What helps personalisation flourish?

It sometimes seems as though our health and social care systems are in a constant state of change. Queen’s speech announced more changes to social care, at a time of increasingly difficult financial constraints. One area which is being widely discussed is the need to improve integration between Local Authorities and the National Health Services. This may sound straightforward, but findings from our own PEOPLE study, recently published in the Journal of Mental Health (Larsen et al. 2013), highlights the many challenges involved in implementing change across ‘integrated’ health and social care.

The PEOPLE study looked particularly at local authorities’ implementation of Personalisation for people with mental health problems. We found local variations in implementation of Personalisation, with the type and extent of integration featuring as a major factor.

Our study also suggested a key issue that made implementation possible in some sites: the presence of an effective leader with a strong vision.

The introduction of Personalisation is a significant challenge to mental health services that requires a shift in culture and practice of social workers and other mental health professionals. Department of Health (2008) emphasised the extent of the change when Personalisation was being promoted across England:

Personalisation is about whole system change, not about change at the margins. It will require strong local leadership to convey the vision and the values, which underpin it and to reach beyond to the confines of social care. It is essentially about a significant cultural shift and management of change for the wider social care and local government sectors.  [Department of Health, 2008, p.5]

The responsibility for managing the complexities and challenges of changes in practice and values often falls on the shoulders of local leaders and managers before it reaches practitioners working on the frontline.

In our study, we found that local professionals often attributed the roll out of personalisation to leaders and managers who were described as “visionaries” with passion and specialist knowledge, who believed in personalisation and inspired others to do the same.

Charismatic and influential leaders, focused on communicating and reaching clear goals, are not enough to achieve success in introducing any organisational change, but they play a crucial role in kick-starting transformation and making sure other people jump on board. Our journal paper concludes that

“Personal commitment to change and expertise in bridging organisational divides are useful qualities for effective leaders and may apply beyond personalisation to any service or system redesign”

A clear commitment to the values of personalisation was shown in the extent to which local leaders worked in collaboration with service users, drawing on their lived experience in planning and supporting front-line practice. The local authorities in our study demonstrated the possibility and value of engaging service users in promoting change and sharing expertise.  Commitment to this way of working, recognising that service users must be at the forefront of change not simply recipients of it, must come from local authority managers, as well as front line staff, if it is to be effective.