The Lib Dem Minister for Care announced this week that from November everyone in receipt of social care will be able to choose to receive an Individual Budget. In short, this means that they can choose to spend the social care money that they are entitled to in ways that they choose – as long as it achieves agreed outcomes. It sounds great – and potentially it represents a life-changing step forward for millions of people.
This is an area I’ve been working in a lot recently – for example on this project in Bradford and this one in Leeds. Our main focus in each project is supporting organisations to set up services which people may choose to buy with their Individual Budget. The big hope is that lots of innovative services will spring up in place of the one-size-fits-all services of the past – day centres and the like.
As we’ve seen elsewhere recently, there’s a lot of faith placed in the market, in competition, and the transformational power of individual choice. It is assumed that the market will develop so that the best services (those for which there is most demand) flourish, whilst those which don’t meet people’s needs disappear. It’s an attractive vision in lots of ways, but I think we all know that markets don’t work quite so perfectly, particularly for those people without much power in the market.
Working with Gill, my business partner at Social Business Brokers, we’ve spent the last few months trying to get behind the rhetoric of Personalisation so that we can start to support people to set up services. I think we’re making some good progress, and I remain hopeful. But I can assure you that when you really start to try to understand Personalisation, it isn’t quite as rosy as it might first appear. Here are some of the issues that I think need to be addressed.
(For clarity’s sake, the points I’m making don’t relate in particular to one local authority – they are issues that we’ve come across in our work and in research into personalisation across the country.)
Anecdotally, we’re hearing that a good majority of people are continuing to receive the same services that they received before – even though they are now statistically classed as having an Individual Budget. It would seem that some local authorities are classifying someone as receiving an Individual Budget if they have been through the social care assessment process. So, in short, that means that their needs have been assessed, nothing has changed in terms of what they receive, but they’re now classed as being in receipt of an Individual Budget. That, to me at least, isn’t right, and presents us with misleading statistics.
It would appear that the majority of the support planning and brokerage work – to help people to agree how they’d like to be supported, and then find appropriate services, is being carried out by social workers. Now I have nothing against social workers, but I would think that there is a link between the point above (that most people are getting what they always got) and this point – that the people who’ve always done the support planning are still doing the support planning. Anecdotally we hear that Individual Budgets are seen as a right pain to administer – and with recruitment freezes and the like you can understand why an overworked social worker might gently encourage a client to stick with what they’ve got – particularly if that lack of change gets hidden in the statistics as I suggested above.
We’re not seeing a great deal of evidence of innovative services setting up. It’s still early days – and I’m sure there are people like us in other parts of the country trying to encourage the development of new services. Much emphasis is being put on third sector services (particularly social enterprises) being set up. But, as you’ll know, times are currently tough for the third sector, and insecurity in terms of funding isn’t providing an environment in which many organisations feel comfortable setting up new, risky, customer-facing services. There is also little funding or investment available to set up new services. And given that, anecdotally at least, most people seem to be sticking with what they’ve got, you can understand why some organisations may make the judgment that the market doesn’t exist for new, innovative services which individuals could purchase.
You can probably see the problem here in terms of market development. Customers can’t be expected to choose services which don’t yet exist – whilst businesses are reluctant to set up services where demand appears weak. It’s a classic chicken and egg situation. Will it be the third sector that drives innovation here? We’re certainly doing what we can in the work that we’re doing – but I think on a broader scale we need to be realistic. Setting up services which individuals can choose (or choose not) to pay for is as big a cultural challenge for the third sector as it is for the public sector. Innovation may come, but it may take time. My hunch is that it will be the private sector which leads on this.
So what do we do about this? At a national level, I hope for some leadership from people such as the Care Minister, to listen carefully to what’s happening, and to try to get beneath the rhetoric and the good stories (people buying season tickets in place of day care etc) to really understand what’s happening on the ground. We need to not be hoodwinked into believing that loads of people have Individual Budgets, when in practice nothing has changed (or improved) for them. And I also think that we need more honesty about the role of social workers in making change happen. Are they best placed to do support planning and brokerage? Or are they best placed to maintain the status quo? I think we need more creative and innovative ways to support people to decide what outcomes they want – and then to help them find the right services.
And, of course, we need a good dose of social entrepreneurship. That doesn’t mean social enterprises will solve it all. But it means that we need enterprising people finding creative ways to create change.
At an event we ran recently, one third sector representative confidently told the room that Personalisation will have been long forgotten by 2020. We’ll be back to State delivery of services, he reckoned. By then we’ll have seen that Personalisation was just a big waste of money and didn’t work. I didn’t agree with his analysis, but I do think that if we don’t up our game a fair bit, he could well turn out to be right.