The speedy roll-out of personalisation has not been met with acclaim in all circles. Academic Jon Glasby tackles some of the arguments
The rapid spread of personal budgets has generated a strong response. A review of the progress of self-directed support by the Care Services Improvement Partnership in 2007 described it as “potentially the biggest change to the provision of social care in England in 60 years”.
In the same year, Peter Scourfield, a social work and social policy lecturer, argued that “in the rush to both ‘hollow out’ and contract out the public sector, too many of its functions and responsibilities are being pushed towards the individual”.
Similarly, Iain Ferguson, a senior lecturer in social work at the University of Stirling, has criticised personalisation for its “uncritical acceptance of the marketization of social workits neglect of poverty and inequality; its flawed conception of the people who use social work services;its potentially stigmatising view of welfare dependency; andits potential for promotingthe deprofessionalisation of social work”.
Views from the frontline seem equally divided. A survey of 500 social workers carried out for The Guardian suggests that 70% feel that Putting People First will benefit both users and carers. In contrast, an online survey of 600 social workers for Community Care suggests that only 11% view the plan to extend personalisation to all users as appropriate, with 96% of local authority staff feeling that it would make service users more vulnerable. To date, these very different reactions seem to be influenced by at least four underlying issues.
1 Misunderstanding key concepts
Some concerns seem to rest on a misunderstanding of key concepts. Nationally, some of the main issues have not always been explained well, and there remains widespread confusion. Anecdotally, some people do not seem to know the difference between direct payments and personal budgets (see box above), do not realise that the individual can decide how to receive a personal budget, are unaware of the spectrum of support options available, and do not understand that personal budgets can be spent on current in-house services as well as on other forms of support. While they may have legitimate concerns, some of the more factual issues can be dealt with easily.
2 Not comparing like with like
Many criticisms seem to suggest a higher standard of evidence for new ways of working than for previous approaches. The national Individual Budget Evaluation Network (Ibsen) study produced a detailed overview, which was seen by some as highlighting more limitations than strengths. Given the complexities involved, however, any national evaluation was always likely to find a mix of positives, negatives, enablers and barriers. Indeed, if we carried out a national evaluation of the current system, the result would probably be equally complex, mixed and difficult to interpret. Any national evaluation is also bound to struggle to unpick which barriers are inherent to the concept of individual budgets, and which are more to do with the nature of pilot projects. One letter to The Guardian called for “well-paid, well-trained public sector care workers providing reliable, high-quality services” rather than “fragmented private provision”.
Arguably, this contrasts a wrong understanding of new approaches with an unrealistic verdict on current provision. Such approaches also fail to appreciate the fact that the architects of self-directed support are arguably trying to promote a citizenship model that is different to the more paternalistic ethos of the previous system. The issue is not therefore whether the new approach achieves the same as the old approach, but about whether there is scope to achieve something fundamentally different.
3Attitudes to current services
Linked to this, some commentators contrast a new and emerging system with an idealised version of how current services work. While this could be for a range of reasons, it seems as if some commentators are predisposed to adopt a particular standpoint based not on the emerging evidence, but on their prior attitude to the role of the state and their understanding of the strengths and limitations of the current system.
4 Different views about what constitutes good evidence
Implementing self-directed support is complex. But direct payments and personal budgets have drawn on published research and also on the lived experience of people using services. While this can often be dismissed as anecdotal evidence, viewing it as human testimony changes the nature of the debate and starts to enable different interpretations about what constitutes valid evidence to come to the fore.
Personalisation is here to stay and it was always likely that such fundamental changes would lead to polarised views.
Ultimately, whether you adopt an optimistic or a more cautious interpretation seems to depend in part on your attitude to current services and to how best to draw on evidence of what works in a rapidly evolving policy context; whether you look for evidence that new approaches will work before trying them, or whether you search for evidence of what doesn’t work and try to improve practice by doing and reflecting.
For all the heated debate they have generated, perhaps the positive and negative interpretations of direct payments, personal budgets and self-directed support are not really to do with different models of care and support, but with different approaches to understanding the world and changing it.
Jon Glasby is professor of health and social care and co-director of the Health Services Management Centre, University of Birmingham.
● Direct payments: The individual receives the cash equivalent of a directly provided service. This is available for social care only, and can be used to contract with a private or voluntary sector agency or to become an employer by hiring your own staff – it cannot be used to purchase public sector services.
● Individual/personal budget: This involves being clear with the person from the outset how much money is available to meet their needs, then allowing them maximum choice over how the money is spent and on what. Initially, the individual budgets were for social care funds only. Subsequently, Department of Health pilots began to explore integrating additional funding sources. Current policy uses the term “personal budgets” for adult social care funds only, and “individual budgets” for more integrated sources of funding.
● Self-directed support: Personal budgets are only one of seven steps towards a new system for social care, which In Control has called “self-directed support”.
● In Control: National social enterprise, independent from government, that pioneered and developed the concept of personal budgets for social care funds and is supporting council members to implement this way of working.
This article is published in the 28 May issue of Community Care magazine under the heading A matter of perception?