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Timeline
In this chapter you will learn about
- The history of personalisation.
- The legislation and policy influencing the development of personalisation.
- The impact of the social model of disability and the Independent Living Movement in developing the personalisation agenda.
- The challenges faced so far.
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Timeline
In order to understand personalisation, it's important to understand some social care history. The dates below represent a brief history of personalisation, showing how social care policy and practice has moved from institutionalisation to independent living over the past century. It shows how personalisation has evolved over many years and has been strongly influenced by people who use services.
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19th century
General information/political climate/influences
Originally charitable social work focused on alleviating poverty and homelessness. The belief then developed that offering charity to the poor would encourage dependency. Social work began to involve case work and the assessment of individuals. Distinction between 'worthy' and 'unworthy' cases.
Policy / legislation:
Poor Law 1834 and Development of Charity Organisation Society (COS) 1869.
Theory:
The 'worthy/deserving receiving 'charity/financial help' whilst the 'unworthy/undeserving' sent to the workhouse – associated with brutal dehumanising regime.
General information/political climate/influences:
Institutionalisation: Disabled people and people with mental health problems or learning disabilities were classified by their medical condition and kept in large institutional or hospital settings where they were rarely treated as individual human beings. Staff were in complete control and people had no choice about food, clothes or activities.
Policy / legislation:
After a series of 'Lunacy Acts' in the 19th century asylums and institutions for people with mental health problems, people with learning disabilities and people with conditions like epilepsy expanded rapidly. By 1914 there were over 120 asylums in England. In the largest, single open dormitory wards housed up to 50 people.
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1940's
General information/political climate/influences
Abolition of the Poor Law – social work able to support those in need without the stigma of the Poor Law and Workhouses.
Policy / legislation:
1948 Introduction of Welfare State and National Assistance Act. Social work separated from administration of money. The Poor Law had dealt with financial support and welfare support together. Now National Assistance Board dealt with financial support and local authorities dealt with non financial welfare support. Local authorities to provide basic residential accommodation to disabled and older people.
Theory:
Less focus on the deserving and undeserving. Social work believed there was a need to separate the functions.
NOTE: Some say this attempt to distance social work from financial support has led to practitioners failure to address poverty issues and that this has hindered the culture change required to move forward in developing a personalisation context.
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1960's
General information/political climate/influences:
Out of the civil rights movement of the1960s and 1970s, which questioned the way power is used and distributed in society, came the disability movement and anti-psychiatry/mental health user and survivor activity.
Campaigning, support and research groups of 'psychiatric survivors' emerged out of the 'anti-psychiatry' movement in the late 1960s. They are very critical of the medical model in mental health and campaign for the closure of long-stay psychiatric hospitals and for people with mental health problems a greater say in decisions about their lives.
In 1961 Enoch Powell makes his famous 'water tower' speech to the National Association for Mental Health (which is now MIND) calling for the closure of huge psychiatric institutions. In 1967 the News of the World exposes inhumane treatment and conditions at Ely Hospital in Cardiff and a government inquiry is launched. This is followed by more media scandals and 30 other inquiries into conditions in big institutions. Popular, political and professional opinion turns against the old institutions.
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1970's
General information/political climate/influences:
Out of the civil rights movement of the 1960s and 1970s, which questioned the way power is used and distributed in society, came the disability movement and anti-psychiatry/mental health user and survivor activity.
In 1972 the Union of Physically Impaired Against Segregation (UPIAS) became the first disability liberation group in the UK . In 1975 they published Fundamental principles of disability which developed the 'social model of disability'. The group highlighted the fundamental lack of control disabled people have over their lives and the power relationship with social care staff. They start to campaign for independent living and rights for disabled people. The self-advocacy movement of people with learning disabilities begins to take shape at this time.
Policy / legislation:
The Chronically Sick and Disabled Persons Act (1970) places the duty on local authorities to provide care and support services for disabled people.
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1986
General information/political climate/influences:
Tightening up of criteria for benefits. Conservative Government wanting to eliminate perceived 'dependency culture' Move to an individualistic, consumer-based approach to social care.
Policy / legislation:
Social Security Act (1986)Supplementary benefit was replaced with Income Support with stricter criteria. Disabled Persons Act (1986) requires local authorities to assess the needs of a disabled person.
Theory: Response – Disability groups lobbied and persuaded Conservative Government to make alternative arrangements for those affected by the 1986 Social Security Act.
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1988
General information/political climate/influences:
As part of the movement of disabled people from institutions to independent living in the community the Conservative Government introduces the Independent Living Fund (ILF).
Policy / legislation:
Independent trust fund intended for a maximum of 5 years with budget £5 million. Established to make direct payments to small number of severely disabled people on low incomes who had to pay for personal care. It still exists today.
Theory:
The popularity of the fund was seen to be related to increased choice and control and perhaps the start of the personal budget option as part of personalised support in order to promote independent living.
