1. Realising the
personalisation 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. 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 role
5 years ago these were the
beliefs of a small
minority, 10 years ago
they were met with
bewilderment - today

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. personalisation can be seen
as a system

5. personalisation can be seen
as a system

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 budget
Some of these systems do help to set
up new patterns of positive behaviour -
but they also present grave danger:

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 budget
Some of these systems do help to set
up new patterns of positive behaviour -
but they also present grave danger:
Means ≠ Ends

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. 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. FROM pushing resources into things -
and hoping they have value
TO pulling resources together - building
on their real wealth - increased value

11. FROM pushing resources into things -
and hoping they have value
TO pulling resources together - building
on their real wealth - increased value

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. 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. 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 legal
and moral responsibilities remain

15. a couple of mistakes:

16. a couple of mistakes:
• ere is a mistake in the 7
Steps of SDS - too much
focus on the money

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. 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

24. RAS-
we are going
down a
slippery slope
to ‘phoney
rationality’

25. • 1996 - RAS = RAS-
professional judgement
of ‘sufficiency’
we are going
down a
slippery slope
to ‘phoney
rationality’

26. • 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’

27. • 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’

28. • 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’

29. • 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’

30. Failure of Trust - we don’t
trust 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

31. Failure of Trust - we don’t
trust ourselves:

34. Focus needs to shift from rules
to:
outcomes, resources and
principles

35. Need to return to social
...and build on what is

36. Need to return to social
...and build on what is

37. Need to use our

38. Need to use our

39. for example: families &

40. for example: families &

42. I want patients to have far more control over the care they get. So people
with long term conditions get to be part of designing the care they need.
Choosing what suits them - and making it work. For mental health
patients. For pensioners in need of care. For people with disabilities. It
works.
A couple of weeks ago in Sheffield, I met a wonderful woman called
Katrina. She's got three disabled sons. e oldest is Jonathan, a charming,
warm hearted young man of 19. He can't walk or talk clearly, or feed
himself alone. He's had a breathing tube in his neck since he was a
toddler.... Jonathan's just got his own individual budget and care plan.
Now he's doing work with a local charity, attending a music group, has his
own personal assistant. A child whose potential seemed so limited. Finally
as a young man, engaged in life in a way he and his mother never thought
possible. Katrina told me with the biggest smile I've ever seen. She said:
We've gone from having nothing to having everything. I wish every child's
needs would be taken this seriously.
Nick Clegg 2008 Lib Dem Conference - now Deputy Prime Minister

43. 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

44. 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

45. headline possibilities...

46. 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

47. 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

48. 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

49. 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.

50. 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.

51. 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.

52. 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

53. managing amidst crisis

54. managing amidst crisis

55. managing amidst crisis
• Discipline - implementing
without waste and delay

56. managing amidst crisis
• Discipline - implementing
without waste and delay
• Integrity - fulfilling our
obligations

57. managing amidst crisis
• Discipline - implementing
without waste and delay
• Integrity - fulfilling our
obligations
• Wisdom - reflecting,
understanding and
challenging

58. managing amidst crisis
• Discipline - implementing
without waste and delay
• Integrity - fulfilling our
obligations
• Wisdom - reflecting,
understanding and
challenging
www.campaignforafairsociety.org

59. The challenge for local
government

60. The challenge for local
government

61. The challenge for local
government
The rational
appeal and
Humpty-
Dumpty
dream of
Total Place

62. The reality is very different:

63. The reality is very different:

64. but the goal was never easy

65. but the goal was never easy

66. but the goal was never easy
and nothing is more

67. The Centre for Welfare Reform
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