Unit 17 Person Centred Care
Samantha Caswell
21st October 2014
Unit 17-Lead Person Centred Practise
Task 1
1.1
Person centred care has been designed and developed over several decades as the Department of Health has worked hard to change the ideas of how care should be delivered in the UK. In past years care was delivered in a way that concentrated on the problems and disabilities of individuals and worked at ways of dealing with this. This created a culture of dependency as health professionals struggled to meet the growing needs of their service users. Person centred care moved away from a ‘one size fits all approach that had previously been used and instead worked at developing a package of care and support that firmly put the service user at the centre of every decision made.
Person centred care is a way of working that supports an individual to take control of their own lives and focus on their talents and …show more content…
abilities instead of the things that they can’t do and this in turn enhances their quality of life, promotes independence, choice and raises self-esteem. Care workers and health professionals are empowered to work closely alongside the service user, getting to know them and therefore being in a better position to support them to make decisions about how best they would like to be supported. With the introduction of personal budgets service users are given money to build up a package of care that they have control of and this again ensures that the individual is at the very centre of the practise. Person Centred care is available to all service users including private paying who do not fall under the category of personal budgets.
In my working day as manager of a residential home I ensure that my team and I deliver care in a person centred way from the very beginning of the time that we meet the individual. When we first go out and assess a person who is looking to come into our care home we spend a lot of time with them, getting to know as much as we can to ensure that the care and support we deliver is tailor made to their needs and that they are able to fully participate in creating the plan as much as they are able to. For individuals that require additional assistance, for example due to sensory loss, we would use communication aids such as picture books or if necessary take a member of staff who is able to use sign language to assist us with this. Where ever possible this first assessment is carried out in the service users home to ensure that they are completely comfortable and at ease in their environment as this helps them to have more confidence when talking with us. The assessment is carried out asking various questions from the support they feel they require with areas of personal care and how they would like to be supported with this through to their likes and dislikes. We talk at length about what they like to do in regards to hobbies and interests, religious and cultural needs as well as finding as much about their life history as they are willing to share. By talking about life history we can learn a lot about the individual, their personalities, their family and what has made them the person they are today. This information is then taken back to the work place and a care plan created that is built with all the needs and preferences of the individual at the very centre and then we, as health workers create a package of care around that that promotes the individuals independence and choices.
When working in the social care sector we meet a variety of individuals with a variety of needs and these are often very unique to the individual. Individuals that we meet come from all walks of life, have different beliefs, opinions, and personal life style choices and each individual should be supported to maintain these while being treated equally and fairly. The job of the health professionals is to look at the diverse needs of the individual and support them to live a happy fulfilling life while ensuring they have equal rights to the high standard of care that others receive. Care delivered in this way by health professionals shows the individual that staff have empathy for their needs and the working relationship grows due to trust and confidence by the individual towards their worker.
When taking into account every aspect of an individual’s life and creating a person centred approach into delivering the care that they need a very specific type of care can be delivered that ensures they are able to plan their own future which is more fulfilling, happier and more individualised.
The Department of Health defines personalisation under four headings: The Quadrant:
1. Universal Services- these include correct information given to the service users in a format that is appropriate to them, access to advocacy, leisure facilities, transport and user led organisations. Every single service user should have equal access and opportunities to all areas of life regardless of disability, employment or age.
2. Early intervention and Prevention- Health professionals to work with service users from the earliest stage to ensure that the correct support is put in place to enable them to live independently in their own home.
3. Social capital- this is a network of people from user led organisations, neighbours, friends, care networks and volunteers who offer support to each other in the traditional statutory structure. Other social capital would also include peer groups and it can be facilitated by service users and carer led organisations.
4. Choice and Control- for every single service user in the way of better housing, personal budgets and person centred support plans and a responsive flexible service. At the very centre of the personalisation initiative is the commitment to give more choice and control to people using social care services. By professionals giving self-directed support this enables people to make their own decisions about their lives and the support they require which in turn leads to a happy fulfilling life.
