Challenges in delivering personalised support to people with multiple and complex needs: qualitative study

Personalisation involves placing service users at the centre of service provision to ensure that the support they receive meets their individual needs, hopes and goals. This paper focuses on a programme delivering personalised support to people with multiple and complex needs (‘beneficiaries’). Each beneficiary received a tailored package of support and a £12,000 personal budget. Despite being well-resourced, the programme struggled to recruit and retain beneficiaries. The aim of this paper is to identify the challenges encountered and to share learning. Repeat semi-structured interviews (n = 56) were conducted with beneficiaries, programme workers and external partners. Interviews were audio recorded, transcribed, coded and analysed via Iterative Categorization. Five categories of challenge were identified: 1. poor understanding of the programme; 2. the characteristics and needs of beneficiaries and programme workers; 3. lack of clarity regarding who owned and controlled the budget; 4. strained interprofessional relationships; and 5. excessive bureaucracy combined with difficulties establishing programme outcomes. Findings illustrate how the delivery of person-centred support is compromised by interacting individual, organisational, and system level factors, particularly poor interprofessional collaboration. The data also suggest that personal budgets may undermine personalisation for people with multiple and complex needs.