Unit 17- lead person centred practise
Social care services in the UK have promoted person centred practice and it remains today high on the national policy agenda, often being hailed as representing best practice with respect to care.
The Government publication Putting People First, A shared vision and commitment to the transformation of adult social care was published in 2007 and outlined its personalisation agenda – the Governments vision of enabling individuals to live independently with complete choice and control over their lives.
Personalisation is about allowing individuals to build a system of care and support tailored to meet their own individual needs and designed with their full involvement. Historically, a one size fits all approach to care was in practice and this meant the individual having to fit into and access already existing care services, whether they were appropriate of not. Now individuals can access their own budget and decide on which services they will spend that budget.
The term ‘person centred care’ has not been consistently used in literature and is often applied to elderly people and those with disabilities. Agreement has been reached, however, and the term is now used to describe care which is user focused, promoting independence and autonomy. Collaborative and partnership approaches to care often use the term ‘person-centred’ to describe their thos.
Over time, there was marked improvement in how society started to accept disabled people, those with learning disabilities, as well as people with mental health problems and older people as equal members of the community. The social model of care enabled this change by forcing the view that society was in fact the problem for such groups because it failed to provide adequate services to meet their needs. The model was hailed therefore as a more person centred approach to care than the Medical Model.
The outcome of all these changes has not only put the person at the centre of the care process but has also shifted power towards them, enabling them to have more freedom of choice – something which most of us take for granted.
In trying to implement person centred care, managers need to be clear about how the support to clients will be delivered. It is not merely a case on including clients and families and asking them what they think or what they want. There are processes to guide practice and four tools have been developed for the implementation of person centred planning and practice.
THE McGILL ACTION PLANNING SYSTEM (MAPS). Which is a planning process for children with disabilities to enable their integration in to the school community. The team in this process includes the child, family members, friends, and regular and special education personnel.
ELP OR ESSENTIAL LIFESTYLE PLANNING are detailed plans to know what is important to someone. When using these types of plans the assumptions behind them are that:
The individual will have a lifestyle that works for them
Our quality of life depends upon how well or badly we achieve that lifestyle.
As care workers we should help people to live their chosen lifestyle – and not try to change the person to fit in with our view of life.
PERSONAL FUTURES PLANNING – the author of this approach , Beth Mount, commented;
‘The person futures planning process suggests a series of tasks and provides a set of tools to help us begin the process with people to uncover their capacities, to discover opportunities I the local community, and to invent new service responses that help more than get in the way.’
This planning process involves:
Getting to know the person to determine what their life is like now.
Developing ideas about what they would like to do in the future.
Taking action to help them to implement this, and exploring possibilities within the
Community and looking at what needs to change within services.
PATHS (PLANNING ALTERNATI VE TOMORROWS AND HOPE). This system was developed by Jack Pearpoint, Marsha Forest and John O’Brien and focusses on what is termed the person’s ‘North Star’ or their dream for the future. E or two years later. This ‘dream’ is then put into action and reviewed one or two years later.
The Poor Laws back in 1834 and the development of the Charity Organisation Society (COS) in 1869 tried to address the poverty experienced by some of at the time. Individuals were categorised into two groups; those deemed ‘worthy and deserving of receiving’ charity and those who were classes as ‘unworthy or undeserving’ of help. The latter were sent to the workhouse with its terribly dehumanising regime and such treatment was to last for many more years in one way or another. The institutionalisation of people who were disabled or who had mental health problems or learning disabilities was a classic example of the control the medical profession had over individuals who had been classified by their medical condition and kept in large institutional or hospital settings. There was no choice exercised in these places and staff were in complete control. These institutions expanded over the next few years and by 1914 there were over 120 asylums in England.
An unfortunate by-product of the institutionalisation of such groups, together with the lack of choice and control, was the discrimination felt by these individuals and the stigma attached to such conditions. It was to take another 50 years before this was actually addressed as a problem in society.
The rising tide of dissatisfaction with the care system saw the development of the civil rights movement of the 1960s and 1970s. It was at this time that the Medical Model and the was power was distributed in society came under scrutiny and the disability movement was born.
Two laws which are useful to know are the Adults with Incapacity (Scotland) Act 2000 and the Mental Capacity Act 2005 (England and Wales). These allow people over the age of 16 to appoint a proxy decision-maker who has the legal power to give consent to medical treatment when the patient loses the capacity to consent. In the case of a person who is detained under mental health legislation, the principles of consent continue to apply and care staff must ensure that the individual is aware of the circumstances and safeguards needed for providing treatment and care without consent.
If you are dealing with a child under the age of 16, then obtaining consent is complex and legal advice needs to be sought. Young people under the age of 16 are considered to lack the capacity to consent or to refuse treatment and that right remains with the parents, or those with parental responsibility. If the child is considered to have significant understanding and intelligence to make up his or her own mind about what is happening to them, then that may be waived.
A child of 16 or 17 is considered to be able to consent for themselves but good practice demands that parents or guardians are involved. Refusal of consent by a child of any age up to 18 years can be overridden by the parents. In exceptional circumstances, it may be necessary to seek an order from the court.
There are a couple of exceptions where a capable individual may be treated without first obtaining their consent. For example, a magistrate can order detention in hospital if a person has an infectious disease that presents a risk to public health – such as rabies, cholera or anthrax (Public Health (Control of Disease) Act, 1984).
Under the National Assistance Act (1948), a severely ill or infirm person who is living in the unsanitary (unclean) conditions can be taken to a place of care without their consent.
The Mental Health Act (1983) instructs that people with certain mental health conditions, such as schizophrenia, bipolar disorder or dementia, can be compulsorily detained at hospital or psychiatric clinic without their consent.
Personalisation gives more choice and control over lives and ensures that people have wider choice in how their needs are met. They are able to access universal services such as transport, leisure and education, housing , health and opportunities for employment regardless of age or disability (SCIE).
Treat each person as an individual by ordering services.
Enable people to maintain the maximum possible level of independence, choice and control.