Britain is an ageing society, with healthier lifestyles and medical advances meaning that our older population will continue to grow. Many older people have lived their lives proud of their independence, and they value the control they have over their life choices. For these people it can be a frightening as well as a deeply disempowering experience to find themselves subject to decisions made by others. Some older and disabled people are told which day centre they will attend, who will come into their home to care for them, when and what they will eat, when they can socialise, sleep, bathe or even go to the toilet. In a time of austerity, with cuts to basic local services, it remains vital to meet the wider challenge of ensuring that people using care services preserve their power over what happens to them.
There are two changes already under way that start to address these problems: integration and personalisation. Integration seeks to remove the artificial barriers between services which are preventative or home-based (often commissioned using council funds) and acute services, such as hospital services provided by the NHS. By integrating the preventative with the acute, there is a clearer financial incentive to stop low-level health problems escalating.
Personalisation is an approach that gives the person using care services more control over what care they receive, who provides it, and what they want to achieve with the rest of their life. By giving the individual more control over what is done with the budget allocated for their care, with appropriate professional advice, they are in the driving seat.
Take-up of personal budgets, particularly of those taken as a cash Direct Payment, although growing, is still low, particularly for older people. There are barriers that need to be overcome to extend personalisation more widely, including better advice, guidance and facilitation for the service user and their carers, and a wider range of flexible services to meet new and changing needs.
Integration is a structural change; personalisation is based on empowerment. That principle of empowerment is key to improving a wide range of public services by making them more responsive to the real and self-defined needs of the people who use them. A logical next step for personalised care budgets is to expand its power to influence the market by encouraging the creation of clusters of budget holders. The cluster would be self-defined as far as possible, and would pool the budgets of a number of service users who have something in common that affects the service they want to receive. This might be as simple as living in the same neighbourhood, or it might be a shared ethnic or faith background, type of disability, or care objective.
By pooling their budgets, care users can have greater purchasing power to influence the market to provide appropriate services. If a group of Somali Muslim elders want to receive home care that is sensitive to their specific cultural needs, they may be able to commission such a service through pooling their individual allocations.
For optimum effectiveness, clusters need to be small enough for individual service users to know and care about each other; stable enough to deliver the outcomes required over a sustained period of time; and flexible enough to adapt as needs change or individuals need to move in and out. They require the full engagement of professionals at every stage so that individuals are supported in understanding their problems, agreeing a care plan that addresses their needs, and moving on when necessary.
This will inevitably lead to demands being identified that are not currently being met. As well as influencing existing service providers in the third, public or private sector, councils are well-placed to help develop new start-up enterprises to meet new needs and to provide the necessary oversight. Local authorities have access to office space; back-office systems including HR, IT and finance systems; and legal advice. They can facilitate mentoring from more established service providers, as well as holding budgets on behalf of users that could provide financing to new providers. By bringing these supply-side interventions together, councils can help develop new community-based services including social enterprises to meet changing demand. In some cases, this would also create new employment opportunities in communities experiencing high levels of social exclusion.
Pooling personalised care budgets is a model of mutualising care services so they become more responsive to the needs of the people they serve. If people don’t like the services they are receiving, they can change them. If they want services that don’t exist, they can help create them. This is not a panacea that can magic away the pain of funding cuts, but whatever level of resource is available, we will generate better value for money if public funds are used to deliver outcomes that service users want.
Read RSA’s new pamphlet The New Social Care: Strength based approaches
Steve Reed MP for was elected as member for Croydon North in November 2012, having previously been leader of Lambeth Council
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