Supporting people

Towards a person-centred approach

Beresford, Peter, Fleming, Jennie, Peter Beresford, Jennie Fleming, Michael Glynn, Catherine Bewley, Suzy Croft, Fran Branfield, Karen Postle

• Publisher: Policy Press
• Year: 2011
• Print ISBN: 9781847427625
• eBook ISBN: 9781447308737
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

There is widespread agreement that care and support services must change radically if they are to meet the rights and needs of the rapidly growing number of people who require them.

For the first time, Supporting people explores with service users, practitioners, carers and managers what person-centred support means to them, what barriers stand in its way and how these can be overcome. It provides a unique roadmap for the future, offering theoretical insights, practical guidance and highlighting the importance of a participatory approach.

Based on the largest independent UK study of person-centred support and written by an experienced team that includes service users, practitioners and researchers, it demonstrates how change can be made now, and what strategic changes will be needed for person-centred support to have a sustainable future.

Part One: The Background to Person-Centred Support

ONE

Setting the scene for social care

When it comes to quality and standards, we should have our views taken into account as service users and carers. Service users’ and carers’ voices need to be heard at all levels of the process of setting standards and improving quality.

(Harding and Beresford, 1996, p 3)

STANDARD ONE: EVALUATION

Services and support must be audited to ensure that policies and provision offer person-centred support and are underpinned by its values. Policy and practice should be evaluated employing user-defined measures and outcomes and involving service users in the process.

Introduction

While our focus is ‘person-centred support’, this is also very much a book about making change. It is concerned with changing the way that people who need support to live their lives, are able to get that support. It addresses the current concern of governments to achieve this. It examines efforts that many people and services are making to work in a different ‘person-centred’ way to achieve this. The book also explores how people can be helped to work better in this way.

There has been enormous interest in making change in social care in the UK. Words like ‘transformation’, ‘revolutionary’ and ‘fundamental’ change have been used by government, as well as by other policymakers and commentators to signify this. The reform of social care funding emerged as a high profile issue in advance of the 2010 General Election, with competing proposals advanced by the major political parties. The two parties, Conservative and Liberal Democrat, that made up the subsequent coalition government, previously had very different, strongly conflicting approaches to social care. Earlier, the former Labour government had invested more than half a billion pounds, an unprecedented amount, in social care change and set up planning bodies to take it forward, as well as organising large-scale consultations, at national and local levels. The Coalition government then followed a similar path, committing itself to fundamental reform of both social care legislation and funding.

Yet change has been a consistent, almost dominant feature of social care for many years – almost since its inception as part of the post Second World War welfare state. It has been the subject of constant, indeed accelerating restructurings and reorganisations. Thus there has been change from the initial welfare and children’s departments of the 1950s, to the social services departments established in the 1970s and then dissolved 30 years later. Social care has been led by different professions, from the welfare and children’s officers first established, through social workers, to the care managers of the 1990s onwards. It has shifted between ‘generic’ and ‘specialist’ professional roles; through the ‘patch’ and ‘community social worker’ and being based in ‘area’ and ‘neighbourhood’ offices. It has been underpinned by radically different ideologies, embracing differing commitments to voluntarist, market and state-led approaches to support.

Despite this apparent preoccupation with change, one thing seems to have remained relatively constant. Service users’ experience of social care does not seem to have changed fundamentally. The repeated message from service users over the years has been that social care policy and provision have tended to be unreliable, inadequate and often of poor quality (Harding and Beresford, 1996; Beresford et al, 2005).

The nature of social care

Social care has helpfully been defined as:

The provision of services to adults who require assistance with aspects of daily living as a result of disability, illness or ageing. Social care is an all-embracing term for the personal social services. (Barton, 2000, p 318)

Social care can not only make a claim to have importance for all our lives, it is also a massive industry in its own right. In 2007-08 around 1.75 million people of working age and older people used different care services provided by their local council or purchased on their behalf from private and voluntary organisations (CSCI, 2009, p vi).

Including children, over two million people of all ages and from every community, used social care services arranged by local councils during 2006-07 (CSCI, 2008, p 9). As well as working with adults and children, social care works with those going through the transition from child to adult status. In 2006 there was a radical reorganisation in service delivery in England (although not in Wales or Scotland), which separated adults’ and children’s services into different local departments, subject to different central government departments (Petch, 2008, p 237). This created additional administrative complexities since there are clearly overlaps between adults and children, not least in the case of parents with disabled children and disabled parents.

