We all have our favourite “I can’t believe that actually happened” stories in social care.
Mine relates to care and support planning: whilst observing a panel process (error number 1), a Head of Social Care instructed a social worker (error number 2) to change a support plan so that all sentences were “I” statements (error number 3) from the point of view of the patient [sic] (error number 4), without going back to the person themselves (error number 5).
It would be funny if it weren’t so normal.
But we hear variations of this all the time, summarised in the line:
Of course what I do is person-centred care – it always has been
If we are honest, relatively little of what currently happens in the care and support system is person-centred (though we’re definitely moving in the right direction).
This being the case, we should ask ourselves: if it isn’t person-centred, then what is it? I think there are at least four alternatives:
- Money-centred care: where what people get is what commissioners can either afford, currently buy, or have always bought
- Provider-centred care: where the primary objective is to ensure the ongoing feasibility of an organisation rather than the people it serves
- Process-driven care: where filling out the paperwork or keeping the IT system happy is the main driver
- Professionally-driven care: where the professional knows best and tends to think of the person in front of them as another one of their caseload or a walking set of conditions
Thinking of it in this way shows why the drive to person-centred care has been so difficult: it requires significant change on a number of major fronts – the flows of money, the role of providers, the supremacy and comfort of process, and the culture of professionals.
It’s why I’m personally so excited about person-centred care and what it means for the future. It isn’t just an optional variation of what we’ve always done; it flips public services as we know them on their head. To make this happen, though, we need to be clearer on the alternatives that being person-centred is replacing.