Good practice in personalisation

This article was originally published in 2009 in a report by Ben Higgins, which was commissioned by the South West Valuing People Board and entitled Good practice in supporting adults with autism: guidance for commissioners and statutory services. Read the full report here.

Putting people first ¹ aims to transform adult social care through the personalisation agenda. Personalisation aims to improve people's quality of life by empowering them, so that they have greater choice and control over their lives and the support that they receive. It is about tailoring support to meet individual needs and aspirations, as opposed to matching individuals to services on the basis of availability. The current process of reforming health and social care provision, with greater emphasis on personalisation, presents a good opportunity to help people with autism obtain more appropriate services. The development of effective personalised support has the potential to help address many of the issues highlighted in previous chapters [of this report].

More transparent allocation of resources, in the form of individual budgets, is at the heart of personalising support. Self-directed support enables individuals to design their own support and the services they need. By April 2011 authorities are required to offer individual budgets to at least one third of people, with many authorities targeting a majority of people eligible for support by 2011. However, so far very few people with complex needs (including autism) are receiving individual budgets.

The amount of money allocated must be sufficient to meet eligible needs. There are significant concerns that specific groups of vulnerable people do not meet the eligibility criteria to access adequate funding to fulfil their potential and maximise quality of life. Local authorities must ensure their Resource Allocation System (RAS) adequately recognises the needs of adults with autism.

There are several cases where self-directed support had been working effectively until, unfortunately, individual budgets were decreased. This reduction in funding available is clearly unacceptable: individual budgets must be sufficient to purchase good quality and good value support as opposed to the cheapest available, which may well not be appropriate to meet individual needs.

If personalisation is to achieve its core aims, it is essential that those being offered direct payments are aware of alternatives, such as trust funds, and can access advice and support. People with autism often find it hard to articulate their aspirations and therefore may require a broker who can assist them in developing a support plan and then procuring services to implement it. Supporting people to take control of their funding through brokerage is central to the success of self-directed support. Local authorities need to consider how brokerage will be funded and how to ensure people with autism can access this support directly or through a social worker. Brokers must be registered and independent of the responsibility of rationing or allocating resources. Agencies that historically provide localised information, advice and advocacy are well placed to develop brokerage.

There are further concerns that people are changing over to direct payments not as a positive choice, but because traditional services are failing to meet their needs. Direct payments only work when there is a sufficient range of support options for people to choose from. Local authorities must stimulate the market to ensure there is a range of appropriate support services for people with autism to choose to purchase. Whilst individual budgets represent a significant opportunity for the third sector, it also involves vulnerability in the transition from block contracts to spot purchasing in a competitive market place. Local authorities will need to ensure that personal assistants, employed directly by the individual, are both available and have received adequate training in autism. 

¹ Department of Health (2007). Putting people first. London: Department of Health