There is a divide over how to deliver external support in the move to personalisation, but both sides are more given to evangelising than offering evidence, says Melanie Henwood
Title: Choice and Control: The training and accreditation of independent support brokers
Author: Steve Dowson, National Development Team
Title: Co-production. A Manifesto for growing the core economy
Authors: Lucie Stephens, Josh Ryan-Collins and David Boyle, New Economics Foundation
The report from the National Development Team (NDT) is a discussion paper aimed at assisting the development of national policy for the training and accreditation of independent support brokers. It builds on earlier work at the NDT addressing the “why, what and how” of brokerage.
In addition, a paper from the New Economics Foundation (NEF) explores the concept of co-production and presents “a manifesto for growing the core economy”. Both papers highlight some areas of tension and possible contradiction between the respective proponents of self-directed support and personalisation.
Neither of these reports is a conventional piece of research. In the case of the NDT document, the process involved discussions with key stakeholders who were developing or receiving individual budgets, and/or contributing to the national debate on them. The NEF document does not appear to be grounded in any such participative approach but offers a clarion call to “make this revolution happen”.
It is evident that the understanding of brokerage as part of the personalisation of social care is moving apace. The 2007 report from the NDT highlighted the original position adopted by In Control that it was preferable for people using self-directed support to be responsible for developing their plans and organising the support they required with help from family and friends if necessary, while outside help – including from paid workers or brokers – remained “the option of last resort”.
The NDT went on to acknowledge a softening of this early position and now recognises paid brokers as one of various legitimate sources of support.
The Choice and Control paper comments that papers exploring brokerage tend to simply list rather than evaluate options. However, the interim report from the Individual Budgets Evaluation Network (IBSEN), and the evaluation of In Control’s second phase have both identified the importance of support from outside a service user’s own caring networks. The NDT document criticises the Department of Health’s neutrality on the subject.
Drawing on the wider research – particularly from North America – Dowson highlights the evidence from at least 40 projects that have implemented comparable versions of individualised funding (IF), with opinion leaning “strongly towards the view that brokers (or independent planning support) are an important and perhaps essential element of effective IF systems”. Dowson argues that this evidence has been questioned in the UK and has had little impact on policy.
Indeed, he adds: “Firm evidence that demonstrates the particular benefits of the independent support broker is not available in the UK, and would be difficult to gather while the number of support brokers who are active in England is so small, and the role so poorly defined.”
On the basis of this lack of clarity, the NDT set out to develop a clearer understanding of the independent support broker’s role and its place in the social care system. Seminars, discussions and interviews undertaken for the project did not lead to a consensus view. But these processes did identify a number of characteristics of the role whereby the broker:
- Is independent.
- Has good working relationships with social workers and support providers.
- Is professional in approach in terms of efficiency, honesty and accountability.
- Is not “professional” in the worst respects of being remote, impersonal or self-serving.
- Assists in support planning and brokerage up to the point of implementing the plan, and no further.
- Is available and equipped to act as a person’s agent, within a relationship in which the broker is accountable to the individual.
- Offers assistance on the basis that it is a paid service delivered to a customer.
If these are the requirements of the role, what knowledge, skills and training are required by independent brokers? The NDT project explored this and highlighted the caution expressed by many who saw training “as a process that turns out people who are ‘professional’ in all the wrong ways”.
While recognising that some training may be required – such as around values and interpersonal skills – the project identified concern that the more extensive the training “the more it will imply that the tasks of brokerage are beyond the reach of ‘ordinary’ people”.
Regulation and accreditation
Whether and how brokers should be regulated is a further issue to be addressed. Interviews undertaken in the NDT project revealed anxieties about the possibility of regulation that could control who can practise as an independent support broker, or what training they should receive.
However, while there was “agreement among a large proportion of people that some form of regulation is necessary”, apparently no one was in favour of regulation through professional routes or by using existing regulatory mechanisms. There was support for disabled people and their carers exercising local regulation. However, this was an option offered to research participants rather than one identified by them.
The NDT conclusion is that some form of regulation is required, to protect individual consumers and to guide the development of independent broker resources. A regulatory framework should extend, it is argued, to training “so that there can be some assurance that people working as independent brokers have the necessary competencies”. However, the evidence for this is far from transparent in the report.