Growth of the disabled people's Independent Living Movement . Fundamental shift in power from professionals to service users through ILF.
Policy / legislation:
Introduction of ILF had led to 'progress by default' and often described as a 'Pandora's box' (Hudson 1993) which once opened would be very difficult to close. As a result experimentation with indirect payments flourished.
Promotion of the Social model of disability by the Independent Living Movement.
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1988-1989
General information/political climate/influences:
The Conservative government under Thatcher promotes 'managerialism' and the 'mixed economy of care' in health and social services. The state is seen as an 'enabler' rather than a provider of care and there is a push to develop a variety of providers so that local authorities do not have the 'monopoly' on the provision of care and support. There is a big increase in private sector providers, particularly in small groups homes, domiciliary and day care services.
Policy / legislation:
The 1988 Griffiths Report on Community Care advises that social services should become 'brokers' to a range of care and support providers. It is proposed that social workers should take on a 'care management' role. In 1989 the 'Caring for People' white paper responds to this report and paves the way for community care and care management in social work.
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1990
Policy / legislation:
The introduction of the NHS and Community Care Act (1990). Set to develop a 'needs led approach' and new arrangements for assessment and care management. Government stated that this would lead to individuals receiving 'individually tailored packages of care'. With further deinstitutionalisation and more people going to live in the community as long-stay hospitals are closed, the emphasis is on providing flexible care in people's own homes. People should be supported to live 'as normal a life as possible in their own homes'. However, the Government also declared cash payments for people to buy their own support services as illegal, reminding local authorities of the legislation. Campaign for new legislation to enable direct payments for disabled people.
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1996
General information/political climate/influences:
After years of campaigning and direct action by disabled people, the government are persuaded to introduce new legislation allowing for direct payments. Seen as a hugely significant step and victory by the Independent Living Movement.
Service user organisations increase their activity. Centres for Independent Living and other user-led organisations are established by and for disabled people to support individuals manage and use direct payments and to advise on welfare and rights. Shaping Our Lives becomes one of the first coalitions of user-controlled organisations covering all groups of people who may need to use social care, including older people and people with mental health problems.
Policy / legislation:
Community Care and Direct Payments Act 1996 – social service authorities/departments could make cash payments to disabled people in lieu of community care services. Included those under 65 with a physical or learning disability who are 'willing and able to manage direct payments' (with help if necessary). Over the next few years the direct payment option is extended to older people, people with mental health problems, carers and parents of disabled children.
Theory:
The key principles behind the legislation are independence; empowerment; choice and control.
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2001-2009
General information/political climate/influences
The New Labour government proceed with guidance and legislation to promote independent living for disabled people, and to give greater choice and control over care and support. They explore the possibility of 'individual budgets'. In 2003 'in Control 'offers a new model of social care provision, initially for people with learning disabilities, based on self-directed support and personal budgets.
Policy / legislation 2001 :
Health and Social Care Act (2001) Section 57 made it mandatory rather than discretionary to offer direct payments to those with an assessed need. Valuing People White Paper (2001) has the key objective to make direct payments available to more people with a learning disability and officially introduces 'person-centred planning' as part of social work practice.
2005 :
'Improving the Life Chances of Disabled People' (2005) outlines proposals to introduce individual budgets to improve choice and control over the mix of care and support. 'Independence, Wellbeing and Choice' (2005) reinforces the role of social care services in helping people to maintain their independence by 'giving them greater choice and control over the way their needs are met' and outlines the human skills required from social care practitioners. In the modernising mental health services policies, New Labour considers the 'recovery' approach which is much more focused on the individual, their self-determination and citizenship.
2006 :
Our health, our care, our say: a new direction for community service (Department of Health White Paper – 2006) heralds a radical shift to the way services are delivered giving people more control and choice in achieving personalised care. It lays foundation for better working between health and social care to address people's needs and to achieve their chosen outcomes.
2007 :
Putting People First: a shared vision and commitment to transformation of adult social care . Ministerial Concordat. Medium and short term reform.
Commitment to enabling individuals to direct, manage and control own support through individual/personal budgets. Drive to increase universal, preventative services in each community.
2008 :
The Independent Living Strategy (2008) is published by the Office of Disability Issues sets out a five year plan that seeks to realise the Government's aim that all disabled people (including older disabled people) to have the same choice, freedom, dignity and control over their lives as non-disabled people. Further proposes personalisation of social care support, including personal budget options.
Theory:
The values, policies and practice which are to lead to personalisation are set out and begin to be implemented.
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2009
General information/political climate/influences:
Launch pilot of personal health budgets.
Policy / legislation:
Personal health budgets: 'first steps'(2009) begins to explore how a personal health budget option could work for people with long-term conditions. The Green Paper, Care Support Independence: Shaping the Future of Care Together (2009) begins to consult on how personalised social care and support can be delivered and funded in the long term through the development of a National Care Service. The proposals aim to build a system that is fairer, more simple and more affordable.
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