For anyone who was interested in the "head to head" between myself and Professor Hatton in the Oct 6th issue, I have placed a response to Professor Hatton in the Resouces section of the CareSpace. It is under the name CS. Below is a link to the original article:
http://www.communitycare.co.uk/Articles/29/09/2011/117526/personalisation-are-personal-budgets-improving-outcomes.htm
In summary, I address Professor Hatton's puzzlement about my hostility to the Personal Budget strategy. I set out why I believe his arguments offer further evidence that the strategy as currently constructed, and the belief system that drives it, not only fails to address the real challenges that are required to make personalisation a reality for all, but have diminished the prospects of doing so by diverting attention from them.
Colin Slasberg
A number of people have downloaded the response to Professor Hatton. For those still interested in the thinking, I have downloaded into the Resources section a further short document that addresses two questions - why has the Person Budget strategy failed to improve outcomes, and how can the Personal Budget strategy be modified so that it can still make a positive contribution.
It would be really good to hear people's thoughts and reactions. It really should be possible to raise debate when the evidence is pointing so clearly to current strategy failing.
As a support worker working with people under SDS I have found that it DOES work very well.
But this is only if care coordinators actually know what they are doing and if they have had training as well as the LA actually allowing a budget to be approved. I have heard of several cases of Service users being told no due to the level of support and ammount of funding they require.
The Service users I have worked with have all benefitted from being able to say what they want and how and where they wish to recieve it. Due to the work I and others in my team have done we have been able to increase our service users quality of life and we no longer hear the individual complaining that a drop in or other service tried to make them fit their critiria for a specific group.
Yes I think that personal budgets are the way to go but only if those responsible for them actually try (with some enthusiasm) to coordinate them properly.
JBD - thank you, thats a helpful perspective. Can I ask if you work with both older people and working age people, and if so do you find any difference between them in finding the conditions that make SDS work?
Last year I was on a secondment to a community based SDS service working with 25-68 year olds with Mental Health and physical health issues.
I'm back at my oridginal service working with 16-25 year olds with mental health issues and I have found that the service aimed for young people seem's to be able to get more funding but only if the care coordinators have any understanding of how the framework is meant to be deployed.
On the secondment I worked with the NHS team who were multi disciplinary (with social workers, CPN, Doctors and Psychiatrists) this team had been trained in SDS when it first came out so was well aware and understood how it worked.
They did how ever make mistakes and were very happy to cut hours and not to increase them. At the time this seemed to the casual observer (and some of the service users) that this was due to funding cuts.
Many of the 25-68 year olds did work but only in a voluntary capacity as they could not do regular planned hours at work due to their needs and critiria for basic benefits. Where as some of the 16-25 year olds have part time jobs or are at College/University although none that I am aware of have had problems with getting the budgets.
However one young person has recently moved out of county to go to University and I was shocked by the response of the Care coordinator who wished to and I quote 'wash their hands of them'!!!
From my veiw point I can only assume that not enough training has been given to those who could become care coordinators and I still have not met a GP who has taken this on (and I believe was one of the groups who were supposed to take this onboard).
Personally I feel the big issue with personalisation as a policy model is that the reference to empowerment and other 'best practice' values is merely the hook to catch not the fish but the worm. Policy makers are aware that, rightly or wrongly, without professionals behind a predominantly economic strategy people receiving care will not be enabled to engage through positive and affirmative interactions with care providers and managers. The academic bulldozing of the value base has in some ways hidden the neoliberal nature of the policy but the dichotomy between slavish marketisation and care creates an uneasy dissonance.
