A discussion on the issues arising for social work and social workers. Contributor: Neighbourhood Networks

1. “all the decisions that count”
Personalisation and Human Rights
Social Services Expo & Conference
19th March, 2013

2. “personalisation”?
• where do we find the roots of personalisation?
• how is personalisation defined and described?
• what is the relationship between personalisation
and the system of social work
• what are the implications for the rights of
individual people

3. ROOTS OF PERSONALISATION

4. Independent Living Movement
• arising out of civil rights movements of ‘60’s
• associated with de-institutionalisation
• adopting key principles and values
– independent living
– participation
– control
– choice and empowerment
• asserting “Social Model of Disability” in face
of prevalent “medical model”

5. social model of disability
asserts that disability is created by three general
types of social barrier, found in:
• people’s attitudes —
stereotyping, discrimination and prejudice
• organisation’s practices — inflexible
policies, practices and procedures
• the built environment — including
inaccessible buildings and services

6. [biopsychosocial model]
“In the Committee stages of the Welfare Reform Bill, the Government
committed itself to the use of the social model of disability…..But when the
Bill was being discussed in the House of Lords, Lord Freud announced that the
Government had decided that the Bill should be based on the biopsychosocial
model of disability instead. This model claims that biological, psychological
and social factors all play a part in human functioning, in the context of
disease or illness……..The biopsychosocial model is about health and
illness, not about impairment and disability. It has nothing to say to the
situation of someone who was, for instance, born with cerebral palsy. For
the majority of us with long-term illnesses, "illness behaviour" is mainly
irrelevant: we're not going to get better, no matter how hard we
try……..Obviously some of us are going to recover, go back to work, lead
normal lives again. That's wonderful. But many of us are not. I have
progressive MS. I'm not going to be getting better - I'm going to get
worse, and there is absolutely no way I'm fit to work at present…..But
because the government has chosen the biopsychosocial model, there's a
very real risk that after a year I'll be forced onto Jobseeker's Allowance: and
face having it removed if I don't turn up for interviews because I'm unable to
get out of bed.”
http://funkymangosmusings.blogspot.co.uk/2012/01/modelling-disability-
spartacusreport.html

7. Social Work Values
historically Social Work has been committed to
five basic values:
• the dignity and worth of the individual person
• fighting for social justice
• providing a service to humanity
• working with integrity
• demonstrating competence
“THE CODE OF ETHICS FOR SOCIAL WORK” BRITISH ASSOCIATION OF SOCIAL WORKERS (2002)

8. social work and the person
• to be treated as an individual
• to have the opportunity to express one's feelings
• to get a sympathetic response from a an
interested professional who adopts a certain level
of emotional involvement
• to be recognised as a person of worth
• not to be judged
• to make choices and decisions
• to keep personal information secret
“THE CASEWORK RELATIONSHIP” FELIX BIESTEK, 1961

9. Social Work (Scotland) Act, 1968
“Essentially this is a matter of promoting the full
personal development of the individual, emotionally as
well as physically and mentally, and is largely concerned
with the ways in which children are brought up and
educated. . .. If positive work of this kind could be
extended and developed, the benefits would be great.
Individual people would be likely to become more
effective, at work as well as in personal life, and
community life could be richer and healthier”
SOCIAL WORK AND THE COMMUNITY WHITE PAPER, 1966
(Cmnd 3065 SWC, 15, pp. 5–6)

10. DEFINITIONS AND DESCRIPTIONS
OF PERSONALISATION

11. definition of personalisation
“by putting users at the heart of
services, by enabling them to become
participants in the design and
delivery, services will be more
effective by mobilising millions of
people as co-producers of the public
goods they value.”
“PERSONALISATION THROUGH PARTICIPATION” CHARLES LEADBETTER, 2004

12. levels of personalisation
1. services that are more customer-friendly
2. services that give people who use them more
say in how they are run
3. services that give people a more direct say in
how money for services is spent
4. services that co-opt the people that use them as
co-designers and co-producers
5. enabling society to organise itself
“PERSONALISATION THROUGH PARTICIPATION” CHARLES LEADBETTER, 2004

13. personalisation and “co-production”
• frontline workers focusing on people’s
abilities rather than seeing them as problems
• increased levels of power and resources being
shared with people on the frontline – people
who use services, carers and frontline workers
• people as assets encouraged to work
alongside professionals as partners in the
delivery of services

