Helen (UK)

How are we getting on with the new way to do support planning?

Support planning - the process where a person thinks through how they would like to spend the money available to them for their support so it can change their life - should be as simple as booking a holiday.

For example, you generally know how much money you have got to spend and whether you want sun, excitement and adventure or culture, relaxation and lazing by the pool. You get the information to book your holiday in lots of different ways - online using Trip Advisor, articles in specialist magazines, asking friends or talking to a travel agent. You also know there are different ways to use your money - give it to someone else to book an all-inclusive deal on your behalf or book the car hire, accommodation and flights separately.

You get the idea. Support planning for people who use services needs to feel that simple too, especially given the government expectations that it must happen at scale so everyone can use a personal budget.

We've been working with Trafford Council and a few other authorities to see just how simple we can make the support planning process. We have been doing this using the Empower and Enable approach which I blogged about back in June. This week we worked with Lancashire County Council to explore what this could mean for them. This is how Irene, a parent carer, describes what 'Empower and Enable' means to her.

At the moment, we know from our work, that even in the most innovative local authorities in England, only one-to-two per cent of people are actually developing their own support plan. The rest are caught up in the complicated paper work and review panels processes. Even though some people get linked up with a peer supporter or care manager to help them develop a support plan, there's often a very long waiting list and people get caught up in a backlog in the system.

This year, we have been saying that support planning is so simple that a person can do it themselves and this is the basis for new national advice on support planning published by Think Local Act Personal, the sector-wide partnership to transform adult social care to transform adult social care.

Joanne Willmott, the personalisation programme manager for Trafford Council, was a guest speaker at our national Support Planning Day in October. She talked through their approach to support planning, and the impact that "Empower and Enable" has had on her council's journey towards personal budgets for all.

For Joanne and her team, they realised they had to change the culture, systems and process that they had originally set up during the first phase of personalisation implementation. They had previously been using a mixed model of brokerage and support planning and used their social care reform grant to fund in house brokers directly employed by council, as well as brokerage services in the community and voluntary sectors.

This worked well initially - it managed people's concerns about a new way of working and supported market stimulation and development. It also improved relationships with providers and in house teams through having to work together on a range of pilots and projects that pushed through barriers and resistance to new ways of working.

But Trafford then realised there was a real need to shift to a model of support planning to one where personal budgets could be mainstreamed and delivered at scale. They recognised that support planning had the potential to become a new bureaucratic burden for customers, especially as use of professional broker had become a compulsory stage in the customer journey.

That's when they started working with us and Breakthrough UK to try the Empower and Enable approach.

The main element behind this approach is a presumption of capacity. This is pretty straightforward and what personalisation is all about: people are experts in their own lives. They may need the tools to translate that into a way that local authority systems demand, but never lose sight of the idea that an individual has knowledge and expertise.

Trafford hopes that this do-it-yourself approach will result in support planning (and therefore personal budgets) becoming a mainstream option rather than something for just the lucky few. They can show hard-headed commissioners that this way of working helps creates capacity in councils systems', freeing up professionals to help the people who really need it. All this without having to spend any more money.

Trafford still accepts they need a wide range of resources to make support planning happen, like peer support, open surgeries and specialist brokerage, and they're keen to stress they don't just give people money to get on with it. But they are changing their operating model and processes to support new customer journey. This is an ongoing process for them and they recognise they don't have all the answers - yet! But when they do, we'll make sure we let you know about it!

You can read more about the Empower and Enable approach to support planning click here.

I think personalisation has to start with a one page profile. A one page profile is a page of information about you and usually has three sections: an appreciation section about your qualities, what is important to you and support and help you may need from others. A one page profile reflects the balance of whats important to and for someone.

Historically, our health and social care services have emphasised what is important for people focusing on what it takes to keep them healthy and safe. Personalisation brings us back into balance. People are the expert in their own lives and we must know and pay attention to what matters to people and deliver support in the context of how people want to live their life. I have been thinking about what this could look like in schools, work and healthcare.

For me, a one-page profile is the foundation stone of personalised services. You cannot deliver personalisation without knowing what is important to the person and how they want to be supported. It can start at birth and can continue to the end of your life. Flo is the youngest person I know that has a one page profile. Her one page profile was created when she was just three months old. The family used it to share with grandparents when they were babysitting and with the team around Flo, who were providing her and her family with additional support. The one-page profile was important in helping Flo settle into nursery, providing information about who she is, and the support she needs.