Indeed when the ethos of care provision is slowly eroded to the status of a patriarchal concept in order to encourage 'positive risk assessment' and 'independence' one can argue that the concepts are evolving around the reductionist economic polemic of central government. Maybe Jordan was right when stating that social workers have no real fidelity to the ethos of public service and that social workers are predominantly interested in the job security statutory social work offers, because the silence is deafening and could be argued is turning social workers from 'useful idiots' to 'good little social workers', taking a passive yet fundamental role in the asset stripping of social care.What amuses me throughout this whole miserable episode is the careful side stepping of the NHS and Community Care Act 1990 section 47(1)... if so much transparency is created by the use of SDS, RAS, IB and PB why is it not made clear that the local authority has a duty to assess and what the implications of that are to self assessment? How many people are told just how much of their self assessment is used in the RAS to calculate their IB?If you consider that for a moment, the fancy coat of personalisation fades a little. It is quite bizarre that in some areas, you really could say that a DLA form is more empowering than SDS, after all in that instance at least it really is JUST the words of the person filling out the form that is used by the software to calculate the funds to be released.There is of course some brilliant potential for elements of the personalisation agenda for some people who access services, but many of the 'best practice' elements of personalisation are flim and flam. If we do our job properly, and most of us do, this has indeed been an integral part of work practice for years no matter what our role in providing care is. But it is also a useful smokescreen to hide behind when one wants to save money in a country that is taking an economic nose dive, seeking to reduce state responsibility and has been following the golden thread of neoliberalism for thirty years plus of government.As for the future of social work? Well, I'd like to believe that it is not just in the hands of government, but realistically? I can't see it being statutory nor based on the vision of Beveridge to work within values deeper than that of profit margin. I fear social workers will be glorified business secretaries, employed merely to direct the money towards private companies and oversee corporate risk assessments of risk.All, of course, wrapped up in a cosy set of values that make everyone feel better about it all.
Although I agree with some of your points of veiw on the ethos behind Personalised budgets. I thought that the idea was to change the services that a service user gets from a one size fits all service to a more person centred approach.
Service users I have worked with did not want to have to go to a drop in which did not meet there needs or help with any of there proposed outcomes or add to their quality of life.
As for DLA empowering clients more than SDS. I was under the impression that DLA was for the service users day to day needs (food, clothing, equipment and travel expenses) and that SDS was for their servicable care needs (employing cookery, cleaning, social or specialised care).
As for Social works future: The social workers I have had contact with have found that instead of trying to fit in other parts of a service users care on to their own shoulders can now have more time for their reports, assessments and client meetings.
This has made the Socail workers more able to do their job knowing that the service user is getting the support they actually require.
I know that the SDS framework is a major upheaval from the past system and yes it does seem to be money orientated but all the individuals I have worked with found it more helpfull as did the social workers. The only problems have come about through Social workers with a lack of training, opinionated ideals that it 'just won't work' or a small minority who had no idea that SDS even existed.
To call it a 'miserable episode' is to take away from a valuable idea that which we are all trying to assist our service users with 'Empowerment'. Admittedly some service users have no idea what they need but this is where the qualified social workers are supposed to help and direct them to the appropriate services.
SDS will work but only as well as the understanding of it and the mentality behind putting in for it. There is a vast group of services and charities out there who do know what they are doing and can help ease the burden of over worked social workers (if we're asked or god forbid allowed to do work).
I would never want to see Social workers become glorified business secretaries or be known as usefull idiots (though from some I've met that could be an apt description) nor would I want to see Social work degraded to being a bunch of 'yes' men. There has unfortunately always seemed (and I'm only coming from a personal perception) that some social workers veiw themselves as the elite side of social care and that we who work in the charitable social sector are some how inferior or unusable due to us not having a BA or MA. Giving added weight to the arguement that service users can't really want 'that' service as 'that' service is not part of statutory body or LA.
Funnily enough we 'little support workers' seem to see sevice users a lot more regularly than social workers and seem to sort out a lot more issues and help with practicle solutions... So why not put in for SDS for us to work hand in hand with you guys and give the service user more support and a better quality of life.
I apologise if I have offended with my comments. I do believe that SDS can be a good thing and that Social work is a very, very important public service. There just needs to be more education and more willingness to try the system.
JBD:I apologise if I have offended with my comments.
Don't apologise - we need more support workers / carers / HCA etc on here who are prepared to say 'social workers are rubbish because of X, Y or Z'. I certainly pay attention to those kind of comments because I look at my own practice and reflect.
'He that is taught only by himself has a fool for a master' - HST.
JBD:As for DLA empowering clients more than SDS...
I was referring to the actual form rather than the product of the form.
JBD: This has made the Social workers more able to do their job knowing that the service user is getting the support they actually require.
Well, not so much the experience that I have encountered, but I guess it's different everywhere. Obviously the more people that have a positive outcome from any policy shift the better. I don't suggest that 'personlisation' is bad per se.
And any social worker that think support workers from anwhere are inferior are daft. Jus' sayin'
The short paper I posted a few days addressed the question can the Personal Budge idea still make a positive contribution despite the evidence that it has not done so to date. It suggested it can, but only by refocussing on the creative support planning element, and abandoning it as a means of resource allocation. I have placed a further short paper in the Resources section that follows it up by briefly setting out the changes in strategy that would be required to make a success of such a change.
alladultsarepapertigers, I agree with so much of what you say. Maybe I am a pathological optimist, but I believe that the power of argument, backed by fact and evidence, can and will win the day and that there can be a change of direction. I for one, will continue to do my very best to try to make those arguments and evidence known and hopefully debated.