14. UK Government and personalisation
personalisation is
“the process by which services are tailored
to the needs and preferences of citizens.
The overall vision is that the state should
empower citizens to shape their own lives
and the services they receive.”
PRIME MINISTER’S STRATEGY UNIT (2007) “HM GOVERNMENT REVIEW: BUILDING ON PROGRESS:
PUBLIC SERVICES”

15. SOCIAL WORK AND
PERSONALISATION

16. Scottish Social Work
and personalisation
“personalisation is driving the shape of all public
services, with a growing public expectation that
services will meet their needs, helping them
achieve personal goals and aspirations….To be
effective in meeting the challenge, social work
services will need to engage individuals, families
and communities and to work in new ways with
other parts of the public sector, focusing
increasingly on prevention.”
REPORT OF THE RECOMMENDATIONS MADE BY THE 21ST CENTURY REVIEW GROUP FOR THE
FUTURE OF SERVICES IN SCOTLAND, 2006

17. Scottish Social Work
and personalisation
“as demanding consumers of goods and services, users of
public services will increasingly expect the same
variety, choice and flexibility that they expect from the
business sector. They will demand a more personalised
approach, much greater involvement at all levels and more
transparency about the level of services available. Because
people are becoming better informed they have growing
expectations that services will be delivered where and
when they want them.”
REPORT OF THE RECOMMENDATIONS MADE BY THE 21ST CENTURY REVIEW GROUP FOR THE
FUTURE OF SERVICES IN SCOTLAND, 2006

18. Scottish Social Work
and personalisation
“The recommendations we set out in this report
will therefore provide the foundations for more
personalised services, including:
• a greater focus on prevention
• delivery across the public sector and partners
in the voluntary and private sectors
• flexible service delivery”
• REPORT OF THE RECOMMENDATIONS MADE BY THE 21ST CENTURY REVIEW GROUP FOR
THE FUTURE OF SERVICES IN SCOTLAND, 2006

19. Scottish Government
and Self-Directed Support
“the Bill published today will give individuals
informed choice and promote positive collaboration
between recipients of social care and those who
provide services on their behalf. There has been
extensive consultation and engagement with
stakeholders on the way forward and I am confident
the Bill will help us build on the very positive
progress made in implementing our 10-year
strategy to providing real choice and control for
those receiving social care."
MICHAEL MATHESON, PRESS STATEMENT, MARCH 2012

20. “personalisation already the goal”
“a version of personalisation is already the goal
of the Scottish social care system. But it is a goal
the system fails to reach consistently. The 1968
Social Work Scotland Act, which inaugurated
modern generic social work, set the goals of
social work that most social workers still ascribe
to today….”
“PERSONALISATION AND PARTICIPATION: THE FUTURE OF SOCIAL CARE IN SCOTLAND, FINAL
REPORT” CHARLES LEADBETTER & HANNAH LOWNSBROUGH, NOVEMBER 2005

21. resource and risk management
“yet the testimony of both professionals, care staff
and clients is that the social work system often fails
to deliver on these goals. In practice social workers
seem to be risk managers and resource
allocators, gatekeepers and controllers, often
working with clients in crisis when the task is to
save them from harming themselves or others”
“PERSONALISATION AND PARTICIPATION: THE FUTURE OF SOCIAL CARE IN SCOTLAND, FINAL REPORT”
CHARLES LEADBETTER & HANNAH LOWNSBROUGH, NOVEMBER 2005

22. resource and risk management
“Social Work is formally committed to
deliver a set of goals – which embrace the
ideals of person centred support – and yet
the system works to a completely
different logic to control risk and
resources”
“PERSONALISATION AND PARTICIPATION: THE FUTURE OF SOCIAL CARE IN SCOTLAND, FINAL
REPORT” CHARLES LEADBETTER & HANNAH LOWNSBROUGH, NOVEMBER 2005

23. “all the decisions that count”
“…our workshops and interviews with service users
…….uncovered a feeling among many that the
service they receive is driven not by what people
need but by what the system can deliver:
it feels as if the professionals and system make all
the decisions that count. Many of the clients feel
as if the professionals are in charge and they have
no choice.”
[EMPHASIS IN ORIGINAL]
“PERSONALISATION AND PARTICIPATION: THE FUTURE OF SOCIAL CARE IN SCOTLAND, FINAL
REPORT” CHARLES LEADBETTER & HANNAH LOWNSBROUGH, NOVEMBER 2005