1.2
For over 30 years the development of good quality personal care has been investigated, tested and evolved to reach the service that we as health care workers deliver today. Starting back in the early 1960/70’s when the move towards ‘normalisation’ first occurred and the vast amounts of long stay hospital’s and asylums began to close down it was thought that the patients would return to the community and be cared for there by community based services. This had not been completely thought through as the need for support far outweighed what the available services could provide. There was also the deep rooted stigma attached to mental health conditions, fear amongst the communities that previously individuals that had been perceived to be dangerous and unfit to be ‘out on their own’ were now living amongst them on their streets. The government, with support from the European Convention of Human Rights (1950) the Mental Health Act (1957) and the Howe report (1969) created a white paper in 1971 titled Better Services for the mentally handicapped and this pushed for a 50% reduction in hospital places by 1991. It was at this time, realising the challenges that they faced, that health professionals and care workers began to reflect on previous working practises and looked at different ways that care and support can be delivered while beginning to educate society as a whole. Communities at this time were very worried and scared that individuals that had previously been ‘locked up’ were living amongst their children and women and it was clear that greater education for the public would be needed in order for this to work. Knowing that the service users who had been placed back into the community with very little way of care and support, dealing with daily battles from the naive community, were now even more vulnerable the previously used Medical Model came under immense scrutiny and the debate began about using a more Social Model of practise.
The Medical Model:
The medical model was created and designed for a very specific purpose. It focusses on the importance of proper diagnosis and grouping conditions together with the theory that this will have better success at treating the condition and therefore the individual. The medical model assumes that disability is an individual problem that is caused by impairment and therefore the focus is based on treating, improving or restarting the function that is lost. There was a clear focus on the investing in health care to identify, diagnose, cure and manage or alter and control the conditions but does not take into account the need for social or environmental issues that clearly contribute to the level of disability that the individual has. It was widely felt that the ‘cure to the problem’ was to have a very specific and clear understanding of the condition and this then provides the answer to the management of it. Cure was the main objective wherever possible and when this was not an option the focus moved to controlling and managing the condition to enable the disabled person to adjust. For example an individual that has poor vision would be expected to have surgery if this was an option and assumed that this would be what she would want without even considering other options that would enable her to live a full and happy life without perfect vison. This is because the model assumes that everyone wants to be ‘normal’ to reach their true potential in society. This form of the model is seen to be learnt through expertise by professionals that learn through qualifications, is evidence based and therefore robust.
Psychiatrist R.D Laing had positives for the Medical Model:
1.
It provides professional and clinical useful information about illnesses, disabilities and conditions to enable a prognosis.
2. It points or suggests specific underlying cause of the disorder
3. Directs professionals to specific treatment for the individual.
Negative points of the medical model:
1. The medical model sees the professional as the expert and patients would be expected to take the advice of them without question. This is because the professional is seen as a person of authority in relation to the patient. The model states that this is normal due to the expertise of the professional and to be expected.
2. Professionals are viewed as dominant as they are trained in diagnosis and treatment.
3. Sick and ill patients were held responsible for their condition whether that is mental health, diseases or frailty.
4. The disease or condition of the patient is seen as the most important factor and other factors such as social, psychological and individual behaviours became second to this.
The Social
Model
This model took on a completely different look to the previously used medical model and looked at empowering individual, seeing them more of the professional, as they live with the illness or condition every day. The positives, successes and aspirations of the individual were all looked at and they were placed at the very centre of the care process and supported to take control of their own lives. The Social Model proposes that barriers, negative attitudes and exclusions by society lead to a person being defined by society. Individuals may have physical, sensory, intellectual or mental impairments and when using the social model this challenges people not to see this as a disability, that is unless society as a whole fails to take account of this and include people regardless of their diverse and often complicated needs. Oliver (1990) wrote about Disability and Personal Tragedy and said “if disability is represented as a tragedy, disabled people will feel like a victim”. This is very true and by empowering individuals to live a happy and fulfilling life ensures that they do not feel like a victim, will have confidence and high self-esteem and this will ensure that society as a whole does not view them as victims either. The approach was originally established by disabled people to challenge society understand their situation and in order for them to claim their civil rights and have equality free from exclusion which had previously happened using the medical model. The idea of the social model was to look at society as the disability not the individual and viewed this as the problem for prejudices and barriers in our world. Due to the lack of understanding, resources and facilities disabled people were automatically excluded from areas in education, workplaces and leisure environments. This change in thinking brought about various legislations that ensured that all areas should be adapted and as much support put in place to ensure that all people regardless of disability/age should have equal access to them. It is now law that all establishments must have disabled access and there has been a huge rise in the amount of disabled individuals attending main stream schools and college with additional support. The change from the medical to social model has seen a huge change in how society views disabled people. Gradually they have come to understand that the environment and society are the main problems and not the disabled person themselves.
