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Must know: Personalisation and Making It Real in adult social care

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This must know guide provides an overview of how to implement personalisation in adult social care, offering an introduction to the principles and practices of personalisation and to implementing these concepts.

Introduction

This guide provides an overview of how to implement personalisation in adult social care.

While this guide offers an introduction to the principles and practices of personalisation, implementing these concepts within individual councils will require tailored approaches for local contexts.

Think Local Act Personal’s Making It Real statements provide a practical way to begin this process in coproduction with people who work in social care and those who draw upon care and support, linked directly to the Care Quality Commission’s (CQC) Single Assessment Framework. 

In this guide, you will encounter key questions designed to prompt reflection and discussion, helping you to identify areas for further enquiry and action within your own organisation.

This guide has been developed by the Think Local Act Personal policy team alongside people who draw on care and support, including family and friend carers.

Key messages

Personalisation in adult social care is about people of all ages being at the heart of decision-making, ensuring that their unique needs, preferences, and aspirations drive the care and support they receive. This approach not only aligns with the mandates of the Care Act 2014 but also reflects what people have consistently said they want from social care: dignity, respect, choice, and control over their lives.

Key to successful personalisation is the effective implementation of Self-Directed Support (SDS), through which people direct their care in a way that best suits them. Whether through direct payments, individual service funds (ISFs), or other ways of managing a budget, Self Directed Support provides the framework for people to take control of their care and achieve personalised outcomes.

Joined up, coordinated health and social care that is planned and organised around the needs and preferences of the individual, their carer and family is critical to delivering seamless, accessible support that prioritises prevention over crisis intervention. Councils must also ensure that universal services, including information, advice, and advocacy, are readily available to all, with particular attention to equity and accessibility. Alongside the range of services that support wellbeing more broadly within local government. 

To make personalisation a reality, it is essential to embed a culture of co-production, where councils work in genuine partnership with individuals, carers, and communities. 

Making It Real offers a practical tool to support these efforts, providing a set of co-produced statements that guide the delivery of personalised care. By embedding Making It Real throughout all aspects of social care work, councils can ensure that personalisation is not an add-on but a fundamental part of service delivery, leading to improved outcomes for all.

What you need to know

For lead members, implementing personalisation isn't just a matter of policy, it’s about advocating for the right to a fulfilling and independent life for people in their communities. When lead members prioritise personalisation, they show a commitment to services that embrace unique needs, preferences, and diverse life experiences.

Personalisation also plays a key role in building trust within communities. It ensures that decisions about care and support are made with the people they affect. This approach helps lead members to uphold democratic accountability.

Why lead members are important in embedding personalisation

Lead members are key in embedding personalisation across health and social care due to their responsibilities as both community representatives and place leaders. This unique position allows them to connect with local people and ensure services align with their needs, wishes, and aspirations. By adopting a co-productive approach, they ensure that services are created with, not just for, people who draw on care and support.

Why Personalisation should matter to lead members:

  • Democratic accountability:
    Lead members are accountable to the public. Personalisation ensures that services are shaped by the experiences of those who draw on them, reinforcing lead members' role in holding service providers accountable for delivering care that aligns with the real needs of their communities. Through personalisation, lead members can enhance transparency and demonstrate that decisions about care and support are genuinely informed by those most affected.
  • Connection to local people:
    As lead members, your role involves understanding the challenges, hopes, and needs of your community. Making It Real encourages co-production, where people with lived experience are involved in shaping services. This connection to local voices allows lead members to directly influence how services are designed and delivered, ensuring they reflect local diversity, preferences, and aspirations.
  • Place-based leadership:
    Personalisation is inherently linked to the local context. As place leaders, lead members can champion personalised, community-driven solutions that reflect the unique characteristics of their locality. By embedding Making It Real, lead members can ensure local strategies, including those on health, housing, and social care, are connected and co-produced with local people.

