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.