Journal of Care Services Management, 5(4), October 2011, pp.173-183.
Publisher:
Taylor and Francis
Personalisation in adult social care raises questions about future risk and regulation. Will this approach make people safer by giving them greater choice and control, or could it put people at greater risk by fragmenting public services and leaving people insufficiently supported? This article offers a personal view based on experience of working with policy makers, managers, practitioners, and service users in health and social care. It argues that ‘risk’ is often perceived negatively by people using services (used as an excuse used for stopping them doing something) – but risk needs to be shared between the person taking the risk and the system that is trying to support them. The article states that although some people fear that personalisation may increase risk, it could help people to be safer by putting them more in control of their lives, helping them plan ahead, and focusing our safeguarding expertise on those who really need it. Finally, it considers the fact that in an era of personalisation, approaches to risk and regulation will need to be equally personalised.
Personalisation in adult social care raises questions about future risk and regulation. Will this approach make people safer by giving them greater choice and control, or could it put people at greater risk by fragmenting public services and leaving people insufficiently supported? This article offers a personal view based on experience of working with policy makers, managers, practitioners, and service users in health and social care. It argues that ‘risk’ is often perceived negatively by people using services (used as an excuse used for stopping them doing something) – but risk needs to be shared between the person taking the risk and the system that is trying to support them. The article states that although some people fear that personalisation may increase risk, it could help people to be safer by putting them more in control of their lives, helping them plan ahead, and focusing our safeguarding expertise on those who really need it. Finally, it considers the fact that in an era of personalisation, approaches to risk and regulation will need to be equally personalised.
ASSOCIATION OF DIRECTORS OF ADULTS SOCIAL SERVICES. WEST MIDLANDS JOINT IMPROVEMENT PARTNERSHIP, NHS WEST MIDLANDS
Publisher:
West Midlands Joint Improvement Partnership
Publication year:
2011
Pagination:
19p.
Place of publication:
Birmingham
Personalised care is for everyone, but some people will need more support than others to make choices about how they live their lives. This paper, commissioned by the West Midlands Joint Improvement Partnership (JIP) provides a framework for Councils in shifting the balance away from risk aversion towards supported positive risk taking. The aim is to share risk between the individual using services, their family, carers, professional care staff, third parties and the Council. Sections include: what is risk; what is positive risk taking; principles of working positively with risk; and risk assessment and identification. The advice given in this document does not replace any existing risk guidance; rather it seeks to highlight good practice, enabling Councils and health economies within the region to share expertise in developing this component of the transformation agenda. Councils and Health bodies may find the self-assessment tool included in this framework helpful as a starting point in understanding their current position.
Personalised care is for everyone, but some people will need more support than others to make choices about how they live their lives. This paper, commissioned by the West Midlands Joint Improvement Partnership (JIP) provides a framework for Councils in shifting the balance away from risk aversion towards supported positive risk taking. The aim is to share risk between the individual using services, their family, carers, professional care staff, third parties and the Council. Sections include: what is risk; what is positive risk taking; principles of working positively with risk; and risk assessment and identification. The advice given in this document does not replace any existing risk guidance; rather it seeks to highlight good practice, enabling Councils and health economies within the region to share expertise in developing this component of the transformation agenda. Councils and Health bodies may find the self-assessment tool included in this framework helpful as a starting point in understanding their current position.
Subject terms:
local authorities, personalisation, risk, self-directed support, collaboration;
This leaflet is one of a series of resources from Skills for Care to help the social care workforce to support people supporting people who use care services to take informed risks. It looks at risk as an essential part of personalisation and its importance in empowering people who use services, and carers. Based on the full guidance, the leaflet looks at why it is important to understand risk,
This leaflet is one of a series of resources from Skills for Care to help the social care workforce to support people supporting people who use care services to take informed risks. It looks at risk as an essential part of personalisation and its importance in empowering people who use services, and carers. Based on the full guidance, the leaflet looks at why it is important to understand risk, supported decision making, developing a model risk-taking policy; and 10 key things to do and not to do.
Subject terms:
personalisation, risk, self-directed support, social care provision, decision making;
The guide from Skills for Care suggests that supporting people who use care services to take informed risks is an essential element of personalisation. Providing real choice and control for people who use social care means enabling them to take the risks they choose, particularly in the use of self-directed support and personal budgets. The Coalition Government has given renewed emphasis to personalisation and the management of risk, saying in the 'Liberating the NHS white paper' (2010): "With effective personalisation comes the need to manage risk for people to make decisions as safely as possible" and "As we pick up the pace on personalisation, we need to ensure that this includes the most vulnerable members of our society, including those who may lack capacity. With effective personalisation
The guide from Skills for Care suggests that supporting people who use care services to take informed risks is an essential element of personalisation. Providing real choice and control for people who use social care means enabling them to take the risks they choose, particularly in the use of self-directed support and personal budgets. The Coalition Government has given renewed emphasis to personalisation and the management of risk, saying in the 'Liberating the NHS white paper' (2010): "With effective personalisation comes the need to manage risk for people to make decisions as safely as possible" and "As we pick up the pace on personalisation, we need to ensure that this includes the most vulnerable members of our society, including those who may lack capacity. With effective personalisation comes the need to manage risk for people to make decisions as safely as possible." Making risks clear and understood is crucial to empowering people who use services, and carers, recognising people as 'experts in their own lives'. This guide is designed to help care workforces with this.
