Personal budgets alone will not make personalisation work for everyone. The commissioning style needs to be overhauled, says Colin Slasberg
Few would disagree with the vision of personalisation through services that are flexible, responsive and support the route to an individual’s independence. However, there is a real risk of that vision being squandered. There needs to be much more debate around the “how” of personalisation, in contrast to the “what”.
We need to challenge the prevailing view that the vision will be delivered primarily through the concept of personal budgets. Personal budgets will work superbly for those people who are able to take their money and purchase a support system outside the mainstream social care market.
However, it is becoming increasingly clear that only a relatively small number of service users have the will and ability to function in this way.
Most are likely to continue to want commissioned, mainstream social care services, so we cannot just build a system that bypasses that. If the personalisation agenda is to be made a reality for everyone, we need to consider what’s needed to transform the mainstream social care market.
The direction will not change without serious debate. We have been here before. The community care reforms of the early 1990s started with a vision that is virtually identical to the current one only the language is slightly different. Where today the keyword is “personalised”, in the late 1980s the key phrase was “tailormade”.
The fact that, just 15 years later, we now have another transformation programme tackling the same challenges, is proof enough that the community care reforms did not work.
I believe a key error in implementing the community care reforms was in shifting the focus too quickly from the “what” of the vision to the “how”. The “how” was more easily measured. Not least, externalisation of services was meant to be a means to create a competitive and person-centred market. It also helped deliver on the other imperative of the day which was the capping of spending on social care.
Councils were very successful in bringing about externalisation. However, no one would now pretend it has led to a realisation of the original vision. It has, though, played a huge part in reducing the price tag of social care as unit costs have virtually halved from what they would have been.
There are two key elements we are at risk of repeating. First, we will once again go for what is measurable and deliverable. The primary indicator of “success” will be the numbers of people with personal budgets. It won’t be hard for councils to find ways to ensure performance is good. But there will be too little regard to what change they are really making for people.
Second, we will continue to fail to understand the true nature of the social care market, and therefore fail to bring about the transformation of provision – the real meaning of personalisation.
So what should happen? Personal budgets should, of course, continue to be developed. They will work well for some and set the gold standard for the rest. However, it will take much more to make personalisation work for everyone. First, the regulatory regime needs to be developed so as to ensure the balance is in favour of genuinely capturing the service user experience. That has to be made the central focus for councils.
Secondly, the government needs to transform mainstream social care provision by building on work that has been carried out in parts of the country. This work has shown how transforming the commissioning style of councils can lead to dramatic transformation of provision – by focusing on outcomes, rather than outputs.
Arguably, the best legacy of the past 15 years has been the development of a plurality of provision. There is now a large pool of organisations brimming with human skills and abilities waiting to be empowered by a new style of commissioning.
Colin Slasberg (pictured) is a social care consultant. His previous role was head of business support at Thurrock Council
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