Positives of the Social Model
1. Individual is empowered to take control of their own live, to live independently, to have access to all areas of employment, leisure and employment
2. Personal budgets have allowed individuals to purchase the support that they feel they require not what the so called professional thinks they need
3. Society as a whole has a better understanding of disabilities and how it affects the individual. This has led to more understanding and acceptance of others diverse needs and there is much less exclusion.
4. Individual now seen as the professional
Individuals are now more confidant, have higher self-esteem and are living more fulfilling lives.
5. There is less emphasis on family members to take responsibility for their disabled loved one but they are supported themselves to be able to be as involved as they are able.
6. Tools have been developed to support professionals to be able to deliver person centred care in the form of planning documents. This enables professionals to gain information and what is important to them. This helps with planning and supporting the individual in the first instance but also for future planning when the individual may be less able to make these decisions. Within my workplace we have just started to use Essential Lifestyle planning (ELP) which are detailed documents that enable us to build up a big picture when getting to know an individual who has come to reside at the home. All the information helps us to understand the individuals past, present and future and assists greatly when creating a support package that works for them. As care workers it is vital that we support an individual to live the life they want and not the life that we want for them.
Negatives of the social Models
1. Requires continual education of society to continue to ensure that prejudices do not resurface
2. Relies on self-motivation of the individual
3. Society must follow laws and ensure that all environments are fully assessable to disabled people.
4. Due to the reduced focus on the medical needs future diagnosis may be missed that could be detrimental to the individuals health
5. Increased need for community led facilities.
Conclusion
Over the last century much has been done to improve the standard of care that is delivered in this country. In the earliest years while using the medical model, control that professionals had over individuals meant they were able to deliver a service that was both direct and robust with little thought for the actual individual themselves. The Social Model took a different approach which was to educate and empower and ensure a better quality of life for all vulnerable individuals. The medical model was narrow in its thinking but it also has to be remembered that opinions, resources and lifestyles were very different at the time that this was used. The social model I believe has not only empowered the individual, but changed the whole of society for the better. It has given a huge amount of power to the individual to live a life they choose, with the same options and choices that we all take for granted daily. It has also helped educate society as a whole. The general public has been empowered themselves and this is due to the information and education from tireless campaigning from consumer led groups, government legislation and initiatives. We have been given a greater understanding of illnesses and health conditions that previously people were frightened and ignorant of and resulted in stigma’s and prejudices which have now greatly reduced.
1.3
As we are now aware there have been huge changes over the years to the way that health and social care is delivered in this country which began in the 19th Century where charitable social work focussed on alleviating poverty and homelessness with the belief that by offering charity a dependency culture would develop. The Poor Law of 1834 continued through to the development of the Charity Organisation Society 1869. At this time institutionalisation began which see disabled people with mental health problems being classified due to their condition and kept in asylums and hospital settings. The already vulnerable and probably frightened individuals were treated inhumanely without choice given of food they want to eat, clothes they wish to wear and activities they would like to take part in. After a series of ‘lunacy acts’ the asylums expanded rapidly and by 1914 there were 120 of these scattered around the country and astonishingly they housed as many as 50 people to every room. Although as health care workers and professionals in a modern society we are probably disgusted at the thought of people being treated in such a way we have to remember that at that time there was very little known about mental health conditions and disabilities and therefore these type of establishments were probably used as a way to keep what they believed to be ‘normal’ people safe. Even the care workers who looked after the individuals in the asylums would have had very little training and knowledge and therefore with the naivety and ignorance they too may have felt vulnerable, there was also a stigma attached to care workers at this time. They may have thought that by keeping the individuals together in a very restricted way would empower the care workers and keep them safer than allowing them independence and choice as we would in our more modern way of thinking.
The 1940’s see the beginning of the end for the Poor Law and by 1948 the introduction of the Welfare State and National assistance Act where social work separated from administration of money, the Poor Law had previously dealt with financial and social support as one package. The new legislation instructed local authorities to provide basic residential accommodation to disabled and older persons and there was less focus on the deserving and undeserving. Some people believed that attempts to separate social work from financial support had led to professional failings as it had hindered the efforts to address poverty and this in turn had caused barriers to culture change and a move forward to person centred care.
