Personalised care in both the NHS and social care must be the default position

Let’s begin with a proposed typology of integration: “integration” is what system leaders often talk about as an organisational construct (it’s pretty much the same with “integrated systems”), then there is “integrated care” in which various professionals and organisations work together to support a person with multiple needs.

Then again there is an “integrated experience” which is the really exciting bit because it provides our best chance to give people the sort of experience of health and social care (and maybe housing as well) so it looks like there is one plan, one understanding and one – unifying – experience.

This is, after all, what we experience when we go online at home to use e-bay and Amazon, or buy a car or renew our road license; and don’t suppose such organisational wiring isn’t complicated – it is, it’s just they manage it better than we do.

This is why the agenda for personalisation in both the NHS and social care is so important and must become the default position for an increasing number of people who receive our advice, support and treatment.

There is a growing body of evidence being built up – piecemeal primarily – that when people are given greater choice and control over the services needed to support them they often show both creativity and entrepreneurship in how their needs are met, sometimes making different choices to the professional (clinical or social care professional) and, the evidence suggests, can obtain better outcomes.

Here is one example: M is 24 years old. She has cerebral palsy, but for the last eight years her life has been dominated by serious mental health issues, including self harm, multiple overdoses and many admissions to inpatient services. She describes herself as a “revolving door patient”, one who has fallen through the gaps on a number of occasions. Things changed when her social worker helped M get a transfer to a rehab unit which on paper did not meet her needs but which allowed her to thrive and become physically more active, enabling her to have the “most positive change in my physical health, mobility and confidence since beginning secondary school”.

Building on this and planning for her discharge to the community, M now has an integrated personal budget with funding from health and social care. It includes a personal assistant, and she has applied for an assistance dog. She’s also receiving specialist neurophysiotherapy offered by physiotherapy students at a local college. This has been a profound experience – she feels understood, and has developed some understanding of how her disability impacts on everything she does. Longer term, she hopes to transfer her learning from the physiotherapy sessions to a local gym, further improving her independence and sense of wellbeing.

Personal budgets

Personal budgets can have a profound bearing at scale. There is an example from Warrington where people receiving a personal budget for their end of life care typically died at home (over 80 per cent) whereas an equivalent number who did not take a personal budget tended to die in a hospital (about 75 per cent).

We should not be surprised then if the policy context in which we operate continues to press the importance of a personalised philosophy, coupled with the realisation that more people want greater control over what happens to them. We might, therefore, expect that both the NHS Plan and, the Green Paper on the future of adult social care will incorporate these elements.

The expansion of personal budgets will take time with very real challenges of delivering at scale given the political, organisational and professional contexts that exist: the concern about use of public funds, that expertise lies with professional groups and, how money and services are organised effectively limits the concept of choice for many.

True, personal budgets are not for everyone but there are many people “with lived experience” who want to be seen as an equal partner in how their care and treatment is organised and delivered.

Our organisational world – the legislation, systems and processes we contend with may be amenable to a level of simplification but the experience that people have should be far less complicated and confusing. In our everyday digital world, an integrated experience is nothing fanciful or unique.

There are three local health and social care systems in the country (Lincolnshire, Gloucestershire and Nottinghamshire) that have agreed to take forward integrated personal commissioning – just three

Why then has it taken so long to deliver what is readily available to us at home to those in need of health and social care services? There are three local health and social care systems in the country (Lincolnshire, Gloucestershire and Nottinghamshire) that have agreed to take forward integrated personal commissioning – just three.

Yet we know that when we bring such services together the outcomes that people obtain are more often better, not more expensive, but better. We need more, far more.

The “system architecture” that exists to promulgate a collective endeavour between health and social care is – at least nationally – partial and incomplete – and yet there are significant developments that reveal the potential benefits when we get this right at the level of place.

The King’s Fund recently commented upon the early promise of integrated care systems and, with the National Association of Primary Care, ADASS recently published Primary Care Home and Social Care: working together that gives voice to increasing collaboration and integration around the country and based on a common sense of place – which also sets an environment in which personalisation and personal budgets are more likely to thrive.

Despite the very real challenges facing social care and health services, integration, personalisation and the opportunity to support people better through personal budgets represent reasons for optimism.