by Mithran Samuel
Devon Council is currently shaking up its care management function in a reform which promises to both lower the costs of adult social care services and make them more personalised around the user - what the jargon lovers among us may describe as a "win-win".
We have been here before of course. Early results from the In Control pilots - the acme of personalisation - suggested giving users a personal budget could both improve outcomes and lower costs, though a recent evaluation was mute on the subject. But can it really be right that councils can sustainably achieve better services for lower costs?
Controlling costs
Interestingly, Devon went down its route of telephone-based care planning for users with lower-level needs, joint health and social care management for those with higher-level needs, a separate brokerage service and the outsourcing of less complex OT functions in order to control costs. But director David Johnstone is insistent that its guiding light is less cost, but building services around the choices of the user.
A few years ago, the debate around personalisation and efficiency was cast in a different light. When, in 2004, the government announced that it would demand 2.5% annual efficiency savings from councils following the Gershon review, even then social care minister Stephen Ladyman identified a tension between personalisation and efficiency if the latter was achieved through big block contracts or regional commissioning, as was strongly promoted at the time.
Working smartly
Things have moved on since then with efficiency being less associated with large-scale commissioning, and more, as with Devon, with microscopically examining processes - assessment, planning, review, purchasing and contracting etc - and who should perform them - social workers, community care workers or finance staff - and working out how to do things more smartly. There's also recognition that service users - through tailoring their formal care around the other aspects of their life - can, under certain circumstances, do more for less with individual budgets and direct payments than councils can through traditionally purchased services.
However, there are pitfalls in any direct association between efficiency savings and better, more personalised outcomes. One is the cost of supporting users to run their own care, which an Audit Commission report in May 2006 found resulted in direct payments costing councils more than traditional services. Personalised care will not work if corners are cut on support, as user-led organisations such as NCIL have long warned.
Capacity for savings
A second point is that adult social care has already delivered a lot of efficiency savings across the country, raising question marks over its capacity to deliver still more, while also providing better outcomes for users.
There is also a political issue to contend with on social care funding. The Department of Health's line appears to be that existing funds are sufficient for authorities to deliver its personalisation agenda to a growing population of social care users. A more direct link between better outcomes/personalisation and lower costs/efficiency than the evidence allows is a gift to those in Whitehall who are reluctant to provide councils with the resources to tackle massive existing and potential demographic pressures, particularly in the light of the forthcoming green paper.
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