The 1960’s/70’s see the beginning of the civil rights movement which questioned the way power was distributed through society. It was at this time the disability movement and anti-psychiatry and mental health users began to surface and campaigning support emerged in the late 60’s to shut down long stay hospitals and asylums and to give people a greater say in decisions about their lives. Enoch Powell in 1961 further called for institutes to close down and media investigations uncovered abuse in these places which put further pressure on politicians to make further changes to the medical model that was currently being used. In 1970 the Chronically Sick and Disabled Persons Act made law that all local authorities provide good standard care for those in need. This although greatly improved on previous provisions was still a far cry from the service we know today and in 1972 The Union of Physically Impaired against Segregation became the first disability liberation in the UK.
The care sector continued to improve and then in 1975 a white paper was published titled Fundamental Principles of Disability and this was what developed the social model of disability. Campaigns began that called independent living for all disabled people and the self- advocacy movement began.
In 1986 see criteria for benefits tighten as the conservative government wanted to illuminate a dependency culture and move towards a more individualised consumer led approach in social care. The disabled persons act stated that local authorities were required to assess needs of all disabled people and two years later they introduced the Individual Living und to help with transition back to independent living. This was intended for a maximum of five years but still is available today and it was the popularity of this that is thought to be the first thinking behind the personal budgets that came in to place years later.
The introduction of the NHS and Community Care Act in 1990 see the development of needs led assessments and different approaches to how they should be carried out as well as different ideas for care management. This would be the start of the new government initiative where they promised service users that they would now receive individualised care packages. By 1996 this had moved on to direct payments for disabled people following relentless campaigning by the Independent Living movement. The Community Care and direct Payments Act of 1996 for the first time gave actual control back to the individual as they were then supported to decide the care and support that would actually benefit them and purchase this directly. This also included the under 65’s with physical and learning disability. The key factors to this move forward was to ensure that service user’s remained independent, empowered with maximum choice and control.
In 2001 the new Labour government continued with the plans of the previous party and continued to promote independence and in 2003 the “in Control” document offers new social care model for learning disability based on self-directed support and personal budgets. In 2001 the Health and Social Care Act section 57 brought in a new legislation that made it discretionary to offer direct payments to those that had been assessed as needing it. This was the officially the time that Person Centred Planning came into play.
.
21st October 2014
Unit 17-Lead Person Centred Practise
Task 1
1.1
Person centred care has been designed and developed over several decades as the Department of Health has worked hard to change the ideas of how care should be delivered in the UK. In past years care was delivered in a way that concentrated on the problems and disabilities of individuals and worked at ways of dealing with this. This created a culture of dependency as health professionals struggled to meet the growing needs of their service users. Person centred care moved away from a ‘one size fits all approach that had previously been used and instead worked at developing a package of care and support that firmly put the service user at the centre of every decision made.
Person centred care is a way of working that supports an individual to take control of their own lives and focus on their talents and …show more content…
abilities instead of the things that they can’t do and this in turn enhances their quality of life, promotes independence, choice and raises self-esteem. Care workers and health professionals are empowered to work closely alongside the service user, getting to know them and therefore being in a better position to support them to make decisions about how best they would like to be supported. With the introduction of personal budgets service users are given money to build up a package of care that they have control of and this again ensures that the individual is at the very centre of the practise. Person Centred care is available to all service users including private paying who do not fall under the category of personal budgets.
In my working day as manager of a residential home I ensure that my team and I deliver care in a person centred way from the very beginning of the time that we meet the individual. When we first go out and assess a person who is looking to come into our care home we spend a lot of time with them, getting to know as much as we can to ensure that the care and support we deliver is tailor made to their needs and that they are able to fully participate in creating the plan as much as they are able to. For individuals that require additional assistance, for example due to sensory loss, we would use communication aids such as picture books or if necessary take a member of staff who is able to use sign language to assist us with this. Where ever possible this first assessment is carried out in the service users home to ensure that they are completely comfortable and at ease in their environment as this helps them to have more confidence when talking with us. The assessment is carried out asking various questions from the support they feel they require with areas of personal care and how they would like to be supported with this through to their likes and dislikes. We talk at length about what they like to do in regards to hobbies and interests, religious and cultural needs as well as finding as much about their life history as they are willing to share. By talking about life history we can learn a lot about the individual, their personalities, their family and what has made them the person they are today. This information is then taken back to the work place and a care plan created that is built with all the needs and preferences of the individual at the very centre and then we, as health workers create a package of care around that that promotes the individuals independence and choices.
