Striking the right balance between giving people the freedom to choose their own care and protecting clients and their budgets from abuse is a tightrope that every council will walk.
With the launch in 2003 of direct payments and the subsequent individual budgets programme now being piloted in 13 local authorities, personalisation is the likely future of adult social care.
The government further endorsed personalisation last month when health minister Lord Darzi’s 10-year reform plan for the NHS proposed extending personal budgets to health services.
Alongside the contentious debate over what constitutes wise use of personal budgets is the issue of how to safeguard clients against abuse and poor quality services. This is the area that Dwayne Johnson, joint chair of the Adass older people committee, is examining for the forthcoming Adult Social Care Workforce Strategy. He is also part of a working group collecting views on personalisation and safeguarding for the government’s review of the No Secrets guidance to protect vulnerable adults.
“The association strongly supports personalisation and direct payments as a step in the right direction,” he says. “People have much more control and flexibility to make choices and they are not so reliant on social services.”
However, Johnson wants Criminal Records Bureau checks to be mandatory for providers of client-procured services, as they are for council services.
He asks: “If you haven’t got organisational checks and balances, how confident are you that an individual will get the same level of protection? Safeguarding is not just about abuse, but also about making sure that people receive good value for their money. So how confident are you that people will get the same quality of service and that you can measure this?”
Here, Johnson draws on his own experience of implementing direct payments as strategic director of health and community services at Halton Council, Cheshire.
“As we have significantly increased the number of people on direct payments, we have had to ensure they are getting the support they need from the council,” he says.
This has required social workers to undertake a comprehensive risk assessment for each client before they move to direct payments and ensure that they understand how the system works, as well as how they can source support from statutory and non-statutory agencies.
“We do a lot of hand-holding at the beginning,” Johnson says.
For example, this could mean signposting clients to council or voluntary services that will help them with advice on how to manage their budgets and keep their accounts in order.
Direct payment clients are monitored regularly, with three-month follow-ups for everyone and ongoing checks depending on individual need. As a result, Johnson says the council has been able to show that the system works well and clients receive good quality services. The council has also extended the variety of services that clients and carers can choose through closer working with independent and third sector organisations.
Johnson attributes this to the freedom lent to staff to run with the scheme. “We have established a strong culture of empowering individuals to take up direct payments by giving staff the freedom to take more risks. But we had to make sure the policy was robust and that if staff wanted to make changes to how these services were developed we listened to what they had to say.
“Letting staff take more responsibility for offering different types of services allowed them to offer more services to carers – for example, respite care or paying for transport.”
He says the same ethos, checks and balances should be applied to individual budgets if they are given the green light. “Most people are confident that individual budgets will be rolled out,” he says, adding that many councils have already been given reform grants to start establishing the system.
“The parameters will be wider with individual budgets,” he says. “This will require restructuring and recalibrating of some of the admin systems, but then it does free up a lot of public services.”
● Ensure there is a strong culture of personalisation, and that where staff administering and running services have the opportunity to provide services in different ways and can be flexible in their approach.
● Involve elected council members and the public in the personalisation agenda.
● Personalisation means there will be a change in the market. Work with independent and voluntary organisations and make sure they are engaged with the opportunities personalisation will bring.
● Robust safeguarding procedures with regular monitoring of the service is essential. Ensure staff understand the parameters of personalisation.
This article appeared in the 24 July issue of Community Care magazine, under the headline “Empower and protect”