In the last few months I have stood in many training rooms and talked, walked, carried and cajoled about 1000 of our sector’s professionals through the Care Act – its complexities, its opportunities, its conundrums and its laughs. Ok. I’m lying about the last bit.
At times, I have felt like an anthropological observer, watching David Attenborough style at the fascinating combinations of reactions to the biggest shake up in social care for years ranging from mistrust and disbelief to relief and even exuberance.
Occasionally I have been a lone messenger dodging the bullets of cynicism and frustration. But more often these are balanced by moments of absolute gold, and I am a delighted observer watching confident, competent professionals beam as they see the opportunities in hand to return to a way of working that is most commonly referred to as “back to our roots”.
What has struck me is that our concept of professionalism in front line workers has been on something of a journey over the last 10-15 years, and for the Care Act to deliver on even some of its promises, we need to boldly re-define what we mean by professionalism under the Act and how it sits with person centred practice.
Person centred practice in its most basic form prioritises the interests of a person over those of the system or service. You can be person led, or you can be service led, resulting in what works for the person or what works for the service, respectively. But can you be both?
Within the statutory guidance, you can’t swing a cat without hitting a strongly worded reminder of the importance of working in a person centred way. As someone who has spent the last 20 years hurling myself against the system in an attempt to make space for person centred approaches, this emphasis is welcome. In fact, I’d be lying if I didn’t confess that upon reading the draft guidance last year, I even welled up a little bit. What can I say? I’m a sentimental type.
But such a focus throws up some interesting dilemmas. A common response in the training room is to ask “but what if the person wants something we just can’t do, or they want something that in our professional judgement would not meet the needs we have identified? How is saying No, person centred?”
Another is “How can we call this person centred, when all the decisions are made by the professional?”
All 3 stages of the core process (assessment, eligibility decision and planning) are required to be delivered in a person centred way:
6.1 …The assessment is one of the key interactions between a local authority and an individual, whether an adult needing care or a carer. The process must be person-centred throughout, involving the person and supporting them to have choice and control.
10.2. …There should be a default assumption that the person, with support if necessary, will play a strong pro-active role in planning if they choose to. Indeed, it should be made clear that the plan ‘belongs’ to the person it is intended for, with the local authority role to ensure the production and sign-off of the plan to ensure that it is appropriate to meet the identified needs.
In terms of eligibility, needs can only be found eligible if they have a consequential significant impact on the wellbeing of the person – a step that puts the uniqueness of each person’s situation at the heart of the new eligibility process – but one that is already being lost as I see assessment practice prioritising the (arguably more tangible) identification of an inability in 2 or more outcome areas, but not the consequential significant impact on one or more of the wellbeing domains (the more “person centred bit”).
We have been describing this in training as the requirement for the professional to make an objective decision, but based on essentially a subjectively-led process. It’s important not to dodge the elephant in the room – the process is littered by wholly professionally controlled decisions.
However, our new defining difference is that the process which the professional is required to follow in order to make that decision has to be person led. It is professionally controlled, but person led. If a professional ends up before a judge presenting evidence that their decision was a sound one, that evidence will need to be of a person centred process.
Potentially, a person led process and professional control, could be uncomfortable bedfellows, and I anticipate some howling examples of getting it wrong. But it could also be a heady combination creating the perfect conditions for adults with needs and carers to actually get support that makes sense to them in their own particular life with the expert guidance and advice from the professional. It requires professionals to focus more on facilitation and enablement rather than the cul-de-sac of narrow FACS banding and subsequent conventional service provisions.
It may be a bit of an elephant – but by seeing it, naming it, and exploring it with professionals, adults with needs and carers, it could be the kind of elephant that we actually end up wanting in our front room.