When working in the social care sector we meet a variety of individuals with a variety of needs and these are often very unique to the individual. Individuals that we meet come from all walks of life, have different beliefs, opinions, and personal life style choices and each individual should be supported to maintain these while being treated equally and fairly. The job of the health professionals is to look at the diverse needs of the individual and support them to live a happy fulfilling life while ensuring they have equal rights to the high standard of care that others receive. Care delivered in this way by health professionals shows the individual that staff have empathy for their needs and the working relationship grows due to trust and confidence by the individual towards their worker.
When taking into account every aspect of an individual’s life and creating a person centred approach into delivering the care that they need a very specific type of care can be delivered that ensures they are able to plan their own future which is more fulfilling, happier and more individualised.
The Department of Health defines personalisation under four headings: The Quadrant:
1. Universal Services- these include correct information given to the service users in a format that is appropriate to them, access to advocacy, leisure facilities, transport and user led organisations. Every single service user should have equal access and opportunities to all areas of life regardless of disability, employment or age.
2. Early intervention and Prevention- Health professionals to work with service users from the earliest stage to ensure that the correct support is put in place to enable them to live independently in their own home.
3. Social capital- this is a network of people from user led organisations, neighbours, friends, care networks and volunteers who offer support to each other in the traditional statutory structure. Other social capital would also include peer groups and it can be facilitated by service users and carer led organisations.
4. Choice and Control- for every single service user in the way of better housing, personal budgets and person centred support plans and a responsive flexible service. At the very centre of the personalisation initiative is the commitment to give more choice and control to people using social care services. By professionals giving self-directed support this enables people to make their own decisions about their lives and the support they require which in turn leads to a happy fulfilling life.
1.2
For over 30 years the development of good quality personal care has been investigated, tested and evolved to reach the service that we as health care workers deliver today. Starting back in the early 1960/70’s when the move towards ‘normalisation’ first occurred and the vast amounts of long stay hospital’s and asylums began to close down it was thought that the patients would return to the community and be cared for there by community based services. This had not been completely thought through as the need for support far outweighed what the available services could provide. There was also the deep rooted stigma attached to mental health conditions, fear amongst the communities that previously individuals that had been perceived to be dangerous and unfit to be ‘out on their own’ were now living amongst them on their streets. The government, with support from the European Convention of Human Rights (1950) the Mental Health Act (1957) and the Howe report (1969) created a white paper in 1971 titled Better Services for the mentally handicapped and this pushed for a 50% reduction in hospital places by 1991. It was at this time, realising the challenges that they faced, that health professionals and care workers began to reflect on previous working practises and looked at different ways that care and support can be delivered while beginning to educate society as a whole. Communities at this time were very worried and scared that individuals that had previously been ‘locked up’ were living amongst their children and women and it was clear that greater education for the public would be needed in order for this to work. Knowing that the service users who had been placed back into the community with very little way of care and support, dealing with daily battles from the naive community, were now even more vulnerable the previously used Medical Model came under immense scrutiny and the debate began about using a more Social Model of practise.
The Medical Model:
The medical model was created and designed for a very specific purpose. It focusses on the importance of proper diagnosis and grouping conditions together with the theory that this will have better success at treating the condition and therefore the individual. The medical model assumes that disability is an individual problem that is caused by impairment and therefore the focus is based on treating, improving or restarting the function that is lost. There was a clear focus on the investing in health care to identify, diagnose, cure and manage or alter and control the conditions but does not take into account the need for social or environmental issues that clearly contribute to the level of disability that the individual has. It was widely felt that the ‘cure to the problem’ was to have a very specific and clear understanding of the condition and this then provides the answer to the management of it. Cure was the main objective wherever possible and when this was not an option the focus moved to controlling and managing the condition to enable the disabled person to adjust. For example an individual that has poor vision would be expected to have surgery if this was an option and assumed that this would be what she would want without even considering other options that would enable her to live a full and happy life without perfect vison. This is because the model assumes that everyone wants to be ‘normal’ to reach their true potential in society. This form of the model is seen to be learnt through expertise by professionals that learn through qualifications, is evidence based and therefore robust.
Psychiatrist R.D Laing had positives for the Medical Model:
1.
It provides professional and clinical useful information about illnesses, disabilities and conditions to enable a prognosis.