I do recognise how hard it will be - there is a very powerful alliance between political and professional interests that has closed down debate. I also agree with you that will be important to try and re-engage pracititioners in the debates. So many seem to have slipped into doing (albeit the minimum) to satisfy their employers and try to help service users despite the systems. I know how hard it is to express views that are not supportive of the current ideology, but their presence needs ot be felt to help drive change.
Any comments you have directly on the contributions I have made so I can strengthen them will be much appreciated.
As a former Personal Assistant and now a Social Worker in a initial assessment (Generic) Adult Social Work Team I would say for SDS and Personal Budgets do deliver good outcomes for many people, especially those requiring a degree of flexibility and those whose priorities may differ to those of traditional social work managers, however ....... please sort the RAS! How many people do we see that seem to score high on the RAS whose needs could be met with half of the budget and how many people do we see whose score on the RAS couldn't meet a third of their needs?
And yes some service users do just see the pound signs and will invent anything at all to meet a percieved need to ensure they make use all of their indicative budget? (Yes one support plan I've seen said my husband is happy to provide me with all the care and support I need however to make us feel supported we need the following......a list was then provided resembling The Generation Game conveyor belt except it did not include a cuddly toy).
Is it fair that those who get lots of miscellaneos one off payments don't have a client contribution to make (unless they are completely self funders with over £23, 250 in the bank) and those who spend their budget on care pay a regular client contribution to their package?
I think the policy makers and planners need to go back to the drawing board, understand that it should be a possible option or choice not directing people that it is the only way to deliver social care - I've been made to do SDS with people who are palliative and end of life. There is to much SDS going on just to cook the books, and the time it takes to actually give quality advice and information to citizens about what is expected of them in terms of developing their own plan is definately a big factor. One of my senior managers said it was a very middle class idea and works more favourably for those with good networks of informal support and to be honest I am inclined to agree.
If I was a service user I would be able to complete a fantastic SDS plan for myself but then I'm experienced in writing support plans, many service users aren't and training people to write their own support plan and think outside the box isn't that easy!
A1ext - Your experiences make perfect sense. They reinforce my view that the way forward is to abandon the effort to make the Personal Budget approach a new way to allocate resources, and instead focus on it signalling the route to creative support planning for all. The contention that the up front allocation is a necessary pre-condition of creative support planning is false. With the right policies and practices in place, it can happen for all. It is interesting to note that even Simon Duffy, the original architect of up front allocations, has moved away from the RAS concept and is advocating a professional judgement/guess about how much a person might need. Why bother at all? It will be a huge relief to the system to abandon this fundamentally flawed idea.
Hi Colin, I am more or less up front with the outcome of the SRQ and the Indicative Budget, however with some service users, I find it works better to say you are eligible for services under FACS, please tell me what support you would like the Authority to provide and the outcomes it will achieve, I always present a range of options; that way the person isn't always swayed by the amount the budget. I really do feel good Self Directed Support and planning is more of an Art than a Science, I think we need to decide is the indicative budget an absolute entitlement to those who are eligible for services? And what should we do with people who are over budget? Just say hey ho thats your budget - go and meet your needs with it ! I don't think so!
A1ext - I think the answer to your question is that only if the IB is not enough to meet 'eligible' needs - in most Councils critical and substantial - should the Council go above it. That much is required by the law. But what if eligible needs can be met with less than the IB? The law has nothing to say about that, but the IB element of the Personal Budget idea says that it should be an entitlement and they can spend up to it on whatever they want. But can Councils afford that? To most people, it will just seem profligate to do so, especially in current financial times, and acutally quite unfair.
My question to you would be could you not achieve the kind of creative support planning you clearly do in your practice without any mention of an IB? As you sau, it works for some, could it work with all service users? Are there particular changes in policy that you would need to support you in achieving that?
This is partly being devils advocate but I would appreciate peoples views/ arguments about a contention that people with disabilities should just get a sum through the benefit system.
Some disability benefits are already paid in this manner so there is already an "assessment" structure in place to distibute resources.
Social Services have been characterised as patronising in the way resources are distributed. Why not allocate all benefits through DWP and people can spend it how they wish to support themselves?
