by Jeff Jerome
Marrying resources and clients' needs is the big challenge facing councils, so we should embrace the Resource Allocation System.
Personalisation in social services has picked up speed in the past year - with the individual budget pilots completing their work and 10 other local authorities joining the In Control 'total transformation' programme. Experience of allocating service users their own cash lies in direct payments and indeed much of what is being piloted now is quite do-able. But the self directed support initiatives involve the cash value of individual budgets being derived from an agreed resource allocation system.
General experience from the 25+ councils working with a resource allocation system suggests that it moves them quickly to thinking about resource allocation solely on a cash value basis, linked to an individual's need rather than to existing service delivery arrangements such as units of home care.
So making social care resources transparent has raised a number of challenges, and the burgeoning interest in main-streaming SDS has opened up thinking around whole system change in process and resource delivery. The council's involved are already talking of how big the task is.
Greater effect
If SDS is more efficient, it will allow councils to use their available resources to greater effect, or to achieve savings. Several council's hope to address eligibility concerns through using a RAS, but getting individual budget values right is difficult. Most of the pilot sites have been repeatedly refining their RAS to create realistic budgets for the individuals involved, and to try to reconcile this to available resources.
Setting costs for existing services is proving challenging, as is the impact of charging and its net effect on individual budget allocations. Addressing such issues quickly focuses attention on the need to ensure that both self-funders and those receiving full or partial public funding can buy care and support services on a more level playing field.
The councils of Essex and Richmond, quite different in size and type, are moving towards a fully self-directed system over the next few years. In Richmond the 'live' process started a few weeks ago, and in Essex it will commence next year. Like the other councils involved, both are addressing the scale of transformation required: staff roles and culture must change, markets must develop to offer real choice, risk must be managed, brokerage and information services must be improved, in-house and block contracts must be de-constructed and all the stakeholders must be fully engaged.
The immediate challenge is to get the RAS right: if too little money is allocated then individual needs cannot be met too much and the system will collapse. But the challenges are worth it, as the changes offer the prospect of real choice and greater control for people needing ongoing support.
Jeff Jerome is director of social services and housing at the London Borough of Richmond
This article, written over a year ago, states that 'all the stakeholders must be fully engaged' when it comes to SDS service design.
A year and a half later, mental health service users have still not been even partially, let alone fully engaged in the London borough of Richmond. The SDS programme is being designed with the bare minimum of user consultation, despite the rhetoric. Various user groups have tried to get involved and found that this is very much a closed shop.
Not consulting properly with the people using services to find out what kind of services they want can only lead to poor services I am afraid. It goes against the whole ethic of In Control, which is about giving people control of their recovery. I can only hope that the rest of the country do not use Richmond as their model, because its foundation is well shakey. A product designed without researching its market is something that no Council should be doing.
Yes resources are limited, but this should not be a reason to exclude users from service design. It is precisely because resources are limited that it is important to engage with users to find out what they want and need.
Service users are the most important stakeholders. Any Council that does not fully engage with them will end up with a watered-down form of SDS that is only a shadow of what it was supposed to be and achieve.
Kaarina Elisabeth
Richmond-upon-Thames Mental Health Joint Commissioning Group.