2. It points or suggests specific underlying cause of the disorder
3. Directs professionals to specific treatment for the individual.
Negative points of the medical model:
1. The medical model sees the professional as the expert and patients would be expected to take the advice of them without question. This is because the professional is seen as a person of authority in relation to the patient. The model states that this is normal due to the expertise of the professional and to be expected.
2. Professionals are viewed as dominant as they are trained in diagnosis and treatment.
3. Sick and ill patients were held responsible for their condition whether that is mental health, diseases or frailty.
4. The disease or condition of the patient is seen as the most important factor and other factors such as social, psychological and individual behaviours became second to this.
The Social
Model
This model took on a completely different look to the previously used medical model and looked at empowering individual, seeing them more of the professional, as they live with the illness or condition every day. The positives, successes and aspirations of the individual were all looked at and they were placed at the very centre of the care process and supported to take control of their own lives. The Social Model proposes that barriers, negative attitudes and exclusions by society lead to a person being defined by society. Individuals may have physical, sensory, intellectual or mental impairments and when using the social model this challenges people not to see this as a disability, that is unless society as a whole fails to take account of this and include people regardless of their diverse and often complicated needs. Oliver (1990) wrote about Disability and Personal Tragedy and said “if disability is represented as a tragedy, disabled people will feel like a victim”. This is very true and by empowering individuals to live a happy and fulfilling life ensures that they do not feel like a victim, will have confidence and high self-esteem and this will ensure that society as a whole does not view them as victims either. The approach was originally established by disabled people to challenge society understand their situation and in order for them to claim their civil rights and have equality free from exclusion which had previously happened using the medical model. The idea of the social model was to look at society as the disability not the individual and viewed this as the problem for prejudices and barriers in our world. Due to the lack of understanding, resources and facilities disabled people were automatically excluded from areas in education, workplaces and leisure environments. This change in thinking brought about various legislations that ensured that all areas should be adapted and as much support put in place to ensure that all people regardless of disability/age should have equal access to them. It is now law that all establishments must have disabled access and there has been a huge rise in the amount of disabled individuals attending main stream schools and college with additional support. The change from the medical to social model has seen a huge change in how society views disabled people. Gradually they have come to understand that the environment and society are the main problems and not the disabled person themselves.
Positives of the Social Model
1. Individual is empowered to take control of their own live, to live independently, to have access to all areas of employment, leisure and employment
2. Personal budgets have allowed individuals to purchase the support that they feel they require not what the so called professional thinks they need
3. Society as a whole has a better understanding of disabilities and how it affects the individual. This has led to more understanding and acceptance of others diverse needs and there is much less exclusion.
4. Individual now seen as the professional
Individuals are now more confidant, have higher self-esteem and are living more fulfilling lives.
5. There is less emphasis on family members to take responsibility for their disabled loved one but they are supported themselves to be able to be as involved as they are able.
6. Tools have been developed to support professionals to be able to deliver person centred care in the form of planning documents. This enables professionals to gain information and what is important to them. This helps with planning and supporting the individual in the first instance but also for future planning when the individual may be less able to make these decisions. Within my workplace we have just started to use Essential Lifestyle planning (ELP) which are detailed documents that enable us to build up a big picture when getting to know an individual who has come to reside at the home. All the information helps us to understand the individuals past, present and future and assists greatly when creating a support package that works for them. As care workers it is vital that we support an individual to live the life they want and not the life that we want for them.
Negatives of the social Models
1. Requires continual education of society to continue to ensure that prejudices do not resurface
2. Relies on self-motivation of the individual
3. Society must follow laws and ensure that all environments are fully assessable to disabled people.
4. Due to the reduced focus on the medical needs future diagnosis may be missed that could be detrimental to the individuals health
5. Increased need for community led facilities.
Conclusion
Over the last century much has been done to improve the standard of care that is delivered in this country. In the earliest years while using the medical model, control that professionals had over individuals meant they were able to deliver a service that was both direct and robust with little thought for the actual individual themselves. The Social Model took a different approach which was to educate and empower and ensure a better quality of life for all vulnerable individuals. The medical model was narrow in its thinking but it also has to be remembered that opinions, resources and lifestyles were very different at the time that this was used. The social model I believe has not only empowered the individual, but changed the whole of society for the better. It has given a huge amount of power to the individual to live a life they choose, with the same options and choices that we all take for granted daily. It has also helped educate society as a whole. The general public has been empowered themselves and this is due to the information and education from tireless campaigning from consumer led groups, government legislation and initiatives. We have been given a greater understanding of illnesses and health conditions that previously people were frightened and ignorant of and resulted in stigma’s and prejudices which have now greatly reduced.