There may be circumstances where people need particular help that cannot be purchased eg safeguarding, so there may be a need for some statutory services.
Of course the idea that the market will provide flexible services which can appear and disapear as demand changes is highly questionable but what do people think of the principle?
My view is that this would be an improvement on the current situation which is neither fish nor fowl. It would need a change in the law to remove the right under the 1990 Act to having a certain level of need met, and would make funding even more vulnerable to political whim, but would have the benefit of being clear.
But I dont think it would be as good as matching spend to actual need case by case, so long as the changes that would be required to make it work properly were to be carried out. I think the profession too easily accepted the criticism that the large variation in the resources given to individuals was about professional whim and the so-called 'professional gift' model. I think the variation is due firstly (albeit not entirely) to variations in complexity of need. If anything, it showed that the professional practice process ws working
Hi GCH, instead of handing the social care budget over to DWP why isn't the DWP budget handed to social care? There seems to be a lot more fraud in the benefits system as opposed to social care, so I would argue that the assessment process the DWP have in place is fundamentally flawed. The DWP assessment I would argue is not as indepth and does not assess or manage risks like a Social Work Assessment. I would like to think that most service users would find social care easier to navigate and access and less patronising that the Benefits system in place, many service users fear DLA Assessments and ask for supporting letters, yet don't seem fearful of social work intervention! Having said that the DWP system does work for some people - it would be interesting to look at the demography of the service users who say it works for them.
There are service users who would not spend the money on the support they need - what would DWP do in those instances? When someone spends their budget on decking for the garden and are then left in bed incontinent and can't get up or clean themselves and have no money to pay for support? I really do feel that it would be open to abuse as more and more fraudsters would jump on the band wagon thinking "I'll have a piece of that!"
Having said that - it could work for some people, but to make a sweeping statement that a form can be filled in and then give people a sum of money to meet their needs, really does not have much insight in to the complex needs of service users.
DWP budgets over to social care. Yes that is a debating point but not one that will convince a Tory party policy wonk when they can have much more control of the budget without resistance from entrenched and harder to manage organisations such as social care departments. They can major on their buzz word "choice" and clearly feel able to distribute some disability resources without understanding the complex individual care needs of claimants.
I would agree that it would be better to individually assess and allocate resources but this is only likely to be a successful argument in the long run if it can be shown to reduce costs and that would include the cost of running social care departments to deliver it.
The argument about people miss-spending their allocation is one that already exists with direct payments, at present we pick up the pieces and indicate that they need more help managing their direct payment but that doesn't have to be the what happens.
The conservative party are not being secretive about their view about privatisation and personal responsibility although they do dress those views up with the idea of the big society and if the NHS is free at the point of delivery you don't have to worry that we've sold the profitable bits to our mates etc.
So far the RAS score has not impacted a great deal on my practise. We don't even tell people what their RAS score is automatically, which seems directly against openess to my mind. Many people's needs can be met under the RAS, and, if not, my managers are hardly so committed to its infallibility that I can't make an argument for it to be increased without to much difficulty.
I do see a time though where this will be challenged from both ends. service users insisting that they are entitled to the RAS figure and Managers insisting that resources have to be limited to the RAS score. In my view we become much more explicitly akin to a benefits agency. We have always served as gate keepers to resources perhaps so is this a significant change?
Thanks for clearing that issue up for me.
To answer your question .... yes I do feel that creative support planning could be in place without an IB. I used to work for a service user who had direct payments before the Personalisation Agenda/SDS came out. The service user was allocated so many hours per week to meet his eligible/assessed needs with some respite for the informal carer. The Employer (with his informal carer) used to manage the allocated hours so that it covered his needs and provided him with extra support that he needed, if they needed to save time, the informal carer would undertake some of the essential care tasks, freeing up hours to be used elswhere. Basically at that time there was no RAS in place, a social worker said you need X hours to meet your needs, here is your direct payment, if you have any surplus in the account you can use it for extra care in crisis situations or extra socialisation. It worked for the service user and his informal carer at the time and continues to do so.
Does the government not already individually assess needs via DLA when people go to DLA reviews and tribunals? Oh but only after someone has claimed DLA for a number of years, which they probably wouldn't have needed to have paid out for so many years had they done an appropriate assessment in the first instance. The Con Gov can give budgets out via DWP - just see how many new applications and appeals they'll get through! And if they do have a open RAS the ones who you can meet needs for £20 a week will probably end up with £100 a week.