What would it be like if one page profiles were used throughout schools, workplaces and health and social care? We are starting to see some of this happening in the UK. Can you imagine having a one page profile for your child at school? If it had information showing what people valued about your child;  recognising their gifts and talents; and was updated every year. What if the curriculum reflected what really matters to your child and every teacher knew exactly the best ways to provide individual support? At one mainstram primary school this is starting to happen, and not only does every child have a one page profile, but the teachers and teaching assistants do as well.

What about work? What if  people in your team had the opportunity to share what they appreciate about you? What if they knew what really matters to you as an individual and how to support you to work at your best? What difference could that make to your work experience? Some national organisations are doing this and are seeing a reduction in absences as a result.

What could this mean as we move towards personalising health care? What would it be like if you went into hospital and the first sheet of your notes was a one page profile? How would your experience in hospital be different if nurses knew you as a person and could talk to you about what matters to you? What if you were asked at admission what would make your hospital stay work well for you, and what would the best care and support look like from your perspective? I don't mean being treated with respect and care - we expect this to happen for everyone, but the very particular things that are just about you. For example the best ways to share information with you and the best ways to involve you in decisions.

You might be thinking, "I don't want everyone to know everything about me", but of course you'd only share the personal information that you wanted to.  For example, I am really happy for you to know that I have three teenage daughters and I'm a black belt in karate; I have a flock of seven hens that lay eggs periodically; I am a morning person and rarely stay up past 10:30pm and I get so excited about work that I have problems sleeping; I love single malts, especially those from Islay, but I am equally obsessed about black teas as well.  But there is information that I would not want you to know in detail, for example, my family's experience of cancer, unless that was directly related to the point you were giving.

What if there was an app for this and you could develop your own one page profile and share it with whoever you want to?

So does knowing more about me and other people change things? I think it does.  Conversation starts in a different place but is even more powerful when this is reciprocated. Imagine the first time you met a new social worker and they introduced themselves by sharing their one page profile with you?

For me, that is what personalisation is all about. It is a change in power. It is a different way to listen to people. It is a different way to work together and to pay attention to how people want to live their lives, not just keeping people safe with professionals in charge. So if your job has anything to do with personalisation and you don't start with a one page profile, where will you start?

On Saturday night, my 13- year-old daughter Laura asked me if she could do another one-page profile. Laura is proud to have had the very first one-page profile ever! This was when she was seven and was struggling at school because her teacher did not know her well, or how best to support her. From age 7 - 11 we updated her one-page profile every year, up to her transition to secondary school. We spent Saturday evening writing a new one and this evening she is finishing a self-portrait to go with it. This has got me thinking again about the headings in a one page profile and in particular, how they convey appreciation.

There are three components of a one-page profile. They are usually referred to as 'like and admire'; what is important to you; and best to support you. In person-centred thinking, we talk about this being what is 'important to you' and what is 'important for you', and the balance between the two. Chocolate is important to Laura. As her parent, I have to try and balance how important chocolate is to Laura, with how it is important for her to have healthy teeth and limit her fat and sugar intake. Therefore she has chocolate on her list of what is important to her and the support section reflects the balance we have negotiated of no more than two treats a day.

Over the last week, I have developed a new understanding of just how important the appreciation section of a one-page profile is. The first people to benefit from person-centred thinking and planning were people with learning disabilities.   I understood the 'like and admire' section as a way to balance and redress the negative stereotypes people had endured.

As one-page profiles are now used widely, for example with people who have long term health conditions, with older people and people who use mental health services, the term 'like and admire' started to jar and people expressed concerns about this being patronising. We even talked in the team about whether having any sort of 'like and admire' was necessary.

My view now is absolutely, yes we do.

Last week I was immersed in Appreciative Inquiry during a summit with the HSA and HSA Press teams. We were planning what we want to achieve together over the next two years. We started with individual interviews and storytelling and shared what other people appreciated about us. This did not feel patronising but rather life affirming and a great place to think about change by building on what was good.

This has convinced me that we absolutely need to keep a focus on appreciation in every plan, in every review and in every one-page profile. Everyone needs to keep hearing and thinking about what is valuable, admired and appreciated about them. Nancy Kline, author of 'Time to Think', talks about how important it is for people to feel appreciation, in order to think well for themselves and how much we need this in our culture.

"Everyday the world pulls us down, shakes us up, slices into us, laughs at our attempts and belittles our triumphs. We need to hear afresh every day a few good things that are honestly good about us."  Nancy Kline

You can use whatever language makes sense to people in describing these appreciations. My daughter Laura personally likes the heading what people 'like and admire' about her. Now, when I talk and write about one-page profiles, I am describing this as the 'appreciation' section, and it has a new sense of significance for me.

