Development of Person Centred
Approaches across the East Midlands
Person centred approaches were first formally introduced across
the Region in 2001 following the publication of Valuing People.
This white paper set out a number of ambitious targets that areas
were required to address.
Valuing people required that by :
 By 2002 each area would have a local framework outlining
their approach to the implementation of person centred
approaches, these were to be driven by local implementation
groups and would include a training programme and action
plan to meet the needs of the priority groups.
 By 2003 both people living in long-stay hospitals and young
people in transition would have benefited from person
centred approaches.
 By 2004 there would be significant progress in extending the
person centred approaches to people using large day
centres, those living with carers over the age of 70 and
people still living in NHS campuses.
Dependant on how you interpret this requirement , in the main
most areas have made significant progress towards this targets,
whilst not all the people in those target groups have plans
significant levels of work has been undertaken to work towards
achieving this goal.
This report presents an overview of the progress based on the
information provided by each local area and sets out
recommendations for priority action required to support the future
development across the region.
The regional position
Dedicated support and budget
All areas except Rutland have some investment in additional
support to develop person centred approaches through a co –
ordinator type role, three of which are called Training and
Development workers though perform similar roles to their
colleagues and the majority have additional support staff ranging
from none in Derbyshire and Rutland to 11 in Northamptonshire.
Many have been in post a number of years but Derby City have
just only just appointed a co –ordinator who will in turn be
recruiting a support team. Leicester City employ two people with
learning disabilities as planning assistants but they don’t carry out
the full role as facilitators. Rutland did have a co-ordinator and
when the post holder left looked to embed in other roles within the
organisation but are now considering a dedicated post again to be
shared between children’s and adult services.
The majority of the posts are funded via LDDF or other transitional
grant programmes. Whilst some areas Leicestershire and
Northamptonshire have used some mainstream funding to
supplement teams it is only short term investment. Only Derby City
has made the commitment to use long term mainstream funding to
support their team. Even though identified funding is only short
term all co-ordinators except two, Derbyshire and Leicester City
have permanent contracts.
Only one area, Northamptonshire has secured investment directly
from children’s services, which has been used to fund a team that
is looking at wider implementation of PCA approaches across
children’s services.
All the co-ordinators have a role in developing and delivering
training, co-ordinating local approaches and driving forward the
agenda within their localities alongside some individual planning
responsibility which is an important part of their role..
The Facilitators have a combined role of supporting individuals to
plan , most have some role in training and some are targeted at
coaching and mentoring but job descriptions don’t currently reflect
this practice.
Four areas have a small budget within their direct control whilst
others have access to funding via training budgets.
There is some concern from co-ordinators about reported
investment by LDPB’s in PCP as in some areas this doesn’t
appear to be related to the PCP teams or their work.
Current strategies
Whilst the majority of areas had developed early plans in line with
the recommendations from Valuing People, most are out of date
and need updating in line with Valuing People Now. Nottingham
City has already held a visioning day with key stakeholders,
Lincolnshire has a draft plan in place.
An area for exploration is the development of local strategies that
support the development of planning across children and adults
services as it is recognised that introducing person centred
approaches at an earlier age will assist in a embedding a person
centred culture and therefore speed up the change process, as
families will have raised expectations and aspirations for their
child’s future and the response that key services offer.
Current focus and priorities
This is where areas differ. All have focused on ensuring that
people living in NHS campus have good plans , 2 areas have
dedicated posts to do this, all areas are addressing young people
in transition and 3 areas are focusing on people accessing days
services. None have specific posts targeted at supporting older
carers by where specific projects exist they do work alongside
them to promote access to planning. Where the teams support
individual planning none have a targeted approach and accept
referrals for people who are want or who are deemed as needing a
plan.
Nottingham city are focusing on supporting planning across all
client groups in line with personalisation agenda through the
delivery of Person Centred Thinking training. To some extent this
is being mirrored in Northamptonshire.
Northamptonshire’s children’s team are working with children in
the care system and early years and are planning to target primary
school children in the near future. Leicester City are now starting
work with looked after children.
Derby City are a Good 2 Great pilot site so have focused on
achieving wider organisational change. This has included a
number of key organisations signing up to the pilot project , this
includes Derbyshire County Council , MH trust and a large
independent sector provider.
Research has demonstrated nationally that whilst planning is
happening that it tends to be in pockets but is not spreading at the
rate that it was originally intended. Equity remains a major
challenge with people with more complex needs and those
experiencing mental ill health are often not deriving the same
benefit of opportunities to be supported to plan.
Since the publication of Valuing People nationally thinking has
moved away from developing person centred planning for all
towards the use of person centred information and person centred
reviews as a first step a way of promoting the wider development
of person centred approaches for a greater number of people and
the introduction of wider scale change within organisations.
Planning for transition
All areas are addressing planning at the transition stage ,
predominately through the use of PC reviews, with varying levels
of success. There is increasing recognition of the need for
investment in supporting planning at an earlier stage and four
areas have decided resource in children’s services focused
primarily on transition.
