Social care services must be focused on the people they support, never forgetting that putting people at the centre of everything we do has to be not only our aspiration, but also enshrined in our practice.
However, often when you talk to people who use services there is a gap between the rhetoric and the reality of their lives. In future our focus must be on how we bridge that gap and make services truly responsive to people’s needs.
If we are going to achieve this ambition, we need a lot of change in the structure of how services are commissioned because it is commissioning that is often one of the biggest impediments to delivering on a personalised service. One of the most stark examples of this is the way in which homecare is commissioned by Local Authorities, who obsess about time and task and do not give care providers the flexibility that will enable them to respond more effectively to people’s needs, wants and aspirations. One of the worst aspects of how services are commissioned and delivered is that they assume that people who use services live a completely regimented life. I spoke to somebody recently who was looking after her husband who was living with dementia, she herself had a stroke which impaired her mobility and she asked me a stark question “ What time do you go to bed tonight? I responded, “well it depends on what I’ve been doing and how tired I feel”. The lady then said to me “I know what time I will go to bed, it’s the same time that I went yesterday, and will be the same time I will go tomorrow because it’s the time when people come to put us to bed and usually it’s very early”. This for me really underlined the fact that however we try to pretend services respond to people’s needs the reality is a long way from the aspiration of enabling people to live the lives they want to achieve.
There is also another challenge which is driven through social care commissioning and that is the ageism of the system. Older people services are often just block contracted and this does not give much opportunity to respond to individual needs. Younger adults, on the other hand, often have individual assessments and also individually funded care packages, which have the potential to be much more responsive to people’s needs. If we are going to truly deliver person centred services, we must ensure there is equality of access to good quality responsive care for everyone who needs it. The equality and human rights act clearly states that age is a protected characteristic; I still do not understand why it is possible for older people to receive such a different response in Local Authority commissioning without any challenge from the equality and human rights commission.
The system also needs to think more clearly about how they coproduce services with the people who use them and also how they enable people who use services to be involved in the planning development and innovation of care. All too often services decide what they want to do and then consult with people who use services after they have formulated a plan. A much better and more effective way of working is to work with people who use the service, to identify the issues and to craft the solutions. In this way, you not only get a clear understanding of what makes a difference to people‘s lives, but you also get some really interesting, innovative creative ideas about how services can be reconfigured to deliver better outcomes for the people they support.
Putting people who use services at the very centre has long been a cherished ambition of social care, but sadly the progress towards this objective has been very slow and we need to move this agenda forward. Person centred flexible services should be the right of every person who needs support if we are truly to have a 21st-century health and social care system.