Good care and support must be individually tailored to the needs of the person who is being supported. It is absolutely vital that care assessments are co-produced and reflect the needs and aspirations of the person using the service and are focused on delivering maximum autonomy, choice, independence and they are also central to maintaining an individual’s dignity.
Sadly, in far too many cases care assessments become very formulaic and are sometimes a battleground between those who deliver services and the authorities who pay for them.
There is a lot of rhetoric within our system about responding to changing needs and enabling people to live autonomous and independent lives. Sadly, care assessments are seldom reviewed on this basis and in recent years we have seen attempts by local authorities to use re-assessment as a mechanism to reduce funding. There is little evidence however, of commissioners rushing to re-assess people when they need their support packages to be increased and commissioners seem to see assessment as a route to budget management rather than a way to ensure high quality outcomes for people.
Our system is also weighted against providers who enable people to live more autonomous lives. I have seen countless examples of success stories where people have been given the support necessary to have higher levels of independence and instead of the system rewarding this, what we see is a rush to reduce the cost of care package rather than to reward the improvement to peoples’ lives.
There is a real need for us to think differently about the assessment process. To take it away from being an administrative exercise and put it firmly back where it needs to be as a facilitator that enables people to live well with long-term conditions and a framework, within which, care providers can ensure services meet people’s needs.
In saying all this, I am conscious that there are good examples of care planning, which are developed with service users and their families and which enable the flexibility necessary to ensure people live good lives, rather than just receiving services.
As with so much in our system, we seem incapable of cascading the very best and translating it from being an exemplar into the norm.
I am frankly exasperated by the number of initiatives I have seen come and go over my many years in social care when the evidence proves that is a good way forward. I would hope that this becomes common practice and yet the system is incapable of making sure that the best becomes the norm rather than the exception.
I am also sick of this obsession with localism, which is often used as an excuse for protective practices rather than moving towards evidence-based outcome focused services. If there is going to be an approach to localism, it has to be justified by some clarity around why it needs to be different in one area than another. If I am a person living with dementia in Halifax, I am not convinced that my needs are very different from a person living with dementia in Truro, yet there may be completely different service offerings. That is fine, if there is some clear and evidence-based reason why it needs to be different, but in reality, often services are developed and sustained without any clear evidence base.
What I think we need is a very clear vision for what we expect from health and social care and within that vision we need to let individual care planning decide the matrix of appropriate services for the individual. We have been talking for over 30 years about individually tailored care plans and individual needs assessments, yet despite all this goodwill and all this rhetoric, we still find people who are using services getting different levels of support based purely on where they happen to live rather than on their needs.
I hope that the coming years will be ones where care planning is at the centre of delivering individual and tailored care packages, and the system will be flexible enough to deliver what people want and need rather than just making this citizen fit the system.
