Andrew Cozens suggests that current concepts of personalisation do not go far enough in transforming services
December will mark the first anniversary of the publication of Putting People First, intended to guide the transformation of social care. One of the proposed measures of success was evidence of a significant increase in the number of individual budgets held by service users and carers. This is suggested as a proxy for the extent of change in the operating model used by councils to commission and deliver care.
This shift to personalised approaches is not limited to adult social care. It is significant in the future direction of support to children and young people with disabilities, looked-after children, and patients with long-term health conditions. But can individual budgets alone carry the weight of expectation placed on them – are they the magic bullet?
Potentially they are a liberating concept, giving you your share of the public purse to use as you think best to lead a fulfilling life. Individual budgets offer a development on the direct payments model allowing service users the benefits without carrying all the responsibilities and liabilities as a commissioner and employer of personal assistants.
In their current form, though, individual budgets and direct payments are a change to the operating model for social care only. They, alone, will not effect the sort of transformation the system needs to shake off its Poor Law origins.
Rules of the game
They only benefit those in the system already, or those gaining entry under the existing rules of the game. Used crudely, they risk destabilising the workforce and the market to the possible detriment of users and carers.
Putting People First needs wider shifts in how we conceptualise support and care, from its reach and purpose to how we renegotiate the balance of responsibility between the individual, family and the state.
Much of this debate is wrapped up in the issues being considered in the drafting of the promised adult care green paper, but much can be done locally now, whether we get a new funding system or not.
We need a new architecture to surround individual budgets, based on the adoption by local strategic partnerships of key outcomes to promote the independence, life chances and quality of life of older and disabled people as citizens and not just potential service users. More attention is needed to how local partners can sustain a community that cares, as well as one that is prosperous, cohesive and safe.
An undue focus on individual budgets risks polarising debate on social care around “my share” and “my responsibility” – concepts not unfamiliar to Poor Law reform 400 years ago. We need to fix as much as possible for everyone, so that personalised care and support really mean choice and control, rather than just being another way of barely coping.
Andrew Cozens is strategic adviser children, adults and health services, at the Improvement and Development Agency