Personalised social care a step on the road to reform – the danger of hitting the target but missing the point?
The government’s new Vision for Adult Social Care stresses the need to create ‘capable communities and active citizens’, fully embracing the personalisation agenda as the key way to deliver this.
This builds on previous policies such as direct payments (introduced formally in 1996 under a previous Conservative government) and personal budgets (developed since 2003 under New Labour).
At their most simple, personal budgets are nothing more complicated than telling the person upfront how much is available to spend on meeting their needs and allowing them greater choice and control over how this money is spent. This brings a greater sense of entitlement and of financial transparency, enabling the person, their family and/or the worker to be more creative in how they spend scarce resources.
- While many elements of the government’s Vision are to be welcomed, there are three key issues:
Most important of all will be not making the new system more complicated than it needs to be, paying lip-service to new concepts but allowing the old system to recreate itself under the guise of the new language. This means being brave enough to let go and to keep systems simple – so that we don’t regulate the new approach to within an inch of its life and prevent any scope for innovation. Although the new government talks a lot about shifting power, strategy is what you do, not what you write – and the proof will be in the implementation.
- There are serious concerns that local government funding cuts will be too severe to enable local councils to respond positively to this agenda. Although social care received a boost in the recent spending review, this money is not ring-fenced and there is a risk that adult social care suffers just as much of a hit as local government more generally. Moreover, Birmingham’s research suggests that social care costs could double in the next 20 years. While personalisation might allow us to spend scarce money as effectively as possible, this doesn’t make up for the fact that there might not be enough money available in the first place.
- Finally, there is a need to move beyond individual policy measures to change the underlying rationale and culture of services. Although personalisation offers new mechanisms and approaches, its main contribution is to recast users of state welfare away from being passive recipients of pre-purchased services towards a situation where they are active citizens with a right to control and shape their own support.
Underpinning all this is a broader sense that the values and ethos of the welfare state remain too dominated by 1940s thinking and assumptions – that some of the concepts inherent in debates about personalisation could help to shape ongoing debates about the future of welfare reform. If the Beveridge Report is widely credited with establishing the thinking behind the post-war welfare state, then a similar document and process is needed to clarify thinking and options around the relationship between the state and the individual in the 21st century. There is alot in the current Vision to suggest that the Coalition have similar ambitions – but to say it and mean it is one thing – delivering it in practice is another.
Professor of Health and Social Care and Director of the Health Services Management Centre
Read the Birmingham debate on the welfare state at www.birmingham.ac.uk
For further information on the University’s work around personalisation, see: http://www.hsmc.bham.ac.uk/work/personalisation_health_social_care.shtml