Recent figures show that local authorities spend £14.2 billion on social care for adults. Nearly two thirds of this is spent on older people (61.0%) and nearly a quarter on people with learning difficulties (21.0%). Of the total of more than 1.75 million adults who receive one or more social care service from their councils, just over a million are supported at home with community services. There are also many ‘self-funders’ receiving social care, the proportions varying significantly between different localities. Almost half a million people live in some form of residential institution. In 2007, there were 18,577 registered care homes for adults of all ages, with 441,958 places. It is estimated that the current social care workforce includes 1.5 million workers. The people working in social care form 4% of the national working population and something like 15% of the public sector workforce (Platt, 2003). The majority of the workforce (69.0%) is employed in the independent sector (CSCI, 2008, p 10).

‘Social care’ is a recent arrival as a description for a discrete area of public policy. This may help explain its low level of recognition from public and politicians. Following the creation of the welfare state, the talk was more of personal social services and social work. This terminology has now been significantly replaced by one based on ‘care’, for example, community care, primary care, care in the community, long-term care and now social care. A set of new key organisations were also developed, framed in these terms, including the Social Care Institute for Excellence, the General Social Care Council, Skills for Care and most recently, the Care Quality Commission and National Skills Academy for Social Care. A sub-set of roles and tasks have been developed framed in terms of care, including care management, care planning, care package, extra care housing and care worker.

Making broader connections

While social care is now identified as a distinct policy area, it would be a mistake to see it solely as something separate. Not only does it relate to a broader range of policies, but other policies also have a role in providing social support. This includes housing, education and training, income maintenance, employment and of course, health. Workers with social care responsibilities, including social workers, occupational therapists and others are also employed in other policy fields and not only in social care.

The need for social care support also does not operate in isolation. It depends on how other policies and services work. For example, if pavements and the built environment are unsafe, then people may be restricted to their homes. If public transport is inaccessible, they may need ‘special’ transport in order to go out. If employment is restricted and inflexible, they may be forced to live on benefits – and so on. Social care has to be seen as part of the whole.

There has been an increasing awareness lately on the part of government that social care cannot be treated in isolation and the broader policy context must also be addressed, if people’s rights and needs are to be met in the round. How far this has been achieved is open to discussion. But there is now formal recognition of the issue among policymakers. This is embodied in ideas like ‘place-shaping’ and ‘total place’, where the idea is that local and other authorities should ‘make creative use of [their] powers and influence to promote the general well-being of a community and its citizens’ to improve and integrate local policies and services, developing a ‘whole area’ approach to public services (Lyons, 2007, p 51; Hampshire County Council, 2008, p 75; HM Treasury, 2010).

The problem with social care

There can be no question that a major cause of continuing pressure for change in social care, extending to government, is its failure to provide a reliably good service for service users. Social care policy and practice have a crucial role to play in enabling service users to live on as equal terms as others. However, the social care system is still often failing to provide the support that people want, services shaping people’s lives rather than vice versa. Staff providing services are often frustrated and disappointed because they are unable to offer good quality support and valuable resources are wasted because services are failing (NCIL and Shaping Our Lives, 2005).

Innovations like direct payments and the Independent Living Fund, have been slow to mainstream the level of choice and independence set out in formal policy. In particular, older people, mental health service users, people with learning difficulties and people from black and minority ethnic communities, have all been shown to experience additional difficulties in accessing direct payments (see for example, Clark et al, 2004). The prevailing culture of social care appears still to be a serious barrier to developments in independence and control for service users. This is not to say that current staff and other professionals do not, or would not support, such a development, but that they frequently appear to have neither the power nor the knowledge or support to bring it about (Clark et al, 2004).

Further evidence of this common inability to adapt practice within social care systems to meet the concerns and demands of the people who use them is provided by the outcomes of most participation schemes. While these have increasingly been required, the extent to which they actually contribute to, or change the system or its plans, is highly questionable (Carter and Beresford, 2000; Carr, 2004). Service planners and practitioners may want to respond to people’s comments and concerns, but frequently find themselves trapped within their own institutional structures, without the experience, power or expertise to change them.

The sustainability of social care

Questions are also increasingly being raised about the sustainability of social care. This is first because of the longstanding financial problems social care has faced, but increasingly also because of the uncertain availability of people to provide support. Two main sources of support have been highlighted in recent years; the paid workforce and unpaid ‘carers’ recruited from people’s partner...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• About the authors
• Acknowledgements
• Foreword
• Introduction
• Part One: The Background to Person-Centred Support
• Part Two: Person-Centred Support: Barriers and Ways of Overcoming Them
• Part Three: Broader Issues for Person-Centred Support
• Part Four: Making Change to Achieve Person-Centred Support
• Appendices