Good practice in social care: the views of people with severe and complex needs and those who support them

Abstract

This paper reports findings drawn from a study of good practice in English social care for disabled adults and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with disabled adults and older people with severe and complex needs, family carers and members of specialist organisations (n=67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats© sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: 1) everyday support; 2) service organisation; 3) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets.This approach focusses very much on the role of the individual in directing their own support arrangements. However, participants in this study also stressed the importance of on-going professional support, for example, from a specialist key worker or case manager to coordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from 2 professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield. KeywordsSocial care, disabled people, continuity of care, qualitative research, dementia, service delivery and organisation What is known about this topic The English policy approach to meeting the social care needs of people with severe and complex needs is personalisation using direct payments and personal budgets  Research has begun to identify gaps between the rhetoric of this approach and the reality as experienced by some groups. What this paper adds People with complex needs and their carers value a range of person-centred approaches which include but are not limited to direct payments and personal budgets  Findings highlight the importance of good practice in service organisation, including flexible systems and coordination via case management. Getting it right at this level could be the key to achieving true personalisation for people with severe and complex needs.

“Why didn’t we do this before?” the development of Making Safeguarding Personal in the London borough of Sutton

“…The outcomes that adults at risk of abuse wanted were in no cases unreasonable. They wanted services to improve and still wanted to be supported but sometimes in different ways, a finding similar to that reported by Gridley et al (2014).…”

How would case managers’ practice change in a consumer-directed care environment in Australia?

“…The main reason is that case managers can co‐ordinate diverse services and ensure good practice at the organisational level (Gridley et al . ). Third, in principle, consumer‐direction means that clients can decide the levels of service choices and control.…”

“…Take the UK experience for example – the power of case managers and their organisations is manifested in providing professional support to older people, so they would not risk being excluded from the benefits that Personalisation can yield (Gridley et al . ). In support of the literature, we suggest that case managers commit to sharing and achieving the balance of power in a CDC environment (Bransford ).…”

Successful collaboration in dementia care from the perspectives of healthcare professionals and informal carers in Germany: results from a focus group study

“…HCP and informal carers agree that a single contact person/institution is an important facilitator of good collaboration. A continuous contact person (e.g., a case manager) is presumed to facilitate access to dementia support [ 9 , 12 ] and is considered good practice in social care for persons with severe and complex care needs [ 33 ]. The findings of our international focus group study confirm that a continuous contact person is crucial in all participating countries [ 23 ].…”