What lead members need to do

  • Champion co-production:
    Lead members should advocate for and ensure co-production processes are at the heart of local service planning and delivery. This involves bringing people who draw on care and support, carers, and their families into decision-making processes, thereby ensuring services are shaped around real needs and aspirations.
  • Promote and support cultural change:
    Personalisation requires a shift in culture from a service-led approach to one that is person-led. Lead members can take a lead in promoting this cultural change within their local authorities by fostering environments that embrace choice, control, and partnership with local people.
  • Ensure accountability and transparency:
    Personalisation must be more than a policy—it requires robust systems of accountability. Lead members should ensure that local service providers are delivering on personalisation commitments, regularly reviewing outcomes and adjusting strategies based on community feedback.

Questions to consider

  • How can we ensure that people who draw on care and support are at the heart of our decision-making processes?
  • What mechanisms are in place to gather feedback from those with lived experience of care and support , and how are we acting on that feedback to improve services?
  • Are we seeing a tangible shift towards personalised, flexible services that reflect the diverse needs of our community?
  • How are we ensuring that personalisation aligns with broader goals such as prevention, early intervention, and community resilience?
  • Where can we get support and connect with peers from other areas to help us understand how to make progress.

By addressing these areas, lead members can ensure they are fully embedding personalisation within their roles and leading the cultural growth needed to transform care and support systems in their areas.

About personalisation

Personalisation is the term used for an approach to care and support which treats people as active citizens with individual agency, responding to their personal needs and wishes.

It may seem easy to assume that this is the approach that should be used in delivering quality outcomes for people drawing on social care, but when it comes to designing a whole system that provides high quality services which are also cost-effective, there are pressures to standardise care and to make assumptions about people who belong to certain groups.

Personalisation is a response to what people have said they want. For example:

  • to be treated with dignity and respect
  • accessible information
  • access to support quickly and easily when needed, including support for carers
  • services from different providers of health and social care which are integrated (joined up), so that they don’t have to have numerous assessments and talk about their needs and preferences again and again, and so that all services have the same essential information about them
  • services which respond to their cultural or religious needs
  • more choice and control
  • to maintain their independence
  • to get support early, avoiding the need for a crisis response such as a stay in hospital.

More than a nice to have or an aspiration, personalisation is rooted in national policy and current law. The Care Act 2014 mandates that councils ensure personalised care is provided, focusing on the individual’s well-being, choice, and control.

The Equality Act 2010 ensures that services are provided equitably, addressing any disparities that may affect individuals based on race, disability, age, or other protected characteristics. Central to personalisation is the principle that when people need ongoing support, they do not cease to be citizens or members of their local community.

The support that people draw on should therefore help them to retain or regain their roles and the benefits of being part of their community including living in their own homes maintaining or gaining employment and making a positive contribution. Perhaps more than anything, personalisation is also about building connections and the quality of relationships with loved ones, friends, neighbourhoods and communities too.

Critically, personalised care takes a whole-system approach, integrating services around the person including health, social care, public health, and wider services. In health, the NHS has adopted personalised care through an approach called Universal Personalised Care and it’s six components of personalised care:

  • enabling choice, including legal rights to choice.
  • shared decision making.
  • personalised care and support planning.
  • social prescribing and community based support.
  • supported self management.
  • personal health budgets.

About self-directed support

Self-Directed Support (SDS) enables individuals to take control of their care and support, which in turn helps to support personalisation by prioritising choice, control and individual wellbeing. 

Everybody should have the option to direct their support in a way that best meets their unique circumstances, regardless of the way they choose to manage their personal budget. Direct payments provide the greatest amount of choice and control for individuals with a personal budget, but people should also be supported  to self-direct their support with other forms of personal budget, such as managed budgets or through Individual Service Funds. 

Personalisation is for everyone, and is a key part of the way in which diverse needs and preferences can be met flexibly and holistically. Equity in care and support requires recognising and addressing the different challenges faced by diverse groups, ensuring that care planning and delivery are sensitive to these differences. Self-Directed Support (SDS) further enhances this by allowing individuals to tailor their support, ensuring their dignity and rights are upheld. This approach helps to secure the best possible outcomes for everyone.