For many of us, New Year is a time for some reflection on the past year and resolutions for the year to come. This is true for HSA, as in the first week in January, we have two days together to learn from and celebrate the last year and plan for the future. I ask everyone to think about three or four things that they want to share that they are proud of. I would like to share with you something that I have been proud to be involved in and that is Jennie's Circle of Support. In December, I blogged about starting Jon's Circle, here Suzie, Jennie's Mum talks about the story of Jennie's circle, and the difference it has made.

"Jennie is 20 and has a warm personality; she is fun with a cheeky sense of humour, a real zest for life and is great company.

Even though it is sometimes hard for Jennie to articulate her thoughts and feelings, I admire her determination to communicate with us about whether she likes an activity, place or a person.

After Jennie was diagnosed with autism, we received four nights of overnight respite care a month and that began our journey with services.

In 2004 I learned about the world of person-centred thinking and planning. I was a bit cynical about the idea of person-centred planning at first and felt it was just another fad to come over from America and I was concerned that local authorities and provider organisations would not 'get on board' with the concept. But as soon as I realised its potential I jumped into it 100%. I went on a course for families and developed a person centred description of what is important to Jennie and how best to support her, with the help of everybody in her life who knew her best. Everyone involved in Jennie's life has a copy of her person centred description. When she was at school, a master copy stayed in Jennie's home/school communication book in her school bag so that comments and suggestions could be added by anyone, at any time who knew Jennie really well. I didn't want it to be this pristine plan that was stuck in a draw and as everyone got into the habit of using it, it became a 'living' document about Jennie with scribbles and crossings out - 'Jennie doesn't do this anymore she prefers this' - so we were constantly learning and everyone was using it and keeping it up to date.

I started worrying about Jennie's future and the transitions she would go through from finishing school, post-16 education and leaving children's services and moving into adult life. We were one of the first families to be offered a person centred review (Year 9 Review). There are a few important things I remember that came out of it. In particular it was the start of us looking at planning for Jennie's future. When we were developing her person centred description, I realised that I was making all the decisions for Jennie and that the emphasis needed to shift to Jennie being involved in making some of those decisions herself, whether I liked them or not!

We had also drawn a relationship circle for Jennie and it hit me that Jennie's circle included family but no friends. Although friendships had not been that important to her I thought we had a responsibility to look at this. So I raised this as an issue at the Year 9 review and asked everyone whether there were any relationships that Jennie seemed to be enjoying and this began work with Jennie to develop friendships. Her friendship with Rowenna came from the work that we did on this. They are still friends today.

A year later, Jennie has her Year 10 review. Both reviews made a huge difference to the way Jennie was included and talked about in a positive way. One of the main things to come out of the Year 10 review was the idea to set up a Circle of Support to help us achieve the future we wanted for Jennie and this has been pivotal. One of the long-term issues for me is that I'm not always going to be here to support Jennie. I wanted to make sure that there were enough people in her life, with the same interests and concerns for her future as me and who knew her well enough, who could make the right choices about what she wants when she is older. This was the reason behind setting up the Circle of Support.

Being a member of someone's Circle of Support is a voluntary role, so we asked everyone at Jennie's review whether they would like to participate. Dave, Matt and I joined the circle as did Julie. Debbie, a friend and colleague, also volunteered. She is a close and valued friend and has two sons with autism so brought a different perspective, as a friend looking out for me and a professional perspective too. Another friend, Carol, who used to be one of Jennie's support workers, also volunteered and attends meetings when she can. Jennie's dad Derek joined the circle at a later stage. It is a brilliant combination of family and friends who know Jennie well and have her best interests at heart. But also the circle has a good personal and professional quality, particularly with Helen and Julie having person-centred and service backgrounds. Once the Circle of Support was established it started to take that weight off my shoulders.

In the first six months of the Circle, Helen suggested we do a Path for Jennie and we used this to start looking at Jennie's future. It was a very visual process, with two facilitators, who drew up a huge poster showing a path and all the things Jennie would need to journey along it. We started off by looking at our hopes and dreams, then what was positive and possible, and then looked at the steps we would need to take in two years, one year, and six months, to reach that point. So, in effect, you start off by looking into the future and then work backwards to set the goals and deadlines to achieve that future and this is all written up on the Path. Using the Path taught me that it is important to think really creatively because it encourages you to aim higher.