“Co-production” is rapidly entering the lexicon of personalisation vocabulary, but there remains considerable confusion about its meaning and implications.
The NEF draws on a literature and practice that has largely been developed in the US, which defines co-production in terms of neighbourhood-level support systems and reciprocity between individuals, families and communities. The concepts of “time banks” and social capital are central components of this non-market economy. Co-production is not about consultation and participation, so much as encouraging people “to use the human skills and experience they have to help deliver public or voluntary services”.
Within this framework, people are viewed in terms of the assets and capacities they bring rather than being seen as burdens. Peer support networks are the favoured method for transferring knowledge and capabilities, rather than relying on professionals.
At its heart, co-production will: “Reduce or blur the distinction between producers and consumers of services, by reconfiguring the ways in which services are developed and delivered: services can be cost-effective when people get to act in both roles – as providers as well as recipients.”
The NDT paper’s arguments draw on “the views expressed by people who were consulted”. There is little information on who these stakeholders were or if their views are in any way representative. If different people had been involved, would the findings and recommendations have been different?
While the NDT paper offers a contribution to the brokerage debate, the nature – and quality – of the evidence underlying the arguments offered is not evident.
Much the same can be said of the NEF document. In fact, this might have been anticipated from the “manifesto” claim in the title. There is a tension between the emerging experience of personalisation and some of the arguments being advanced about co-production.
In particular, NEF argues that “personal budgets were never intended to cover every aspect of people’s lives, to replace relationships with market transactions by themselves, individual budgets entrench the ineffectiveness of the consumer model of care by encouraging users to ‘buy solutions’ rather than have an active stake in delivering (or ‘producing’) their own solutions.”
In fact, as the NDT points out, within the development of self-directed support there is increasing recognition that there is a role for paid brokerage. NEF argues instead that the preferred route of “genuine co-production” offers mutual support, and that community budgets and arrangements that allow people to pool their budgets “may be a better alternative”.
The NDT notes that the current scale of brokerage development is very small it estimates that there are probably not more than 100 people working as independent brokers in England – although the basis for this calculation is not clear. While a “significant increase” is likely, it is argued that the rate of growth is difficult to predict.
It is concluded that “any system of regulation that is put in place now needs to be appropriate, in complexity and cost, to the small size of the workforce, and reviewed in about three years”.
While it is true that regulation must be proportionate, it can surely be anticipated that brokerage is poised to grow exponentially so designing an approach to regulation that is grounded in the current realities risks becoming rapidly obsolete.
The prospect of widely disparate local approaches to brokerage regulation is one that many people will view with alarm.
At a time when there is uncertainty about the best way forward for personalisation, there is no shortage of people who are evangelical about their particular solution. This is a dangerous path the language of faith is inappropriate in a field which should be evidence-based.
The NEF manifesto reveals no queasiness in identifying named individuals in the UK as part of “a growing band of prophets of co-production”, but it is this proselytising that could discredit the wider objectives of personalisation.
There is a role for mutual support and mobilising community resources within personal budgets, but that should not be pursued as a fundamentalist tenet.
Melanie Henwood is a health and social care consultant. She is a board member of the General Social Care Council board
- Steve Dowson (2007), Independent Support Brokers: The why, what and how, National Development Team.
- HM Government (2007), Putting People First: A shared vision and commitment to the transformation of Adult Social Care.
- HM Government (2008), The Case for Change – Why England needs a new care and support system
Brokerage: There is a lack of agreement on the nature and scope of the role of independent broker. It is argued that they should be independent of the council and of support providers, and should provide a task-focused service based on a customer-contractor relationship to meet the needs of each individual. Brokers should not provide “secondary supports” that people may require after their plans has been implemented.
Regulation and Accreditation: Regulation processes risk over-professionalising brokers. The NDT recommends voluntary inter-linked systems for broker training and accreditation that would allow local variation. Local accreditation bodies in this model would develop in each council area and would be controlled by people who use services and their carers.
Co-production: The future of the “core economy” envisaged by NEF is one in which divisions between professional and client, service provider and service user and between work and volunteering are broken down. Co-production allows public services to build networks and support in the community.
This article is published in the 7 August issue of Community Care under the heading Research Realities: Brokerage and Co-Operation