About co-production

An important concept in personalisation is that of co-production. This is the idea that commissioners and providers of services should work in partnership with people who draw on care and support, carers and citizens to design, commission, deliver and contribute to the ongoing  Improvement of are and support. 

Failure to listen to people has been a key theme in all the high-profile scandals in health and social care in recent years. Conversely, research suggests that co- production networks can help to build capacity and social capital in communities. It increases awareness and understanding of community issues, bridges social divides and encourages collaboration. Research by the Joseph Rowntree Foundation suggests that being involved in co-productive social programmes can make an important contribution to people’s physical and mental health, especially people with long-term conditions.

Co-production provides a framework to develop more equal and meaningful relationships. Collaborative co-production in social care assumes that people who draw on care and support and their families are experts in their own circumstances and capable of making decisions and seeing how services could be improved, while people who work in care and support must move from being fixers to facilitators.   

This necessitates new relationships with people working in social care, who may need support and mentoring to develop new skills to help take on their new roles as co-producers. Successive government policies, including personalisation have themselves been created through co-production. 

Research suggests that the most valuable co-production takes place in communities and neighbourhoods – therefore the form it takes needs to fit local situations.

Critical to the success of coproduction is the question of trust and power, and the relationship between the two. Councils need to be willing to “let go” to some of their own control which in turn requires a higher level of trust in people drawing on care and support, for example over the controls and bureaucracy on how direct payments are spent. Senior leaders within councils have a crucial part to play in granting permissions and developing cultures and practices that support the important shifts in power and trust coproduction and personalisation depends upon to thrive. 

About Making It Real

Making It Real is a set of statements that describe what good care and support looks like, organised into six themes.

1. Wellbeing & Independence

2. Information and Advice

3. Active and Supportive Communities

4. Flexible and Integrated Care and Support

5. When Things Need to Change

6. Workforce

The statements are written from two different perspectives: 

  • The ‘I statements’ describe what good looks like from the perspective of someone who draws upon care and support. 
  • The ‘we statements’ describe what people who work in care and support should do to make the I statements real.

The Care Quality Commission (CQC), which regulates health and social care in England, has incorporated Making It Real I statements into their Single Assessment Framework as a way to focus on the things that matter to people. 

This framework is used to assess providers, local authorities, and integrated care systems. Using Making It Real as a way to improve people’s experiences of care and support, and recording the way you have coproduced change, can help organisations to evidence the work they are doing to provide personalised care, health and support. 

By recording the outcomes of individuals using Making It Real, organisations can therefore record information which might support them in a CQC assessment. 

The LGA has produced a Must Know for lead members on CQC assessment. 

Making It Real can help:

Organisations that genuinely want to get better at personalisation to look at their current practice against the statements, identify areas for change, and develop plans for action. 

  • Organisations achieve a more positive and productive relationship with people who use services. 
  • Organisations to meet their legal duties and contribute to raising standards. 
  • People have a really good conversation with local services that focuses on making things better. 
  • Support co-production between people, commissioners and providers. 
  • Guide organisations that do not directly provide services, in how to support the spread of personalised care and support. 

Not all of the statements will be equally relevant to all people and organisations, and there will be some variation in how organisations use them within the overall approach. 

Organisations and their staff have certain legal requirements which they must meet, for example around safeguarding. Making It Real can help organisations think about how to meet these legal duties and responsibilities through working in a person-centred way. 