1.3
As we are now aware there have been huge changes over the years to the way that health and social care is delivered in this country which began in the 19th Century where charitable social work focussed on alleviating poverty and homelessness with the belief that by offering charity a dependency culture would develop. The Poor Law of 1834 continued through to the development of the Charity Organisation Society 1869. At this time institutionalisation began which see disabled people with mental health problems being classified due to their condition and kept in asylums and hospital settings. The already vulnerable and probably frightened individuals were treated inhumanely without choice given of food they want to eat, clothes they wish to wear and activities they would like to take part in. After a series of ‘lunacy acts’ the asylums expanded rapidly and by 1914 there were 120 of these scattered around the country and astonishingly they housed as many as 50 people to every room. Although as health care workers and professionals in a modern society we are probably disgusted at the thought of people being treated in such a way we have to remember that at that time there was very little known about mental health conditions and disabilities and therefore these type of establishments were probably used as a way to keep what they believed to be ‘normal’ people safe. Even the care workers who looked after the individuals in the asylums would have had very little training and knowledge and therefore with the naivety and ignorance they too may have felt vulnerable, there was also a stigma attached to care workers at this time. They may have thought that by keeping the individuals together in a very restricted way would empower the care workers and keep them safer than allowing them independence and choice as we would in our more modern way of thinking.
The 1940’s see the beginning of the end for the Poor Law and by 1948 the introduction of the Welfare State and National assistance Act where social work separated from administration of money, the Poor Law had previously dealt with financial and social support as one package. The new legislation instructed local authorities to provide basic residential accommodation to disabled and older persons and there was less focus on the deserving and undeserving. Some people believed that attempts to separate social work from financial support had led to professional failings as it had hindered the efforts to address poverty and this in turn had caused barriers to culture change and a move forward to person centred care.
The 1960’s/70’s see the beginning of the civil rights movement which questioned the way power was distributed through society. It was at this time the disability movement and anti-psychiatry and mental health users began to surface and campaigning support emerged in the late 60’s to shut down long stay hospitals and asylums and to give people a greater say in decisions about their lives. Enoch Powell in 1961 further called for institutes to close down and media investigations uncovered abuse in these places which put further pressure on politicians to make further changes to the medical model that was currently being used. In 1970 the Chronically Sick and Disabled Persons Act made law that all local authorities provide good standard care for those in need. This although greatly improved on previous provisions was still a far cry from the service we know today and in 1972 The Union of Physically Impaired against Segregation became the first disability liberation in the UK.
The care sector continued to improve and then in 1975 a white paper was published titled Fundamental Principles of Disability and this was what developed the social model of disability. Campaigns began that called independent living for all disabled people and the self- advocacy movement began.
In 1986 see criteria for benefits tighten as the conservative government wanted to illuminate a dependency culture and move towards a more individualised consumer led approach in social care. The disabled persons act stated that local authorities were required to assess needs of all disabled people and two years later they introduced the Individual Living und to help with transition back to independent living. This was intended for a maximum of five years but still is available today and it was the popularity of this that is thought to be the first thinking behind the personal budgets that came in to place years later.
The introduction of the NHS and Community Care Act in 1990 see the development of needs led assessments and different approaches to how they should be carried out as well as different ideas for care management. This would be the start of the new government initiative where they promised service users that they would now receive individualised care packages. By 1996 this had moved on to direct payments for disabled people following relentless campaigning by the Independent Living movement. The Community Care and direct Payments Act of 1996 for the first time gave actual control back to the individual as they were then supported to decide the care and support that would actually benefit them and purchase this directly. This also included the under 65’s with physical and learning disability. The key factors to this move forward was to ensure that service user’s remained independent, empowered with maximum choice and control.
In 2001 the new Labour government continued with the plans of the previous party and continued to promote independence and in 2003 the “in Control” document offers new social care model for learning disability based on self-directed support and personal budgets. In 2001 the Health and Social Care Act section 57 brought in a new legislation that made it discretionary to offer direct payments to those that had been assessed as needing it. This was the officially the time that Person Centred Planning came into play.
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