The Path was really useful because it kept us focused on what was important to Jennie and the possibilities that were out there. But I personally found the Path quite a challenging person-centred planning process to use because I had to change my attitude from thinking 'this is ridiculous, it's never going to happen' to, 'if you don't strive for the ultimate then you are never going to take little steps to reach your hopes and dreams'. This is when we started to think about personal budgets. To cut a long story short we got a resource allocation for Jennie and used information from her person centred description and Path to put together a support plan. Everything we had learned about Jennie, from person centred thinking and planning, pointed to the fact that it was crucially important for Jennie to live on her own, supported by people who understand her. We based our decisions on our collective understanding of Jennie.

We also did a community map(person centred thinking tool) and the circle members were tasked with looking at local activities, groups or places that Jennie could visit or be part of, that were linked to things that we knew from her person centred description and her Path were important to her, for example could she visit an art gallery or take art classes, were there any groups where she could develop friendships? It was about making sure that she had a full, rich, active life and was spending time with people that were important to her; the sort of thing that we would all strive to have in our lives.

This was all recorded in her support plan. As well as recording what is important to Jennie, the support plan outlines how her personal budget will be used; sets out her 'perfect week'; and includes a communication chart and decision-making profile. The support plan is a really important document because everything we wanted for Jennie in the plan was costed, so it had to be signed off by us and the local authority.

Life for Jennie, who is now living in her own flat, is fantastic. In fact, I would say that Jennie is really deliriously happy most of the time and it is a delight and a relief for me to see that. Jennie had a few difficult months settling in and so did I letting go. She has a really happy, active life and is supported by great people. She is enjoying the independence away from us. If you had said to me 10 years ago this would have happened I would never have believed it. I was worried that by then she might be in an institutional setting or in supported living with people she didn't like or, worse still, didn't choose to live with, but now all the worry has gone which has been amazing for me."

This week I have had the powerful experience of facilitating a Circle of Support for Jon, the son of a good friend of mine Emma (who you met in my October blog about family budgets and support plans how-to-develop-whole-family-support-plans). It reminded me of just how important Circles of Support are in creating person centred change - not just for an individual but for the families and people who support them in their community.

It got me thinking - what can we do to ensure more people and communities benefit from them?

I have been facilitating Circles for over 12 years but I always get a little nervous beforehand as each new Circle has a different character.  My challenge - as facilitator - was to keep Jon firmly at the centre.

Jon is described as having 'high functioning autism' and the original reason for setting up the Circle was to gently support and encourage him to try new things and meet new people. Eventually, Jon would need more people in his life who can support him, rather than just his Mum and Dad. Feeling comfortable with other people in his life was going to take a while and he was very cautious and nervous about the Circle.

The local church minister where Emma and Jon attend, agreed to come, as too Matt, who supports Jon's Brother Tom for a few hours each week. They were joined by long-time family friend Patricia and her son Robert, who is a few years older than Jon but who had known each other as children.

I put my pinboard up in Emma's lounge and after tea, mince-pies and introductions, I asked Emma to explain what we hoped for the Circle and the evening's meeting (knowing Jon would not want to do that himself).

"Teeny-weeny steps" was how Emma described what we wanted to achieve.

I started by drawing three interlocking circles (a Venn diagram). One was 'new people'; one was 'new places' and the other 'new things to do'. I explained how where the three circles overlapped in the middle - a new thing to do, with new people in a new place - was a big step and not what we were after right now. A 'teeny-weeny' but important step was either a new thing to do, but with familiar people in a familiar place, or a new place, but with familiar people, doing a familiar thing.

I suggested that our roles tonight were to act like an 'ideas team' for Jon to come up with possible new places and things to do. Jon would then evaluate each of them and let us know which ones he was interested in taking forward.  Then together, we could see what we could do to take these forward.

We then did several rounds where everyone contributed their ideas, based on how they knew Jon, their best guesses at what he could be interested in and also sharing their own hobbies and interests, in case he wanted to share them. The list included  playing chess;  going to a book club,  bible study group or astronomy club; obtaining National Trust membership and doing walks; going to movie nights, photography course, philosophy classes, Tai Chi  or meditation Group; bird watching and playing Monopoly.

So that Jon did not feel on the spot, I asked him to evaluate each of them over a break for more tea and mince pies. Emma explained, with Jon's agreement, that he could do complex evaluations, so we asked him  to evaluate each of them in relation to how interesting they were to him (1 - 10 using an orange pen) and how scary they felt (1 - 10 with a purple pen).

We took the two with the highest scores for interest, and the lowest scary scores, and started there.