In Nottingham City and Nottinghamshire the work is being driven
by Connexions with Educational psychology frequently using MAP
and PATH. Within Nottinghamshire and Leicestershire year 9
reviews are well established and there is increasing use of year 10
citizenship reviews.
Three areas are working with schools to develop local
implementation strategies. In Leicestershire all special schools are
now signed up to PC reviews and in Leicester City Westgate
school is looking at adapting their curriculum to support planning at
an earlier age.
Despite the requirement in Valuing People to support all young
people in transition to have a person centred plan progress has
been slow in some areas, common challenges still remain in the
engagement of schools within the process, particularly where
young people are within mainstream schools and the lack of
engagement of children’s services at a more strategic level.
Types of planning
Most areas are supporting people to use the full range of planning
tools including person centred thinking tools, MAP, PATH ,ELP
and One Page Profiles. In some Person Centred reviews are being
extended to adult services and are being actively being used for
people accessing day services. All people in Nottinghamshire
accessing day services have had this type of review.
Leicestershire are piloting these with their review teams and Derby
City are using for all adults currently accessing services.
The further development of person centred reviews within adult
services are seen as a key way of widening peoples access to
person centred approaches and a key step towards indentifying
what is important to the person both now and for their future.
Training
All areas offer a regular training programme including Person
centred thinking and a range of tools e.g MAP/ PATH/ ELP either
directly delivered or commissioned. Most areas now offer PC
review training and 4 areas offer courses in person centred risk. A
key area of development has been an increased move towards
bespoke training that is designed and targeted at the audience,
this is particularly valuable when working with teams and services
where time is a key factor.
The co-ordinators have a long established relationship supporting
each other across boundaries to co train where required this has
ensured that training is a particular strength in the region as there
are people who can deliver most of the majority of the training that
will be required which reduces the reliance on costly external
facilitation. In all except two areas people with learning disabilities
are involved in delivering many of the training programmes, though
paying people is still an issue, Nottinghamshire have set up to
community interest company to address this . There is little
involvement of carers in delivery of training with only Leicestershire
currently reporting this as common place.
Most areas have some parts of their programme as mandatory
training for staff within the Local Authorities, in Nottingham City all
managers have been through Person Centred Thinking training
and as part of the Good to Great programme Derbyshire MH trust
ensures that all its staff have both person centred thinking and
person centred risk training. All except one area operates an open
training policy and will train people from other local organisations
at no cost .
In the majority of areas the training is still delivered directly by the
co-ordinators and their teams. There is little evidence of training
needs analysis or links to workforce development, these needs to
be addressed as part of the strategy development.
Information to people with learning disabilities and families
The region has its own PCP website www.empcp.org which is
maintained by Leicester City on behalf of the group. It contains lots
of information but people have to know its there and have access
to the internet. Most areas supplement this with dedicated pages
on their LDPB websites.
Four areas have produced DVD’s , the Leicester and
Leicestershire Lets Plan Together which incorporates Health
Action Plans, Communications Passports and PCP is available in
a variety of community languages. A number of other areas have a
range of leaflets and promote PCA through local events,
Leicestershire is working with the library service to develop
information to be distributed through their local resources.
Whilst areas are reporting that information is available this needs
to be tested with people with learning disabilities and their families
to ensure that information is being shared in their area.
Nationally it is recognised that people with learning disabilities and
their families play a key role not only in developing their own plans
but offering leadership to others who want to plan so access to
good quality information and training is key.
Audit, Quantity and Quality of plans
Most areas have either done some work in this area or are
currently looking at this but all have recognised it is an area for
development. Most are using or looking at recognised audit
models developed by Helen Sanderson Associates or National
Development Team . Leicester City has developed a local system
that is being implemented in residential services by people with
learning disabilities employed in the team. Northamptonshire is
carrying out an audit of plans within day services and
Leicestershire are piloting with adult social care providers. Good to
Great does involve a quality audit process for the providers that
are part of the programme which is being followed in Derby.
There is no consistent performance information though some
areas keep a variety of databases of information on one page
profiles , training and active plans.
Whilst it is widely recognised that purely counting the number of
plans can be counter productive unless it is linked to a clear quality
auditing process, there needs to be some way of quantifying
progress connected alongside a process for checking the quality of
the plans or processes like person centred reviews that are being
used.
Links to Personalisation Teams
All areas are now looking at offering personal or individual budgets
to people with learning disabilities but this is at different stages
across the region. All except two of the person centred planning
co-ordinators, Nottingham City and Northamptonshire, reported
that the links between the teams are not well developed and this
was echoed by the regional PCP network . Rutland and Derby
City are planning to offer individual budgets to all new people in
the near future.
Person centred thinking and information is the key to developing
the personalisation agenda and links between the teams needs to
be developed.
Organisational capacity
Whilst there has been a lot of progress across the region since
2001, there are some key organisational issues that are hampering
further development. As part of the review this was considered
over 3 main areas- Leadership, Support and Commissioning/
Contracting.
