It was his annual case conference. Michael hoped that this would be the one, after twenty-six years of using human service systems. He left the special school without a qualification. Three years of personal development in the vocational training programme had enhanced his skills, developing himself- This case conference would be the one to decide that it was time to pursue one of his interests, that of working in a recording studio. Everybody had known his interest in music since he first discovered FM radio.
A recent medical, attended with his mum at the request of the service, highlighted a slight muscular abnormality that might over time become a minor problem. His mum and dad have been invited to attend a wedding of a family friend in London, requiring them to be away for four days. They had asked the service for respite. The service administrator has requested that Michael’s database details be updated at the meeting.
Michael himself wanted this annual meeting to plan how he will get that job in the recording studio. The meeting however, was taken up with the next steps in exploring his medical problem, the arrangements and negotiations required for the provision of respite, and the rest of the meeting confirmed all the information about Michael’s disability on the coded forms. At that point the team disbanded—to rush off to manage the latest crisis, plan the next programme, and attend another important case conference.
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Our present planning systems fail people. A service that describes itself as supporting people in their own communities, fails to do just that. A closer look at Michael’s circle of friends shows there is nobody in there from his own community—and that’s after twenty-six years of service provision. Most of our sense of ourselves can be measured in relationships. Michael’s day service costs £8000 a year; the past three years have cost £24,000 but have not given him even one more relationship of any kind.
How have we gone about our business and delivered such poor results? How have we planned for this person, what programmes have we devised, what meetings have taken place during those three years that have cost us so much money and delivered so little?
When we explore a person’s circle of friends, we find that more often than not people’s lives are full of human service workers. At the centre of people’s networks are the staff of agencies, close family members and other people with a disability. In the case of paid workers, the challenge is to move them out to the edge where they belong. If we move too fast on this we empty the centre of people’s lives! So that’s a process that has to be managed carefully.
The old regime has failed Michael. It is clear that we need to decommission all current planning systems—case conferences, IPPs, crisis management interventions and so on. We need to hand in our forms. And we need to set a deadline for this. We need to find a new way of doing our business. For the sake of giving it a name, let’s call it ‘person-centred planning’.
Anyone who has watched D’Telly with D’Unbelievables will remember the Grunt who is in the shop making all sorts of noises, but everyone understands him. Everybody understands his stories and finds them funny. After Grunt has left, one of the brothers who run the shop comments to the other that his stories are so funny that he could have made it on the stage; the other responds, quoting the Grunt, ‘Sure, I likes the teaching’. Even in this parody, it is clear that everybody is so in tune with each other that the skills of articulation don’t really matter.
What our planning systems should be about is planning for people, rather than planning for services. We identify people’s needs in terms of services, that is, the services we offer! If this person doesn’t speak very much, and we ask what they need, our immediate reaction is to describe this person as needing speech therapy. More accurately, we should describe their need to be understood, to express their choices and preferences. This person needs people to know them better, so the kinds of signals they send out are interpreted. While therapy may assist in this, the point is that a lot of other people, including people not connected to the agency, may also help. This is just one example (and there are lots of others) where services become so inward-looking—and so self-consumed by our own tools, skills, expertise, knowledge and policies—that it’s understandable how we have ended up this way: focusing on our agenda, rather than on Michael’s agenda.
Knowing the person is the key. This is the basis of good communication, especially in the absence of speech—the mother who recognises the baby’s cry as hunger or pain or fear; the staff who recognise, by facial expression or grunt or posture or sigh, what the person is communicating. With the current higher level of staff turnover, the importance of knowing the person very well becomes even more important in understanding the person, their preferences and capacities.
It is inevitable that we create services, even when there is no need to, when we should be supporting communities to support people belonging. By creating specialised services, we actually disempower communities. By going the specialist route, we ignore the community option.
While we can point to remarkable achievements in our specialist areas of service, there has been a down-side. Services have grown bigger and bigger, with more staff, more specialised services, more on offer—and the people using these services have fewer friends, fewer choices, less exposure to ordinary experiences—and less contribution to make to ordinary communities, because they are not there—they go to a service someplace else! As we organise ourselves to accommodate more people, we end up with artificial groupings, mass management and the rhetoric of an individualised service.
As a result of what we do now, are communities any better equipped to support people with disabilities? Are people really present in our communities, in our workplaces, in our schools, our churches, our clubs, and our groups? Have we meaningful alliances with community groups? Or are human service systems seen as discrete systems?
Person-centred planning will support communities to become more inclusive, creating an alliance between services, communities and people with disabilities and their families, to create places where all belong. Person-centred planning is first and foremost a way of looking at what we’re about in services. To reduce it to a set of forms and steps is to remove its potential to fundamentally change what we do and how we do it. The development of real person-centred planning reflects the struggles and challenges and complexities and tensions we have encountered in our attempts to promote and introduce it as a core system in human services.
How do we set about building up the new approach? We have enough resources. The tools are there. What we don’t have is enough models of good practice. We don’t have the strong commitment, the systems, the skills, the consensus, and the clarity to deliver this new approach.
How can we create good systems? Good systems need to be responsive to the individual. And we need new skills for staff—listening, visioning, networking, negotiating, managing tensions. These ‘soft’ skills are crucial to the effectiveness of a planning system which supports the individual. Paid support workers need huge degrees of flexibility, innovation, creativity, resourcefulness, common sense, strong values and commitment. These skills and attributes don’t just happen—they need nurturing, management support, opportunities to develop, and to be valued in an organisation. It’s more likely that these are valued and supported in organisations which are well grounded in the local communities. Disconnected organisations are more likely to be preoccupied with policies and procedures. This new approach requires strong leadership. Paid workers and community members respond to what they see, just as people with disabilities do.
Person-centred planning is a complex process; it is more like a journey than a line between two points; a windey road, not a motorway; there are hills and bends and potholes and obstacles. To take on person-centred planning is to take on the whole endeavour; if it were a motorway, we would miss all the discovery of the journey—the hills and trees, the people we pass. It has implications for the culture of the organisation, the systems within the organisation. We sometimes make the mistake of assuming that all that is needed is a patch to mend the wheel.
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In preparing for his next annual case conference, Michael is asking us—as the people who should know how to figure this out—to come up with a way of planning that responds to his agenda. A system that creates a partnership with him, his family and other people involved in his life—or who could be involved!
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We’d welcome your response. If you have an individual planning system and it works, tell us about it. We wrote this article to challenge, question, explore and acknowledge some of the work that needs to be done to make person-centred planning the essence of what we do The issues raised in this article are based on our experience so far. And that experience may not be true for everyone we support, it certainly is for some people. It’s an issue worth addressing.
Our Decommissioning Crisis continues…