilities...
    38. 38. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year
    39. 39. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion
    40. 40. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion• Out of area placements - Total out of area placements in Yorkshire & Humber: £15,635,000
    41. 41. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion• Out of area placements - Total out of area placements in Yorkshire & Humber: £15,635,000• Continuing healthcare - national pilot is already demonstrating efficiencies of 20% on existing packages.
    42. 42. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion• Out of area placements - Total out of area placements in Yorkshire & Humber: £15,635,000• Continuing healthcare - national pilot is already demonstrating efficiencies of 20% on existing packages.• Frequent users - 22% emergency admissions for conditions that can be managed outside hospital, saving: £500 million.
    43. 43. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion• Out of area placements - Total out of area placements in Yorkshire & Humber: £15,635,000• Continuing healthcare - national pilot is already demonstrating efficiencies of 20% on existing packages.• Frequent users - 22% emergency admissions for conditions that can be managed outside hospital, saving: £500 million.• Integrated care - integrated approach to homelessness in Denver produced savings of nearly £3000 per person.
    44. 44. headline possibilities...• End of life - if 40% of people who die in hospital could die at home - saving of £450 million in bed days a year• Mental health - 10.8% of NHS secondary healthcare budget on mental health services: £10.4 billion• Out of area placements - Total out of area placements in Yorkshire & Humber: £15,635,000• Continuing healthcare - national pilot is already demonstrating efficiencies of 20% on existing packages.• Frequent users - 22% emergency admissions for conditions that can be managed outside hospital, saving: £500 million.• Integrated care - integrated approach to homelessness in Denver produced savings of nearly £3000 per person. ...but a long way to go yet
    45. 45. managing amidst crisis
    46. 46. managing amidst crisis
    47. 47. managing amidst crisis• Discipline - implementing without waste and delay
    48. 48. managing amidst crisis• Discipline - implementing without waste and delay• Integrity - fulfilling our obligations
    49. 49. managing amidst crisis• Discipline - implementing without waste and delay• Integrity - fulfilling our obligations• Wisdom - reflecting, understanding and challenging
    50. 50. managing amidst crisis• Discipline - implementing without waste and delay• Integrity - fulfilling our obligations• Wisdom - reflecting, understanding and challenging www.campaignforafairsociety.org
    51. 51. The challenge for localgovernment
    52. 52. The challenge for localgovernment
    53. 53. The challenge for localgovernment The rational appeal and Humpty- Dumpty dream of Total Place
    54. 54. The reality is very different:
    55. 55. The reality is very different:
    56. 56. but the goal was never easy
    57. 57. but the goal was never easy
    58. 58. but the goal was never easy and nothing is more
    59. 59. The Centre for Welfare ReformThe Quadrant, 99 Parkway Avenue,Parkway Business ParkSheffield, S9 4WGT +44 114 251 1790 | M +447729 7729 41admin@centreforwelfarereform.orgGet a free subscription at:© Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org
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