At the end of the evening, we had agreed actions based on Jon's evaluations for him to start playing chess with Alan, the church minister every week and for the family to buy a National Trust membership, plan walks in different places and invite Circle members to join them. We have another three possibilities that Jon was interested in thinking about more - meditation, a book club and a philosophy course.

Jon looked quietly pleased and relieved. Emma was delighted. As the meeting finished, people started to talk about how great it would be to start a book club together and whether Jon starting chess, could lead to a chess group where some of us played each other. It was clear that the Circle was creating opportunities for all of us to try new things together, find other ways of connecting together and enrich our lives, in a way we probably did not expect.

It reminded me of this New Economics Foundation report (http://neweconomics.org/articles/ten-big-questions-about-the-big-society-html) that says evidence shows that when people feel they have control over what happens to them and can take action on their own behalf, their physical and mental well-being improves. When individuals and groups get together in their neighbourhoods, get to know each other, work together and help each other, there are usually lasting benefits for everyone involved. Networks and groups grow stronger so that people who belong to them tend to feel less isolated, more secure, more powerful and happier.

So if Circles are a good thing, that benefits not just individuals but communities as well, what would it take to have more of them in the UK?  I've listed some possibilities - not all new nor without their challenges and some controversial - but I would be interested in your thoughts:

1) All social work, community and health courses have an opportunity for people to learn about Circles of Support and learn the skills to facilitate or contribute to them as a core part of their curriculum. Some may be able to contribute to Circles in their own time, as I do.

2) There is an expectation that social work students (and those from other related courses) are matched with an individual or family (family chooses!) to support them as part of a Circle of Support in a commitment that lasts three years. The best way to learn about personalisation is to be part of creating it with a family or individual.

3) Providers and other organisations explore contributing to Circles of Support as part of their Corporate Social Responsibility. For example, banks could fund training for Circle facilitators; providers could release some staff for four hours per month to contribute to a Circle.

4) Partners in Policy Making courses and their graduates enable people to both have a Circle of Support but also to contribute to someone else's Circle.

5) People buy Circle facilitation with their personal budgets - facilitators provided through social enterprises (where did all those person-centred planning facilitators go?)

What else could we do? Can we move forward on any of these? Please let me know what you think.

In the meantime, I'll let you know how Jon gets on with trying his new activities.

How can person-centred approaches help people make decisions about their healthcare?

The Secretary of State for Health Andrew Lansley has announced that from 2014, all people will have the right to ask for a personal health budget. Early findings from the evaluation are showing improved health outcomes for people. But there is a risk this important work will be distracted by critics fuelled on a diet of media stories about severe financial restrictions, cutbacks to services and "bad" use of public money. We are starting to witness an increasing climate of "fear" that creative solutions to managing people's long term health conditions must be continually justified - and in the worst case scenario, severely restricted.

Some work needs to be done to allay the anxieties of some of our health colleagues, the media and others that creative, person-centred solutions that combine both the clinician and individual's expertise is a good long-term investment that improves people's lives.

We have been doing some thinking around this with colleagues from the Department of Health's personal health budget pilot and amongst our own team. We also hosted a well-attended and earnest discussion at the Gathering in October about how we take what has been learnt from social care and apply it to health.

Rita Brewis from In Control said at The Gathering that we can't simply pick up a system from one working context (social care) and drop it into another (health). We must instead acknowledge that there are different legislative frameworks and cultures, as well as a vast amount of clinical expertise to treasure and cherish.  We of course want to keep hold of best practice and the research-based advice about best treatment options. But we also want to bring in an individual's view of what matters most in their life and shift some of the power and decision making to change the relationship between the NHS and individuals.

I agree that our goal should be improving the conversations between clinicians and people (I blogged about this back in September http://bit.ly/tBThLQ). Our work in this area must lead to a personal care plan that includes options and advice from the health service, but also understands the personal impact of the long term health condition, an individual's preference, the options they have in their local communities and the real wealth and capacity they can bring to managing their condition.

One of the factors central to the success of personal health budgets is the idea of co-production. This is where the person who is being supported, alongside their family members and friends, are considered equal partners while developing a package that will help them manage their long-term health condition.

Person-centred approaches have a vital contribution to make here. There are a whole range of tools and techniques available that can help people do this thinking, together with family and friends, and health practitioners. For many, the essence is a good conversation that focuses on what is really important to them, and what they want to change.

