By Stephen Lowe, policy adviser, Age UK
Visions are not, by their nature, detailed manifestos. The new vision for adult social care is no exception; it sets out values and seven principles, all of which begin with the letter ‘p’, but leaves many of the wicked issues which affect the care system unresolved. There are few surprises. Personalisation will proceed apace, the so-called Big Society features prominently, and councils will be expected to make savings. A multitude of new forms of organisation – mutuals, co-operatives of service users using pooled budgets, worker-led social enterprises and independent social work practices – will take over local authority functions and services.
The main practical significance of the vision is that it is intended to give a steer to the Law Commission review of adult social care law and to the Dilnot Commission review of long-term care funding. Both of these major projects will change the long-term landscape of social care. In particular, the vision contains several clear messages to the Law Commission. The government is willing to consider strengthening safeguarding legislation, as proposed by the commission, and would like legislation that would enable assessments to be carried out independently, either by people themselves, or by user-led or community organisations.
The law should also enable assessments to be more portable so that people moving from one local authority to another will be able to take their assessment with them. The vision also flags up this point as one for the Dilnot Commission, presumably because it will have a bearing on whether or not Dilnot feels that a more nationally based system of assessment is a possible option. People should have a right to have care and support offered as a personal budget or as a direct payment, and the vision is supportive of the Law Commission’s proposal for statutory principles which will underpin the new legislation.
The vision does however pose particular challenges for older people’s services. Direct payments are seen as the ‘preferred way’ of providing a personal budget. But most older people who qualify for local authority support have complex, variable or deteriorating long-term health conditions, so a care package will change over time. A direct payment is therefore harder work. Older people often obtain help following a crisis such as a stay in hospital at which point they may not feel well enough to think about arranging their own care. So whilst some older people will want direct payments many will not, regardless of how much support is offered, so they should not be pressured into having one. Personalisation means that it is the older person’s preference, not the government’s, that should matter.