What you need to do

  • Develop your understanding of what good care and support looks like for people who draw on it by familiarising yourself with the Making It Real ‘I’ and ‘we’ statements and the Making It Real Guide available at makingitreal.org.uk.
  • Ensure that you understand the concepts of co-production, community capacity building and social capital.
  • Embed an overall culture of personalisation in all aspects of your council’s adult social care work, ensuring that the individual's needs and preferences are at the forefront of care planning and delivery. This includes:
    • Ensuring that your council’s approach provides genuine choice and control for people who draw on care and support.
    • Emphasising the importance of seeing people as individuals with a right to be treated with dignity and respect and develop a clear understanding of what that means.
    • Ensuring your council is actively involving communities and individuals as co-producers in the development and delivery of services.
  • Develop a co-produced Making It Real action plan setting out the actions and priorities that have been identified, and how and when these will be taken forward.
  • Regularly report publicly on progress towards Making It Real.
  • Embed Making It Real as a ‘golden thread’ throughout all your health and wellbeing board priorities, involving people who use draw on care and support and their carers in your work on personalisation.
  • Ensure that your Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) prioritise personalisation, focusing on community capacity building and resilience.
  • Develop clear commissioning strategies with your NHS and voluntary sector partners, aimed at a significant shift in care and support away from intervention at the point of crisis to proactive and preventative models of care.
  • Ensure you have a proactive strategy for allocating personal budgets to all those eligible for ongoing social care.
  • Ensure your council understands that direct payments provide the greatest amount of choice and control for individuals with a personal budget. Be clear that people can use direct payments flexibly and creatively with minimum restrictions, other than the statutory limitations. Work positively to support people to get the best from their direct payments.
  • Ensure that your council is developing innovative ways of using individual service funds (ISFs) for those people who wish to have a managed personal budget. This ensures that even those who may not want to manage their budgets directly can still benefit from personalised care and support options.
  • Ensure that universal services, including information, advice and advocacy are easy to find and available to everyone, regardless of who is paying. Pay particular attention to accessibility that is equitable for all.
  • Ensure that the local care market responds to the diverse needs of the community, allowing individuals to purchase services that best meet their personal needs and preferences.
  • Develop a strategy for housing and the use of technology such as telecare to support people to live more independently at home for longer.
  • Take time to learn about Personalised Care in health services and monitor local initiatives.
  • Work towards better integration of health and social care services, ensuring that these services are seamless and accessible to all.
  • Request a copy of the latest Association of Directors of Adult Social Care (ADASS) self-assessment survey of all councils. See the national report for an overview, the regional report which identifies key issues for individual councils and ensure your council has a co-produced action plan to address the issues.
  • Regularly assess your council’s progress in personalisation, ensuring that equity is a central consideration.
  • Ensure that the skills, behaviours and values needed for co-production are recognised in your workforce development strategy.

Further questions to consider

  • Do you fully understand the principles of personalisation, including tools like personal budgets, direct payments, and person-centred support planning?
  • Is there an understanding at a senior level of Making It Real and co-production?
  • Is Making It Real integrated into all aspects of your council's work?
  • Is personalisation a priority across your activities?
  • How well does your council co-produce with disabled people, older people, and their carers in shaping services?
  • How will you know if power has shifted towards people and away from commissioners and providers?
  • Is co-production embedded in your council’s strategies, and how inclusive and equitable is this process?
  • Are prevention strategies and universal services truly accessible to all community members?
  • How is equity being addressed in the management of local care markets and in the delivery of care and support?
  • How effectively is Self-Directed Support (SDS) being implemented to ensure all individuals have control over their care and support?
  • Is social capital built into the support plans so that people have a good choice of support, including from user-led organisations?
  • Are people treated with dignity and respect?
  • How do you monitor the number of personal budgets, direct payments, and Individual Service Funds, and assess whether they are being used effectively?
  • How well is the council fulfilling its duty to develop and provide universal information, advice, and advocacy services?
  • Are you shaping the local market and creating commissioning agreements to enable a wide-ranging choice of providers and types of support so that people have the best choice and control of their support?
  • How are people who draw on care and support, and carers, involved in co-producing commissioning outcomes on which contracts with providers will be based?
  • How proactive and sustainable is your strategy for housing and social care?
  • Has your council developed an action plan to respond to the issues identified in the ADASS self-assessment survey of councils?

Glossary of terms