We have published a minibook - Person Centred Thinking & Health (http://bit.ly/vpaHMg) - which describes how to do this in more detail. For example, the "Circle of Influence" can help people disentangle the things they have control over with those they can't, so energy and time can be redirected to focus on what would help a person feel better and take more control. The "Helps and Hinders" tool helps a person think about their condition and build up a picture of what a person needs more and less of in their lives. The "Support to Confidence" tool looks at what a person wants to achieve and what support it would take to have more confidence to self-care.

We must all remember that personalisation is a movement of change that is about helping people get a better life. Let's take what we have learnt from social care and use it constructively within health.  And let's continue to get the message out that a great planning process taps into creativity, integrates what matters most for an individual's health with clinical best practice and importantly, innately makes public money work more effectively.

I am passionate about my work and love my family. Sometimes my life gets out of balance trying to juggle both, and find time for myself. Does this sound familiar? How do you know when your life is out of balance? What can you do? I want to show how person-centred thinking can help - both on a personal level, and also within teams.

The last few weeks have been excellent from a work perspective - we held two great events that were both fully booked  and launched two new books, including one at the National Children's and Adults Services conference in London.

At the same time, I felt my 'balance' slip. It was the 'little things' that gave it away for me. I was catching late trains home from London, grabbing a bag of crisps and perhaps chocolate as I carried on with emails. I noticed that I wasn't sleeping as well, drinking a glass or two of wine every night; and skipping my exercise or yoga. My iPhone became an extension of my body and I lost count of the time I looked at my most recent obsession, Twitter.

In the support planning process there is a great question at the end - 'How will we know that we need to review this support plan?". In our personal lives, another way of asking that question is 'How will we know that things are not going well for you?". The things I have just described are my way of knowing the answer to that question

I want to get sharper at noticing when I start to get out of balance so that I can do something about it before it gets too bad. It's a bit like the Johari window for me - there are things that I notice that others may not (the extra junk food and Twitter obsession) and then there are things that others notice that I may not be aware of.  For example, my husband Andy notices that I am irritable and I don't do my strange 'opera' singing around the house. I wondered what the other people in the office or team notice about me when I am feeling more stressed? What would I want the team to do if they did notice?

In my journal this week, I used the following questions to help me think about this and what I wanted to do about it: 

• How do I know when I am feeling out of balance or stressed?
• What do I notice?
• What might others notice?
• What gives me energy or makes me feel good?
• What drains my energy or makes me feel out of balance?
• What can I change this week?

I know that there are similar approaches used in WRAP (a process used in mental health services) and other approaches to relapse prevention that have useful questions like these.

My action plan for getting more balance this week is to make sure I am doing some exercise three times this week; not looking at Twitter after 5pm; taking 10 minutes in between meetings to breathe; going to the cinema with a friend and doing the photobook I have been meaning to do for weeks.

It made me think about whether we know this information about our colleagues. When I was working with Deb and her team last year, we did a similar exercise and completed the following table with information about each team member.

In teams that are striving to be 'person-centred' and in families supporting each other, this is important information. How can we tell by people's behaviour when things are tough for them? What can we support them to do for themselves and what can we do to help?

Do you do anything similar within your team or family, or for yourself? Please share what you are doing and learning.

One size can never fit all. While councils are adopting tools and processes to personalise services, they must ensure that the way they use those tools makes their services more personal where it really counts - at the point people experience them. Good quality plans, strategies and reconfigured services are all vitally important, but if someone's immediate support worker isn't working in a person-centred way, then high level strategies won't make much difference to the person on the receiving end.

This is particularly true of people with dementia. Recently, over 73 organisations committed to a Dementia Action Alliance that will work towards transforming the quality of life of people living with dementia in the UK. http://www.dementiaaction.org.uk/downloads/file/1/national_dementia_declaration Amongst their declarations was a commitment to delivering personal choice and support that is designed around the person and that helps them live the life they want and be part of a community.

A number of councils and residential care homes have started to use person-centred thinking tools as a way of providing individualised support to people with dementia.

Many of the approaches that feature in the book - like 'sorting important to and for', 'communications charts' and 'histories' can be illustrated by Jenny's experience of living in a residential care home in Hull. 

Jenny has dementia and staff members were finding it difficult to cope with her behaviours. She wandered around the home day and night punching people and the walls. Three staff members were required to supper her when she needed assistance with personal care, but she constantly hit out at them. When Jenny wasn't walking about the home, she would remain in her bed all day and refuse medication. She never communicated verbally and the situation saddened staff because they felt they were letting her down. She was barely having her basic human needs met and had no quality of life.

