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29th January 2016

Is it on the trolley?

Which wayAre we really offering people choices about their lives, or is the choice defined by what we make available, rather than what people want or need? And is that OK?

I'm a big advocate of giving service users a say in the way they are supported. In fact, if I was anything but, I would be drummed out of my profession and probably lose my job. It’s all about customer choice and so it should be.

We are able to demonstrate that we offer the client a range of opportunities around how they spend their time, what they do for leisure, who they live and socialise with, what they wear... It's a far cry from the institutional past where all of those things were provided or even enforced.

In a recent care planning meeting, a service user was asked what she wanted in terms of her new placement, since she was moving into a very independent future as a young adult. She stated categorically that she wanted to live in a house with a pool, near to her friends and with no close neighbours. She wanted a dog, a cat, a boyfriend and a job at the local supermarket. In that order.

Careful what you offer

We acknowledge the right of people to have the things that are important to them but we are not always in a position to grant them their wishes. Sometimes it's just not possible to widen the range of choices beyond a handful, because either finances, practicalities or legalities prevent us from doing so. The young lady in her planning meeting might desire a pool, but the local authority budget would not allow it. Her allergies also precluded the pets, but the other wish list items were at least possible to achieve.

There is also the school of thought that says unlimited choice is something that nobody really has, that all of us have to be satisfied with choosing from a limited range of options. Moreover, with choice comes responsibility - we have to live with the consequences of our choices. This is often a harsh reality, but one we should not protect service users from. If we choose not to attend our work placement, a consequence might be that we lose our place. If we choose not to wash the dishes, it's a fair bet that we will not have a clean mug for our tea.

Choice and compromise

We are there to enable and to facilitate people having full and meaningful lives. Just as we do ourselves – and there’s the rub. You see, I would contest that none of us (aside from the ludicrously wealthy) have the opportunity to have everything our heart desires in life. We can aim for the things we value, but not necessarily attain them. It's just not realistic. Moreover, when we live in shared circumstances, be that with parents or as part of a couple or a larger group, we have to consider the rights and desires of others at the same time, and compromise.

The important aspect of offering choice is that we always enable service users to have at least an element of control over their lives. Choice can be huge and life changing, for example whether to live at home with mum or leave and be independent. Or it can be seemingly trivial: toast or cereal. But the important thing is that we are asking and we are acting on people's wishes. All of us have to live with limitations, it's part of life. We will always have unfulfilled desires because actually even if we did have everything available to us, we'd still be contrary enough to hanker for something else. But we do have the right to have things our way in lots of areas of life, so this should be something we extend to those we support, no matter how trivial. If it's on the trolley, you can pick what you prefer.

Ginny Tyler – QCS Expert Learning Disabilities Contributor

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