Personalisation and personal budgets have brought new skills and jobs in social care, including brokerage. But it is unclear what this role involves and who should be doing it. Steve Dowson argues it is best done independently of the local authority rather than by council care managers
A personal budget is just a number until the recipient has gone through a process which translates the money into a set of supports and activities that not only meets their assessed care needs, but does consistently with their goals and lifestyle.
Two terms are often linked to this process and the help provided to assist people with it: “support planning” and “brokerage”. And they are the causes of confusion and controversy – not least because they have implications for the roles, even the jobs, of care managers.
In general, there are four main stages, plus one other area of activity, to this process.
1 A recognition of the person as an individual with hopes, fears, preferences and goals, all of which must shape the final plan. This stage should be driven by effective person-centred planning, though often in a simplified form.
2 Discovering and inventing ways in which the person’s needs and wishes might be met, not just through standard solutions, but informal support, community resources and ordinary answers.
3 Evaluating the risks and benefits of each idea – where necessary gathering more information – to arrive at one detailed and coherent plan which in written form is submitted to the council for approval.
4 Turning the plan into reality, including by agreeing contracts or recruiting staff, and co-ordinating all the plan’s elements.
The other activities, which may continue indefinitely, underpin the primary supports – the hands-on assistance – and so are usefully termed secondary supports. These include support co-ordination and troubleshooting, help with personal assistant recruitment and payroll administration.
In England, support planning is often considered to be geared to delivering a written document – the support plan – and so covers stages one to three. It’s a definition shaped by the needs of the system, not the people needing support. Some councils that have moved staff into support planning have used commissioning or procurement teams to set up the contracts specified in each support plan (stage 4). However, this fracturing of the process seems certain to weaken the personalised nature of the service, and the status of the individual as customer.
What about support brokerage? Some have assumed it deals only with making contracts for support – a subset of stage four. Some bracket it with secondary support; for others it is a catch-all term to cover not only all the stages of planning but also secondary supports. This latter is particularly unsatisfactory because it muddles different kinds of activity and skill.
In fact, support brokerage has long been widely accepted internationally as spanning stages one to four, but not secondary supports. This definition was used by the National Development Team for Inclusion in a project for Skills for Care to define the training needs of brokers.
Not everyone will need help to complete the process. It is absurd and dangerous, however, to assume that everyone can do it on their own. Also, with personal budgets shrinking, it’s all the more important to help people make the best of the money.
So who should help them? It would be convenient if existing care management staff could simply be redeployed, and it appears that many councils have chosen this strategy. But there’s good reason to doubt whether people who are part of a system that also rations public funds, answers to taxpayers and worries about risks to vulnerable people are in the right place to support creative and holistic planning.
That’s not to say council employees will never do a good job, just that it doesn’t make sense to build in a conflict of interest. The planning process starts with a person-centred, community-oriented, creative approach, but needs to deliver system-centred documents – not only the support plan but also specifications for services and staff.
There’s a risk that systems-thinking will yield unimaginative plans that confine people in specialised services. This is far more likely to happen when planning is supported by people embedded in that system.
So who else should provide the support? The answer from government is that it can come from many places: community organisations, user-led organisations, existing advice and information services – and from expanded online sources. However, it’s a mistake to suppose that support planning and brokerage is easy.
Over the past eight years the NDTi has trained scores of people to be independent brokers, including disabled people, family members, former social care workers, and people with no knowledge of social care. All have brought strengths, and all have found it challenging to acquire the necessary baseline skills over a five-day course.
Many people will want and need support from someone of their choosing who comes with an assurance of trustworthiness and competence. This is why councils need to ensure access to independent support brokers, with the necessary systems of training, funding and accreditation.
This does not mean that you should refuse to help someone plan how to use a personal budget because you work for the council. The key is honesty – with them and yourself. Do you have the skills and knowledge that are needed? Is your job and accountability likely to influence the advice you give? Have you the time and commitment to support them through the process? Or can you suggest other, perhaps better, sources of help?
The article above was published on 1 September 2011. In a response, Simon Duffy, director of the Centre for Welfare Reform, argued that there was no need for independent brokers, and that they would be the most expensive way of helping people manage personal budgets. Here is Dowson’s answer to these points:
Independent support brokers don’t come with a guarantee of total independence. That is indeed true of other established professional groups. But as a society we still think it worth striving, for example, to have judges and doctors who are not subjected to major conflicting interests. In the case of support brokers, the primary need is to keep them separate from support providers and from the council. Fee-for-service brokerage systems can be developed which give customers a very real sense that their brokers works for them, and on their terms.
Brokers don’t undermine decision-making opportunities for disabled people. On the contrary, one of the fundamental characteristics of independent brokers – as I have defined, developed and trained them – is that they have no decision-making rights whatsoever. Moreover, brokers work with people in a way that helps them to learn the skills to plan more for themselves next time.
Statements about the comparative cost of brokerage are meaningless without defining terms, and I am sure there is no evidence to support the claim they are ‘the most expensive’ option. Accredited brokerage services that are delivered on a fee-for-service basis are likely to prove very cost efficient, as they avoid bureaucracy and keep fixed overheads to a minimum.
UK policy development on personal budgets has been focused on functional requirements – on the jobs that need to be done. It has neglected the structural considerations about the appropriate people to do the jobs, and how these different ‘actors’ relate to one another. This is convenient, as it avoids difficult issues about power and the need to reconfigure the social care workforce. Social workers don’t need ‘rescripting’ – they need to escape their conflicted care management role. And people who require social care won’t trust the system until they know whether the professional at the door has come to help them, sell them a service, or ration their funding.
It’s true that many people won’t need brokerage help, or will get it from other sources. But to assume that this is enough – ignoring the reality that sometimes planning will be complex, and will need to be followed up with contracts for supports and finding community resources – is dangerous wishful thinking. For the Canadian parents who, three decades ago, defined the individualised funding, independent brokerage was an essential component of the model. Without access to adequate, skilled, and trustworthy planning support, many people will find that a personal budget is just a meaningless number.
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