We need to know what works in personalising services

Personalisation is widely championed but more rigorous evidence would identify the most effective approaches.

[W]hen Miasha was struggling to attend health appointments, she got a standard response: Community Transport would pick her up. But that solution didn’t work because of deeper issues. So, instead, Poppy, a connector, built a relationship with Miasha, helping her to gain confidence to do daily tasks, leave the house and take public transport. That’s now working well and Miasha attends her appointments.

The relationship with Poppy has been different from the many previous professional interventions that Miasha found unsuccessful, explains Martin Walker, policy advisor for Think Local Act Personal. TLAP pioneers new approaches to personalised support.

Martin describes how Miasha has found Poppy to be very understanding, pushing her when she needs to be pushed. It has led Miasha to feel a responsibility for making changes in her life which she didn’t feel previously with other professionals.

As a result, Miasha’s mind-set has changed about getting the bus, going to the shops, feeling confident enough to use the cooker and being motivated to clean the house. “I want other people to do everything for me – you won’t do that,” Miasha explains to Poppy, who responds: “We share our lives. We are invested in each other.”

Personalisation is based on relationships

This is just one of many people’s stories transformed by a new approach that is rooted in understanding relationships, two-way conversations and a personalisation of support that builds on people’s strengths. With this approach, a person in need is regarded not as a problem but as a potential solution. As an evaluator, I’m trying to find ways to develop robust evidence showing which models of personalisation work well and in which contexts.

Personalisation, almost because of its very nature, is hard to evaluate and is not easily subject to traditional scientific evaluation methods. So, although an increasing number of government departments are champions of personalisation, both in social care and beyond, there is limited formal evaluation of specific interventions and very little evaluation of change at a system level. There tend, instead, to be mostly small-scale, qualitative, case study evaluations which offer inspirational stories without providing a basis for broader generalisations about how effective personalisation can be.

“Small-scale, qualitative evaluations offer inspirational stories without supporting broader generalisations.”

Case for better evidence

Developing the evidence base is important because there are lots of different ways to design personalisation. Some models focus on personal budgets, while others are more asset-based, community approaches. This lack of evidence makes it difficult to determine whether some models are more effective than others. At national level, social care is considered to be underfunded and likely to be reformed. Cost effectiveness data will be vital if a case is to be made for more personalisation to be part of any reform or new funding regime.

I am spending my Chancellor’s Fellowship working with Think Local Act Personal (TLAP). As part of the Fellowship I have been looking at innovations at a number of sites to better understand the challenges to building a stronger evidence-base. These are a few of the many places where organisations, services or commissioning are being reoriented towards more personalised ways of working. A good example is the Wiltshire Centre for Independent Living, where Miasha has been coached and supported by Poppy in pursuit of her goals.

How personalisation works

The centre supports adults with social care needs, using a strengths-based approach. It has set aside the traditional service model that typically involves lots of formal assessment and bureaucracy. Instead, the centre has just two or three questions which boil down to: what does a good life look like to you; what assets and strengths do you have to achieve that life; what else would you need?

There is an onus on working with a person, helping them to achieve what they want, rather than operating in a formulaic way where services are offered such as filling in housing applications or help with washing and cooking. This form of personalisation can involve challenging conversations – it’s about co-production, working together, not about supplying services that fulfil a wish list.

The process of making these interventions is as important as the outcomes, because an important goal is to build resilience and living skills that can help people to improve their lives. A service might work intensively at first with a person and then, as they become stronger, it may draw back. This contrasts with traditional service delivery where a person might have their basic needs met over the long term, but might not feel that their life is necessarily getting any better.

I’m also looking at innovations in commissioning – Hammersmith and Fulham council in west London have changed the way they commission and deliver services related to disability. Co-creation is at the heart of their strategy: they have involved people with disabilities not only in developing the strategy, they have also specifically recruited among disabled people to fill key council posts that govern services.

“We should develop a ‘What Works’ centre for personalisation, a clearing house for evidence.”

Developing evaluation

Intelligent, mixed method evaluations are needed to capture and quantify key outcomes. A challenge is to define specific outcomes. In Miasha’s case, for example, feeling able to leave the house is important. But this is underpinned by broader outcomes, such as improved wellbeing and confidence that are more applicable and comparable across a whole range of different interventions.

That’s important because personalisation is being tried in a number of sectors beyond social care. For example, I am involved in Co-creation of Service Innovation in Europe (COSIE), a major programme which is looking at personalisation in the criminal justice system. It is believed that a more collaborative relationship between offenders and probation officers may reduce crime. We have found, for example, that giving offenders discretion to spend a small “empowering fund” is helpful. One offender, reluctant to attend a college course because he feared standing out among other students, used it to pay for a textbook and laptop, so he looked just like everyone else.

Influencing the personalisation debate

More immediately, for my Chancellor’s Fellowship, I aim to bolster TLAP’s capacity to influence not only the sector but also national policy debate about personalisation. I’ve chosen TLAP because it includes representatives from across the social care sector, from small local groups to the National Institute for Clinical Excellence (NICE).

The tools I am developing are, first, broad guidance on how to embed evaluation and evidence in the sector, setting out what outcomes might be measured and how commissioners might evaluate services. Second, with colleagues, I am compiling and articulating clearly the existing evidence on key aspects of personalisation, notably personal budgets, coproduction and strength- or asset-based approaches.

Crucial questions for study

There are many questions to resolve about personalisation. There is increasing interest in the asset-based community model, partly because the NHS Long Term Plan (LTP) emphasises it and supports more social prescribing. But evaluations have been limited, small scale and usually qualitative.

We also need to understand better the changing skill sets that may be needed by a shift towards personalisation that may require strong professional identities, as practitioners work less off a menu of services and focus more on co-producing more with users. We also need to understand how technology can help – remote communication can replace face to face meeting sometimes and technology can be helpful in managing personal budgets and helping people to access local resources.

I hope that my Chancellor’s Fellowship will lay foundations for building a long-term institutional relationship with TLAP, drawing in colleagues from across the University who are thinking about different aspects of personalisation and place-based research, so the University as well as the Policy Evaluation Research Unit, within which I am based, nurtures a close relationship between research and policy.

I believe that the next step should be development of a “What Works” centre for personalisation, a clearing house for evidence, like the centre recently created for children’s social care. Ideally, this additional centre would not only review evidence but also commission new research to fill gaps in the evidence base. That would create general agreement on the nature of the evidence, making debate within the sector much more fruitful.

Chris Fox is Professor of Evaluation and Policy Analysis at Manchester Metropolitan University where he is Director of the Policy Evaluation and Research Unit (PERU). He is also a co-founder and co-lead of MetroPolis, the University’s think tank on developing public services, cities and a caring society.