To address the situation, staff observed Jenny as she walked around the home. There was very little interaction with her, but when care staff did speak to Jenny, her mood rose and she would smile. She also appeared to enjoy rubbing the wall paper and her clothing, which were textured. It was noticed that Jenny interacted with music that was playing by clapping and singing along to it.

Person-centred thinking tools could support the staff to take what they learnt from these observations to make a real difference to Jenny's life. Once staff members were able to understand Jenny's behaviour, they were able to suggest potential activities around the home that Jenny may like to do. Staff members' ideas included a tactile/rummage box - to meet Jenny's sensory needs -and to find out what type of music Jenny enjoyed.

Learning what was important to Jenny and what great support would look like for her was a way of ensuring she had a better quality of life.  This information was written into a one page profile that was developed with Jenny, her staff and her family.

Staff also developed a communication chart to explain that when something is happening at a certain time that there are suggestions about what it means and how to support her.  For example, if Jenny shouts when using the lift, it is because she is anxious about the gap between the floor and the entrance to the lift, so staff need to reassure her and link her arms as they get into the lift together.

Staff members used the 'histories' tool to explore Jenny's life, as this explained some of her behaviours and identified her interests and hobbies. Jenny just loves Mars Bars and when she lived in her own home she would buy them in bulk.

Recognising little things like this have resulted in a real change in Jenny's behaviour and both her family and other agencies involved with Jenny have commented that she is a new woman.  Jenny appears content and is involved in meaningful activities around the home such as folding the laundry and walking around the garden with staff.

Jenny's one page profile has become a key point of reference for staff and provides important insight. The person-centred thinking tools have also had an impact on the home's environment and the staff culture too.  Staff members appeared more motivated and interested in the people they supported and the changing interaction has given a measurable increase in people's care and support experiences, making a significant difference to the lives of the people living in the care home.

Community Care ran a recent news story about the need to empower people and carers to take control of support planning based on the "Empower and Enable" approach we have developed. It ran with a headline about cutting back the role of the social worker, which wasn't in the spirit of our work.

Our approach to support planning is about taking a capacity view of disabled people. That means supporting people to do their own plans to free up social workers to support people who don't have capacity to plan themselves.

We hear a lot about the difficulties social care professionals face in helping people develop a support plan. Despite calls for individuals to do it themselves, we're still seeing tiny numbers doing so.  Councils where support planning is working well are the ones where the focus is on empowering and enabling people to do it themselves. They provide comprehensive information about support that is available locally from peer supporters, independent brokers or user-led organisations.

I have asked Jo Harvey, from HSA to do a guest blog this week, and she has four simple pieces of advice to give to professionals when it comes to support planning.

1. Never assume that a person can't or won't do their own plan.

There is a perception that people don't want to or are unable to participate in the support planning process and too many professionals feel they have to take on this responsibility themselves. People tell us they can and do want to be involved. Have trust and confidence in people to either do their own plan or engage in the process.

You can take more of an empowering and enabling approach that starts from the assumption people will do their own support plans, regardless of age or impairment. For example, give people all the information that is available to help them nationally and locally, then in two weeks' time, check in on how they're getting on. If the person or their family says they need more help, then recommend services where they can speak with someone who's been there before and can talk the process through. Wait another two weeks and then check back in again to see if more intensive support is required.

2. Know your role.

There has been some confusion over social care professionals' responsibilities when helping people to develop a support plan.

There is a statutory responsibility around the assessment process, giving people indicative budgets and providing information, tools and resources to develop the plan. There is also a need to share the rules on what the money can and cannot be spent on.

However, professionals do not have a statutory duty to do the support plan for the person themselves. I see many professionals who are still struggling to let go of their power and assume that people won't be able to do it as well as they can.

3. Change the conversation to a more person-centred approach.

We need to increase support for professionals to use the right tools that enable a different type of conversation - one that focuses on what a person wants rather than one that comes from the care management process. Person-centred thinking tools shift the focus from the deficits and impairments of a person, to what that person can do, what is already in place to help them, and what works and doesn't work for them as individuals.

The support planning process has become overly complicated, with templates that focus on meeting key performance indicators rather than a truly person-centred support plan. Complex sign off procedures in an era of severe funding cuts are restricting creative solutions when it comes to spending personal budgets. We should do all we can to work locally towards a simple sign off process that is honest and transparent.

4. Ensure you know and can share information about what information and support is available locally to help people do the support plan themselves.

Professionals need to know what is expected of someone's support plan - the local rules on what will and won't be agreed and what the person can spend their money on and how it will be signed off - so they can clearly communicate those to the person doing the support planning.

