The Reality of 1-to-1 Care: What It Really Means for People

with Nik Jones, Business Development Manager with CareCubed

CareCubed’s mission is to build a successful and imaginative company that delivers innovative solutions that advance and improve the social care sector. This is why the CareCubed team is made up of experienced individuals who know the heart of the sector.

Nik Jones has worked in health and social care for over 25 years, with just under 20 years as a Registered Manager across a range of care homes. The experience he gained from working on the front lines of the sector has been translated into data and insight to help understand how CareCubed can best serve providers and commissioners alike.

The 1-to-1 debate

There is an ongoing debate in health and social care about the role of 1-to-1 support.

On one side, 1-to-1 can be essential. For some people, it provides the additional support they need to meet personal care needs, access the community, pursue individual goals, and live with greater choice and independence.

On the other side, there is growing concern that 1-to-1 support is sometimes overapplied, particularly where it becomes the default rather than a carefully assessed intervention. In some settings, high levels of 1-to-1 may not always deliver better outcomes. In certain circumstances, they may limit the opportunities for independence, social connection and confidence building.

Neither perspective is incorrect. The challenge is to move beyond binary debates and ask a more powerful question: ‘What model of support is most likely to achieve the outcomes for this person, in this setting, currently?’

The Value of 1-to-1 Support

There are many circumstances where 1-to-1 support can be highly beneficial and, in some cases, necessary or critical.

For those who have specific personal care, mobility, behavioural, communication or social needs, 1-to-1 support can act as a key to being able to participate in daily life more fully. 1-to-1 support can enable people to complete their functional day-to-day tasks, attend college or day opportunities, build routines, access the community, and work towards their personal aspirations.

At best, 1-to-1 support is not only supervision. It can offer enablement, helping a person to make choices, develop skills and improve their quality of life.

This is important in settings where the support is constructed around individual activity and outcomes. This could include colleges, resource centres and community groups. In these cases, 1-to-1 support can help ensure that people are not limited by the preferences, pace or needs of others.

In these instances, 1-to-1 can be a proportionate and person-centred approach. It can open opportunities that may otherwise be unavailable to individuals.

The Challenges of 1-to-1 Care

While 1-to-1 care can be appropriate for some people, it is not always the most effective or proportionate model for everyone.

In some residential care settings, 1-to-1 support can become intensive. In these cases, a person can be accompanied throughout much of the day. While this may be in place with good intentions, it can sometimes have unintended consequences. It can reduce the opportunities for natural social interactions and increase dependency on a support worker, limiting the development of confidence.

There can also be situations in which 1-to-1 support is present but is not actively enabling. This could be a person being accompanied in the community, but the support worker may not be actively engaged with the individual in their care, with limited interaction or purposeful engagement. Where this is the case, the provision is in place, but the outcomes for the individual may not reflect the purpose.

This is where the debate around 1-to-1 becomes more nuanced. The question around 1-to-1 is not simply whether it is being commissioned, but whether it is being delivered in a way that drives meaningful outcomes and enhances quality of life and opportunity.

The Role of Shared Support and Core Staffing

A more balanced approach requires a closer look at core support within a service.
In some residential settings, every individual may have 1-to-1 support allocated, resulting in a high number of staff in the home at any one time. There will be circumstances where this is justified. However, there may also be scope to meet need more effectively through a stronger core support model.

Enhanced core staffing can sometimes provide greater consistency, familiarity, and flexibility. Instead of intermittent 1-to-1 hours attached to specific tasks, a stronger core team may offer a more stable presence across the service. This supports safeguarding, personal care, routines, wellbeing, and responsive support, while also allowing people to interact more naturally with staff and peers.

Shared support can also be beneficial in the right circumstances. For some individuals, being supported alongside another person may create opportunities for communication, social connection, and confidence-building. It may encourage support workers to engage more actively with the people they are supporting, rather than defaulting to passive supervision.

This does not mean shared care is always better. It means it should be considered as part of a wider assessment of needs, outcomes, risks, strengths, and aspirations.

Changing Perspectives

My own view on 1-to-1 support has become more balanced over time. I previously advocated strongly for 1-to-1 provision where shared arrangements risked limiting a person’s ability to pursue their own interests, make choices, or work towards specific outcomes. That position was based on real practice and remains valid in many settings. However, 1-to-1 is not automatically the most person-centred option in every context. In some circumstances, stronger core support provides more consistency and delivers improved person-centred outcomes.

The key is not to view 1-to-1 support as either right or wrong. It is to assess when it adds value, when it may unintentionally restrict development, and when a more flexible support model may improve quality of life.

Balanced 1-to-1

The use of 1-to-1 support should be considered on a case-by-case basis. Any review of 1-to-1 across the sector needs to avoid blanket application or reductions. Removing support without understanding the need can create risks. On the other hand, maintaining high levels of 1-to-1 without reviewing the delivery, purpose and outcomes may not always serve individuals well.

A balanced approach means that we need to ask practical, person-centred questions, such as:

• What are a person’s needs, goals, and strengths?
• What outcomes should the support achieve?
• Is 1-to-1 required for safety, communication, access to community, personal care or behavioural support?
• Could the same or better outcomes be achieved through enhancing the core staffing?
• Would shared support promote social connection, confidence and independence?
• If 1-to-1 is needed currently, is there a plan to review if it can be safely reduced over time?

Asking these questions keeps the focus on the needs and outcomes of the individual.

CareCubed & 1-to-1

The 1-to-1 debate is challenging, and it comes at a time of many challenges for providers and commissioners. CareCubed is happy to provide support with the Cost of Care tool and Brokerage tools to help commissioners and providers find the right level of care for those who need it.

CareCubed can help both teams work together to explore need, provision, staffing and outcomes in a structured, transparent way. This can support case discussions and clearer commissioning decisions with needs-based support planning.

Contact us to find out how CareCubed can help your organisation right-size 1-to-1 provisions and encourage discussions around complex needs and person-centred care in your communities.