Leadership- All except 3 areas still have implementation groups
though not all are meeting regularly or has an agreed current work
programme. The PCP champions role on LDPB’s are held by a
variety of people including the co-ordinators themselves in some
areas and a family carer in one area, this isn’t really in line with
original thinking and could be contributory factor where teams are
struggling with impact at a senior level.
Whilst some co-ordinators reported they did have senior
management support others weren’t sure where they could
successfully take issues for resolution.
Another key feature of leadership is the embedding of PCA/
Thinking within the organisation, as a good 2 great site Derby city
has progressed this but other areas are struggling. Apart from
Derby City only Leicestershire reported PCA as a part of appraisal
and supervision practice and this wasn’t across the whole service.
Rutland have developed their job descriptions to include PC
practice.
Northamptonshire have tried to address leadership in provider
services through only offering training to organisations once their
senior managers have attended but this has only applied to
independent sector.
A common theme seems to be lack of links back to the local
LDPB’s , this is primarily due to the way agendas are structured
but it is a part of leadership that could assist with problem solving
and addressing organisational cultural change. Some coordinators are board members but the majority are not.
The most recent national research on the impact of person centred
planning highlighted lack of leadership as key to the reason that
planning has not be as widespread as it was originally envisaged
in Valuing People. Improving local leadership and embedding
person centred approaches needs to be a key part of the emerging
local strategies.
Support to Facilitators and Co-ordinators
Areas have different approaches to supporting their trained
facilitators, in some areas they offer one to one support via either
the co –ordinator or a member of their team, eg in Leicester City
the co-ordinator does follow up one to one session with all newly
trained people , some areas like Derby City bring together their
champions or trained staff in group sessions, Nottinghamshire
offer coaching and mentoring as part of their person centred team
work. . One area just responded to individual request for support.
Nationally it has been recognised that training is not enough,
trained facilitators need ongoing support and guidance to help
them to develop and expand their skills.
The Co-ordinators have established their own regional community
of practice which provides them with the opportunity to share good
practice and discuss challenges . This group works well and is
valued by its membership. This model has been replicated by
children’s workers though this network is still under development
and securing representation from all localities.
The Regional PCP network has been running for over 7 years , its
membership includes the co-ordinators , LDPB leads and self
advocate and family representation. Over the last few years this
group has organised and run a successful regional event, but
recently attendance has dropped off and this seems to be primarily
as it doesn’t have a clear focus or workplan, which has led to
people prioritising their time elsewhere. Bringing together the
personalisation leads with the network seems positive way
forward to build on the existing good practice, develop the much
needed links and identify priorities for the future action.
Commissioning and contracting
The majority of services are now provided by external partners yet
in the past PCA had not been seen as a key part of the contractual
requirements. Most areas have now made links with their
contracting sections and increasingly PCA is being built into the
specifications of new contracts with contract monitoring officers
and CM staff are part of the auditing process. Whilst this is a
positive move the effectiveness of this approach will need to be
tested as part of the quality audit system.
A major challenge that remains is the link between outcomes of
PC reviews and individual plans into strategic commissioning. In
recent national consultation this has been highlighted as a source
of frustration by many families that have been involved in planning
as the actions identified in plans where not being delivered primary
as the right kinds of supports were not available. Both Nottingham
City and County have just started to how to link the outcomes of
PC reviews into the commissioning process and this has been
identified as an area for development by other localities.
In summary
Overall whilst as expected there is a need for major change and
improvement, the East Midlands has made significant progress
over the last few years , in the main the challenges are recognised
and being addressed and the Region is well placed to meet the
vision of transformation in Valuing People Now of using person
centred approaches to deliver improved outcomes for people with
learning disabilities and their families.
Recommended Local Actions
Local areas to :
1. Addresses the development of their local strategy in
partnership with key stakeholders taking account of the key
issues highlighted in this report alongside local priorities.
Plans should include a clear implementation and
development plan including locally agreed targets and
monitoring arrangements
2. Review its investment in dedicated resources against the
revised delivery plans and focus skilled specialist facilitator
action on coaching and mentoring others
3. Consider how they will prioritise local resources taking
account of national and local priority groups to fit with the
vision of including everyone.
4. Ensure that PCP teams are closely linked with the teams
working on the personalisation agenda to ensure that both
the best use of resources and improved outcomes for people
with learning disabilities and their families.
5. Build their commissioning strategies based on good person
centred information gained from individual plans and reviews
.
6. Address transition, and preferably the wider introduction of
PCA into children’s services, as part of the local
implementation strategy and to secure support and sign up
from children’s services through the local children’s
partnership arrangements
7. To develop training plans based on accurate training needs
analysis to ensure that training offered matches local need
and any areas of under or over provision can be identified.
This needs to feed into the local and regional workforce
plans
8. Extend the use of PC review and promoting the use of
person centred tools to develop one page profiles for all
these individuals in receipt of support from adult services
9. To address information, promotion and communication as
part of their local strategy
Priorities for regional action
At a recent away day the Co –ordinators identified their key
priorities for region development and action as:
 Developing audit processes that ensure quality
 Strengthening links with self directed support
 Improving leadership
 Developing their local plans
 Individual planning outcomes feeding into strategic
commissioning