They also need to share more examples of what people have done with personal budgets so there are plenty of creative ideas that inspire people as to what can work.

The individual's capacity to do their own support plan is clearly an issue; so check the support around the person - whether family or friends can and are willing to help. If not, or if a person has complex needs, then ensure there is investment in locally developed support options like independent brokers, user-led organisations, peer support or drop in groups that can step in to help.  For example, in Derby City they're creating a hub of people that will offer a range of help for people when they are support planning.

We have been asked to share these tips with Community Care readers so watch out for them in a forthcoming edition!

I have been helping a friend of mine - Emma - with developing a support plan that takes into account the needs of her whole family, but only costs £20,000 per year.

Emma has two sons with autism - Jon and Max.  Max is 15, and beginning his transition from school to adult life. Jon is 17 and attends mainstream secondary school with full time support. Emma is separated from Mike, the boys' father, but he shares the childcare and support with her.

Balancing work and supporting her sons is challenging and exhausting. The way that services are set up adds a significant degree of frustration. As far as Emma is concerned, it makes no sense to solely focus on each son's individual needs without looking at this in the context of the family. Services working together to support the family are the only sensible way forward.

If Emma and Mike were no longer able to support their sons, and they had to be supported in a different way, they would be prime candidates for out of county placements, costing the Local Authority in excess of £200k per year. The additional cost to relationships and quality of life far exceeds this. Surely it makes sense to invest in supporting the family to stay together and stay strong?

I attended Jon's review with Emma, as a friend to offer support. It was not a person-centred review as we know them, and I can see how powerless families must feel when faced with a room of professionals around the table. I found it very uncomfortable.

Emma and I decided to see how we could look at a family support plan, bringing together the direct payment funding that Max receives from children's services, and the budget that Jon would be eligible for from adult services. Stockport's Director of Social Services, Terry Dafter, was interested in exploring this, and so the relevant assessments were set up and then Emma and I got started on the support plan.

The support plan needed to address the seven criteria used in Stockport;  reflect the whole family; and be something that other families would be able to replicate. Many years ago, Emma had been on a 'Families Leading Planning' course, and was familiar with one-page profiles and 'working and not working'.

This is what the family support plan looks like:

The first page introduces the family and describes the purpose of the support plan, what people like and admire about each individual in the family, and summarises what is important to the family and how to support the family.

Then came one page profiles for each of the family - Jon, Max, Emma and Mike.

The next section is what needs to change. To do this there is 'what is working and not working' from the perspective of each family member (and the best guesses about Max as he cannot tell us directly). This working and not working from the different perspectives is then summarised into what the family wants the support plan to achieve - their outcomes.

There is a table with each person's outcomes, and how they plan to achieve them.

Jon's outcomes include being supported by people that he chooses, extending what he does outside of the home, and slowly building a social circle. For Max, his outcomes are to get involved in more leisure activities, particularly physical activities like swimming, trampolining and the gym. Mike's outcomes are to be able to continue his voluntary work at the Citizens Advice Bureaus, and to have regular short breaks. For Emma, the changes that she is seeking are to decrease her stress, have regular breaks and improve her health.

The support plan then describes how the budget will be used to achieve this. This means extra support for Jon and Max, particularly to support the activities outside of the home, to enable Mike to continue with his voluntary work, and for both of the parents to have regular short breaks, and a course of mindfulness and regular yoga for Emma.

The total cost per year is £20k.

The support plan ends with how they will stay in control - this means whole family person-centred reviews - another first for Emma and her family.

This is what Emma said to me about the process:

' I always knew that it didn't work to look at Jon and Max in isolation as their needs significantly impact on each other, and on me and Mike as carers. To make matters worse, services often only want to address one area of difficulty of one member of a highly stressed family of four… Consequently, interventions and supports are a lot less helpful than they might be, if the real life context of our family and lives was properly taken into account. 

'Direct payments help as they provide a degree of flexibility around meeting the boys social care needs, but with Jon's transfer to adult services looming, it was clear that we were going to lose that small flexibility as now funding and assessments for Jon and Max would be provided by different directorates with very different practices and cultures. We wouldn't be seen as a family at all any more, despite the fact that both Jon and Max are still very dependent on us. When Terry and Helen suggested a family-centred plan and budget, I knew that this was the answer for keeping our family working, and ensuring we all have some quality of life. 

' I'm really excited about the possibilities of this new way of working - particularly for the increasing number of families where more than one person has significant health or social care needs.'

Do you know of any other whole family approaches to individual budgets and support planning?