24. Griffiths Report, 1988
“the doctrines of choice and consumerism
challenged the profession’s view of itself as a force
promoting social change and greater equality. The
profession was left with the difficult, if not
impossible, task of reconciling its vision with the
new ideological and social climate of the 1990s
and early twenty-first century”
A TALE OF TWO REPORTS: SOCIAL WORK IN SCOTLAND FROM “SOCIAL WORK AND THE COMMUNITY
(1966)” TO “CHANGING LIVES (2006)”:
IAN BRODIE, CHRIS NOTTINGHAM AND STEPHEN PLUNKETT, 2007

25. Changing Lives, 2006
“No longer was social work seen as a universal
service, but one that is ‘targeted and
personalised’, and no longer was it expected to
right the wrongs of society, but ‘build capacity
for sustainable change’.
The vision of a benign, competent state in 1966
was lost in the rhetoric of consumerism and
performance management in 2006.”
A TALE OF TWO REPORTS: SOCIAL WORK IN SCOTLAND FROM “SOCIAL WORK AND THE
COMMUNITY (1966)” TO “CHANGING LIVES (2006)”:
IAN BRODIE, CHRIS NOTTINGHAM AND STEPHEN PLUNKETT, 2007

26. PERSONALISATION AND
HUMAN RIGHTS

27. personalisation:
the direction of travel
• foundational thinking and values
• broad public policy thrust
• specific Scottish social work policy
• current Scottish legislation
• report of the Christie Commission
…………………..so what’s the problem??

28. the privileges of personalisation
• the choice, control and autonomy proposed and
long promised through “personalisation” seem to
represent a set of privileges rather than a set of
rights
• a set of privileges variously afforded or
denied, allocated or withdrawn in the absence of
consistent criteria
• a set of privileges determined by professionals
not acting on behalf of the “person”, but acting
on behalf of the state through the apparatus of
local government

29. personalisation by right
• it’s not acceptable that the basic freedoms
personalisation encompasses –
participation, control, choice, self-
determination, equally valued citizenship, the
power to make informed decisions about your
own life – should be in the gift of others or of the
state
• these are rights - not privileges
• and in the absence of these rights being
respected by the system it is necessary for them
to be asserted and claimed

30. Living Independently
and Being Included
Article 19 of
the Convention on the Rights of People with Disabilities
• the right to live independently and live in
the community
• the right to the same choice and control as
non-disabled people
• the responsibility of Government to do
everything it can to ensure that disabled
people enjoy these rights

31. Private Home and Family Life
Article 8 of the European Convention on Human Rights
• the right to respect for
– private and family life
– home
– correspondence
• the right to informed consent to any limitations
placed on human rights
• the right to personal autonomy and personal
development
• the right to conduct life in the manner of one’s
choosing

32. no exceptions
• the ECHR prohibits discrimination on any
ground
• provision of services must be assessed for
indirectly discriminatory impacts
• taken together with a human rights based
approach to issues of capacity (e.g., under
S12 of the Disability Convention)
personalisation becomes
– an approach for all regardless of status
– not contingent upon meeting certain criteria

33. MOVING FORWARD

34. SHRC “Care About Rights” project
using FAIR decision-making model
• Facts
• Analysis of rights at stake
• Identification of responsibilities
• Review of actions

35. Facts
• what is the experience of the individual?
• is the individual being heard?
• if not, do they require support to be heard?
• what are the important facts to understand?

36. Analysis of rights at stake
• what are the human rights at stake?
• can the right be restricted?
• if so, what is the justification?
• is the restriction proportionate?

37. Identification of
responsibilities
• what changes are necessary?
• who has responsibilities for helping make the
necessary changes?

38. Review of actions
• have the actions taken been recorded and
reviewed?
• has the individual affected been involved?

39. Independent Living in Scotland
• Core Reference Group Partners
–Scottish Government
–Independent Living in Scotland
[ILiS]
–COSLA
–NHS Scotland

40. Independent Living in Scotland
“independent living means all disabled people
having the same freedom, choice, dignity and
control as other citizens at home, a work and in
the community………It means rights to
practical assistance and support to participate
in society and live an ordinary life”
INDEPENDENT LIVING: A SHARED VISION, 2010: ILiS, SCOTTISH GOVERNMENT, COSLA, 2012

41. this presentation is based on
PERSONALISATION AND HUMAN RIGHTS: Kavita Chetty, John Dalrymple & Henry
Simmons, Centre for Welfare Reform (2012)
http://www.centreforwelfarereform.org/library/by-az/personalisation-and-human-
rights.html
SCOTTISH HUMAN RIGHTS COMMISSION
NEIGHBOURHOOD NETWORKS
ALZHEIMER SCOTLAND
CENTRE FOR WELFARE REFORM