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27th November 2015

Making Person-Centred Support a Reality under the Social Services and Well-being (Wales) Act, 2014

The Social Services and Well-being (Wales) Act makes a strong pitch for Person-centred care and support. It is sometimes difficult to pin-down what that means. So what exactly is it and why is it important? Karl Rogers was a psychologist who coined the 'person-centred' term back in the 1950's. He saw it as a therapeutic focus upon the unique needs of the individual borne out of a genuine concern for them. So person-centred applications have developed since then in therapy and related fields including health and social care .

Person-centred support...

...and care is often seen as 'best-practice' as it upholds many of the core values upon which our society rests. These include respect for diversity, dignity, and the unique worth of the individual. Another reason why person-centred support it is important is that it sits well with the service-user in matching what they would like, and is therefore motivational. In this respect person-centred support helps make best use of available resources, because interventions are welcomed and valued. However, professionals, paid carers and the organisations they work for often have difficulty in implementing this best-practice.

WHY do organisations and professionals sometimes struggle with person-centred support?

The answer to that is that organisations and professions inevitably have rules, regulations and policies which while designed to define what the professional or organisation does, cannot be focussed entirely upon the needs of a single individual. For example a nurse will be able to dress an ulcer but may not be so good on much-needed benefits advice. For a social worker the converse may be true. Now this doesn't matter so much when various teams and services complement each other and provide the totality of what is needed, but often the rules and regs can get in the way.

In my own practice I can identify times when my nursing background placed limitations on what I could or was prepared to do...and what I saw as the roles of others. I also witnessed a situation where a social landlord failed to recognise that an individual's acute distress was being exacerbated by their inability to secure their home. I ran in to the 'it's on the waiting-list' mentality. Now waiting lists are a way of promoting equitable access, true, but in this case it was just too rigid for what was required.

Fail to prepare...prepare to fail?!

Too often we fail to prepare practitioners to understand what best-practice looks like and equip them with the necessary knowledge and skills to achieve it. And sometimes organisations fight 'turf-wars' rather than cooperate in the best-interests of the service-user. The new Act is aiming to overcome these hurdles, and deliver something more patently person-centred and seamless.

New measures

A number of measures in the Act seek to provide the tools to achieve this including new funding arrangements to provide 'direct-payments' so that the service-user is able to shop-around for the best offer of care and support. The measures to support social enterprises are also recognition that local situations need local and imaginative solutions and that non-profit structures often give the most responsive and flexible route to achieving responses which are best-fit and person-centred. If these seem like uncomfortable bed-fellows (i.e. best-fit and person-centred) it may be because there is a tension between what is ideal and what can be provided.

The point is that if we can get our cart and horse in the right order, we can often provide a more person-centred service from WITHIN the available fund of goodwill and available resource. This has tangible benefits for the service-user and can also offer improved value for money.

In my next blog: I will consider the specific measures around direct-payments and social enterprises in more detail.

Paul Rees – QCS Expert Welsh Care Contributor


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