Subject terms:
personalisation, risk, self-directed support, social care provision, decision making;
The guide from Skills for Care suggests that supporting people who use care services to take informed risks is an essential element of personalisation. Providing real choice and control for people who use social care means enabling them to take the risks they choose, particularly in the use of self-directed support and personal budgets. The Coalition Government has given renewed emphasis to personalisation and the management of risk, saying in the 'Liberating the NHS white paper' (2010): "With effective personalisation comes the need to manage risk for people to make decisions as safely as possible" and "As we pick up the pace on personalisation, we need to ensure that this includes the most vulnerable members of our society, including those who may lack capacity. With effective personalisation
The guide from Skills for Care suggests that supporting people who use care services to take informed risks is an essential element of personalisation. Providing real choice and control for people who use social care means enabling them to take the risks they choose, particularly in the use of self-directed support and personal budgets. The Coalition Government has given renewed emphasis to personalisation and the management of risk, saying in the 'Liberating the NHS white paper' (2010): "With effective personalisation comes the need to manage risk for people to make decisions as safely as possible" and "As we pick up the pace on personalisation, we need to ensure that this includes the most vulnerable members of our society, including those who may lack capacity. With effective personalisation comes the need to manage risk for people to make decisions as safely as possible." Making risks clear and understood is crucial to empowering people who use services, and carers, recognising people as 'experts in their own lives'. This abridged version of the guide is designed to help care workforces with this.
Subject terms:
personalisation, risk, self-directed support, social care provision, decision making;
Journal of Care Services Management, 5(1), January 2011, pp.29-34.
Publisher:
Taylor and Francis
Personalisation in Scotland is being developed in a complex policy context that differs in key aspects from that in the rest of the UK. This article outlines the current policy context and challenges faced in the delivery of the personalisation agenda, emphasising the commonalities and differences with the rest of the UK. It goes on to evaluate the initial stages of the implementation of personalisation for the local authority South Lanarkshire in conjunction with an independent sector provider. The article analyses the development of the strategy, including the decision to take a co-production approach, and the associated risks. It concludes by identifying the key lessons learned so far, and the future direction of the agenda
Personalisation in Scotland is being developed in a complex policy context that differs in key aspects from that in the rest of the UK. This article outlines the current policy context and challenges faced in the delivery of the personalisation agenda, emphasising the commonalities and differences with the rest of the UK. It goes on to evaluate the initial stages of the implementation of personalisation for the local authority South Lanarkshire in conjunction with an independent sector provider. The article analyses the development of the strategy, including the decision to take a co-production approach, and the associated risks. It concludes by identifying the key lessons learned so far, and the future direction of the agenda
Subject terms:
personalisation, risk, social policy, collaboration, co-production;
Health and Social Care Delivery Research, 8(26), 2020, Online only
Publisher:
National Institute for Health Research
Place of publication:
London
Background: The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives: MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design: A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting: The setting was in the community. Participants: Older people, informal carers, and health and care practitioners. Interventions: Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Data sources: MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods: Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results: Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations: Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions: MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work: Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners.
(Edited publisher abstract)
Background: The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives: MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design: A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting: The setting was in the community. Participants: Older people, informal carers, and health and care practitioners. Interventions: Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Data sources: MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods: Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results: Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations: Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions: MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work: Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners.
(Edited publisher abstract)
Journal of Social Policy, 46(2), 2017, pp.291-311.
Publisher:
Cambridge University Press
Place of publication:
Cambridge
With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse.
(Publisher abstract)
With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse. This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual-level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and found the main perpetrators of the alleged abuse to be home-care employees. The findings are discussed within the context of current policy and practice.
(Publisher abstract)
Subject terms:
personal budgets, risk, adult abuse, personalisation, adult social care, safeguarding adults, social policy;
The research presented in this document explores the lives of older people who are living with different degrees of frailty and considers the factors that could have a positive impact on their quality of life. Five filmed ethnographic interviews were completed, followed by three discovery visits to older people’s day-centres where informal focus groups and depth interviews were conducted with people attending the centres. Finally, five follow-up depth interviews took place with participants who had consented to re-contact during the discovery visits. The report covers the main findings regarding frailty, independence and control, support and assets, loneliness and isolation and adapting to life changes. It also outlines the policy implications of this research, highlighting the core objectives of supporting people living with frailty, including maximising capacity and capability, personalising care goals and managing risk. A series of case studies are included in the appendices.
(Edited publisher abstract)
The research presented in this document explores the lives of older people who are living with different degrees of frailty and considers the factors that could have a positive impact on their quality of life. Five filmed ethnographic interviews were completed, followed by three discovery visits to older people’s day-centres where informal focus groups and depth interviews were conducted with people attending the centres. Finally, five follow-up depth interviews took place with participants who had consented to re-contact during the discovery visits. The report covers the main findings regarding frailty, independence and control, support and assets, loneliness and isolation and adapting to life changes. It also outlines the policy implications of this research, highlighting the core objectives of supporting people living with frailty, including maximising capacity and capability, personalising care goals and managing risk. A series of case studies are included in the appendices.
(Edited publisher abstract)
Journal of Care Services Management, 6(4), 2012, pp.161-171.
Publisher:
Taylor and Francis
This article discusses personalisation and safeguarding in social policy for adult social care and as practised in local authorities in England. It considers the research evidence on outcomes of current policies on personalisation and adult safeguarding, and reviews proposals in the Care Bill for reform of this key area of policy and practice. Specifically it discusses the balance it proposes to strike between personalisation and safeguarding, and between empowerment and protection. The paper concludes with implications for practitioners and managers.
(Edited publisher abstract)
This article discusses personalisation and safeguarding in social policy for adult social care and as practised in local authorities in England. It considers the research evidence on outcomes of current policies on personalisation and adult safeguarding, and reviews proposals in the Care Bill for reform of this key area of policy and practice. Specifically it discusses the balance it proposes to strike between personalisation and safeguarding, and between empowerment and protection. The paper concludes with implications for practitioners and managers.
(Edited publisher abstract)
Subject terms:
personalisation, safeguarding adults, choice, risk, community care, rights;