Personalisation has been the cornerstone of public services reform over recent years, combining service-user demand for greater choice and control with the aspiration that tailored services could deliver greater efficiencies. It's an approach which empowers local people and communities and chimes with the coalition government's vision of a "big society" as well as the current health white paper's focus on patient choice.
Giving people control over the way their health and social care services are designed and delivered is a key part of personalisation. However, it also requires service providers to transform services, engage in partnerships and rethink commissioning practices. Set these demands against a backdrop of the biggest public spending cuts in living memory and it's clear there are challenges ahead for local authorities and voluntary and community sector organisations involved in service provision.
Unravelling the challenges and opportunities that personalisation brings to voluntary and community sector organisations on a local level was the focus of a recent roundtable discussion convened by the Guardian in partnership with Navca, the National Association for Voluntary and Community Action. Navca is the umbrella body for local support and development organisations, which provides learning and networking opportunities, advice, policy information and strategic partnership work.
Roundtable participants included leading figures from thinktanks, the statutory sector, voluntary and community sector and academics. The event was conducted with the anonymity of reporting allowed under the Chatham House rule to encourage frank debate, so this report reflects the themes discussed without attribution.
A range of approaches
The personalisation rhetoric has become a reality for public services to varying degrees. In adult social care, there has been strong national direction to increase choice and control for service users through personal budgets, more effective spending on preventative services and more accessible universal services (such as transport or housing). Individual budgets are being piloted in children's services and family intervention projects have been developed to provide tailored support to those who most need it.
In the health sector, personalisation has translated into services such as "choose and book" facilities for hospital admission and expert patient programmes for people with chronic conditions. Personal health budgets (PHBs) - designed to give service users greater choice in the health care they receive - have been piloted in 70 sites across England since 2009.
Despite these developments personalisation is still a nascent market, one roundtable participant pointed out. Others thought service users were confused by the concept and that some service providers were "in denial" or didn't "fully understand" personalisation. There was a need, many felt, for raising awareness in local areas.
Many felt that the current climate of spending cuts could mean a widening gap between the aspiration for personalisation and the reality on the ground. For at least one participant, this pointed to the importance of "co-production" - the need to work in partnership with people with support needs to create a shared understanding of solutions.
Giving patients and their carers better access to information was an immediate challenge, said one participant. "If you only know the colour blue, you will only ask for the colour blue. How do you get knowledge [about personalisation] out to the public?" Another asserted that empowering service users would require "a different approach and a different language" from health and social care professionals.
Some pointed to the crucial role that brokers - from in-house teams to charities and dedicated social enterprises - could play in supporting informed choice for service users. "Personalisation is about empowering the consumer. But we are talking about the most vulnerable people in society who may need help with support planning, budget minding and so on," said one participant. Brokers would need "much more knowledge and courage to hold the line on what people need".
Services such as online resource Shop4Support could help people manage their personal budgets; however, it was thought the most vulnerable service users would still need professional support to understand their care options. It was important "not to fall into the free market approach", said one participant, which could create "supermarket providers" that limited choice. There were concerns that the current financial climate would limit resources to support people to make real choices. A more coherent approach to support planning, brokerage and advocacy services was needed.
Other roundtable participants stressed the need for service providers to harness the knowledge and experience of service users. "We do meet service users who are very well informed. If you are creating a market where the service user is champion, it makes sense to involve them in the process," said one participant.
The effect of public sector spending cuts was a recurring theme. As one participant put it: "There is a tension between the aspiration to give people more options and the reality that there isn't a lot of money around." With some local authorities having to slash up to a third of their spending, one contributor warned personalisation would be underfunded "by stealth".
Cutting red tape could be one way for personalisation to flourish despite financial restraints. One participant said: "The financial climate is such that, if we don't cut out some of the bureaucracy [in social care], we just won't be able to deliver. For example, we need to share information so people don't have multiple assessments."
Many agreed that a priority was to enable service providers to engage with the personalisation agenda. "We need to upskill the third sector to market itself to appeal to consumers. The sector is used to selling on a block contract basis but we're talking about individual contracts commissioned by service users."
Understanding this new procurement process was "a challenge for everyone". As one participant said: "It's all very well telling [voluntary and community sector] organisations about personalisation, but how do you move them forward to talk about business opportunities? It's not a word that they like to use." Another thought this could be "a real challenge for some third sector organisations who are value driven, not profit driven".
Navca's Local Commissioning and Procurement Unit (LCPU) was set up in 2008 as a direct result of requests from Navca members who needed help and support with the commissioning agenda. An LCPU survey found 42% of respondents were involved in influencing adult social care commissioning strategies. Additionally many Navca members have workers who facilitate and support health or social care networks of frontline organisations.
Voluntary and community sector infrastructure "is a really crucial part of managing the market", said one participant. The sector "has tools to share information" so that smaller community groups can engage in personalisation.
Market making and moving services "from wholesale to retail to bespoke" was the subject of much debate. At least one participant felt that local authorities' focus on meeting the April 2011 performance target had been at the expense of developing the local marketplace for personalised services. It was also felt better relationships between commissioners and the voluntary and community sector needed to be built. But at least one participant felt more focus on individual needs could change the service provision landscape: "If it means some providers or commissioners going, so be it."
For some around the table, personalisation demands "a massive cultural shift" to embrace new approaches to service provision. Meanwhile, the hysteria in some parts of the media about choices that budget holders make should remind service providers to think about risk, especially when dealing with unusual requests. "Going to a festival might be more important than a clean house for some people. It can have a transformative effect that can keep you out of hospital or social care."
A fundamental change was needed in how councils balance protecting vulnerable people with letting them take risks - the risks involved "in doing nothing" versus taking action, as one participant said.
The government says 13% of social care users have a personal budget; it still hopes to achieve 30% by the end of next March as part of what social care minister Paul Burstow has called "a very stretching target" of getting 100% of those eligible on to personal budgets over the next five years.
Given unprecedented cuts to public spending, many participants felt the voluntary and community sector was well placed to work with local authorities to provide imaginative, cost-effective services that do what service users ask of them. But as one participant warned, taking a place at the personalisation table now was vital: "Whether we like it or not, this juggernaut is coming to us."
At the table
Jane Dudman (chair)
Editor of Public, The Guardian
Director, Centre for Public Service Partnerships
Dr Helen Sanderson
Managing director, Helen Sanderson Associates
Chief executive, Care Forum
Chief executive, Grenfell Housing Association
Professor, Centre of Disability Research, Lancaster University
Dr Alison Austin
Department of Health, Personal Health Budgets Team
National development manager for care and communities, Age UK
Development officer, Voluntary Action Rotherham
Director of MSc managing partnerships,
HSMC, University of Birmingham
National director, Social Care Transformation
Commissioning manager, Hampshire County Council
Public affairs manager, Radar
Commissioning officer – health, Nottingham CVS
Director of improving local services, Navca
Chief executive, In Control
Director of external affairs, Mind
Voluntary Organisations Disability Group