Shift to individualised care must not be smokescreen for cost cuts

The government has promised better quality services at lower cost by moving to individualised care for people with learning difficulties. Maria Ahmed reports

A move from commissioning traditional services to providing individualised care could help alleviate a funding crisis in learning difficulties services, a recent Department of Health paper has suggested (Commissioning to solve funding crisis, 16 February).

DH agency the Care Services Improvement Partnership proposes a three-year plan to develop individualised services that, it claims, could save struggling councils “millions” of pounds a year.

It follows a report by the Association of Directors of Social Services last year (news, page 8, 20 October) warning that learning difficulties services faced the highest spending pressure in adult social care, due to increased demand.

The CSIP paper describes a project to help councils achieve spending reductions while producing better outcomes for individuals. The cornerstone is training for service commissioners, tools to forecast demand, and a support team for councils.

It suggests the project’s central costs would be funded through money from CSIP- which would provide around £50,000 over three years – and the DH’s care services efficiency delivery programme, set up to implement the efficiency review in adult social care.

It predicts that a “modest” target of reducing growth in spending by 3 per cent a year at 50 participating councils could yield savings of about £35m a year overall.

Councils would pay a yearly subscription of £5,000 a year and would be asked to find additional external funding sources.

Social services directors and campaigners have welcomed the proposal as a sign that the issue of the huge spending pressures on learning difficulties services is on the DH’s radar.

But they also warn against accepting the assumption that letting people direct their own care, for instance through individual budgets, will be less expensive than traditional council-commissioned services.

John Dixon, director of adult social services at West Sussex Council and co-chair of the ADSS disabilities committee, says he is “cautious” about the proposal’s assumption that self-directed support will cost less.

However, it receives some support from the experience of the In Control pilot in West Sussex, part of a project set up by Mencap, councils and the government’s Valuing People Support Team, now part of the CSIP.

In Control is testing individualised care packages and focuses mainly on people with learning difficulties.

“Our early indications are that people are getting services for the same cost as before or less, but with substantially improved quality of care,” Dixon says.

Martin Routledge, lead on self-directed support at CSIP, says there is a “dearth of research on what’s possible”. He says the government will have to wait on the progress of In Control and the 13 individual budget pilots to conclusively test this assumption.

“There are initial findings that individualised support is less expensive and better quality than traditional services, but there is a need for a rigorous evidence base.”

There are also concerns that the proposal could be seen as a cost-cutting measure that does not result in better services. Jo Williams, chief executive of Mencap, says: “We would be concerned if models like In Control were used as a smokescreen for a cost-cutting programme, when their true aim is to help people be more in control of their lives.”

Margaret Goldie, the ADSS lead on learning difficulties, does not think that the proposal could lead to cost-cutting. “Where there are savings, money should not disappear into a black hole. It should free up resources for care for others,” she says. She warns that the government “cannot get away” from the rising numbers of people with learning difficulties in the population – something the CSIP proposal fails to mention.

Dixon agrees. “This will not alter the effect of the overriding population pressure that has led to rising demand for services. We are seeing more people born with learning difficulties who are surviving into adulthood and more people who are surviving into old age who are increasingly dependent.”