Does anyone have any comments around the future implementation of personalised budgets???????

It has been said that this will herald a return to a more 'hands on' social work practice with more time spent with people, more advacacy and support and a move away from the mountain of paperwork involved with the present care management process!!!!!!

Any comments

 Hi Bri

Most people I speak to seem to be broadly in favour, arguing that it gives service users more choice and power over the services they receive. Some of the individual budget pilots in the mental health field seem to have had positive results, with service users spending their money on vocational training, a camera, transport and things that would generally help them get a job and integrate more into society. I did an article on it, if you're interested.

On the other hand, some people have suggested that what people want is good quality services not choice and many service users do not want the stress of becoming an employer of a support provider. It seems to present a new role for social workers as "navigators" helping people choose what kind of support would best help them.

We actually have a conference on this very topic on 30 April in London. It's proved very successful but I think there's still a few places left.

Hope that helps

Simeon 

It worries me that 'giving people what they want' involves spending less money. Is it overly cynical of me to suggest that councils like the idea that personalisation might mean not spending so much?

Hi Brian,

Who are they trying to kid? I feel that this will be another nail in the Social Work profession why would they need a qualified Social Worker to fill in a form? If people are to be signposted to appropraite services why would be needed? While I am sure that there is a place for Personalised Budgets like Direct payments in my service user group I feel that the take up rate will be relatively low but perhaps this will mean I will hang on to my job which is already 70% form filling or computer work and 30% hands on !

Oh Brian!

Try to remember why you came into the job in the first place.  If anything, like most of the Social Workers I have known over the past ** years, you came in with a strong values base that was about respecting and valuing people and feeling that you could support them to get a life. You  did not opt in to a relentless bureaucracy that blocks you, and neither did the people who live the life. Not only is self direction starting to enable individuals to get much better lives, it is also creating different opportunities for those great Social workers who have kept the belief - or can find it again. I now work within the independent sector within an organisation that is supporting people at a practical level to get the lives they really want. Some fantastic outcomes, I still bang my head at times, but know that we are faced with an unprecedented opportunity, in our working lives, to do the stuff we joined up for, within or outside of formal serviceland.

As a radical development - and much more flexible than direct payments alone - it will be glitchy, especially whilst those within the bureaucracy come to terms with the reduced power they have over people, but the journey could help you to rediscover that missing ingredient - job satisfaction.

 After being initially sceptical I think I agree with you PippaH. From what I've heard it could make a big difference to the lives of a lot of service users. There are definitely going to be challenges ahead though, in terms of workforce organisation and in terms of media perception. There's bound to be a misplaced furore when the press finds out about someone who has spent their individual budget going down the pub. We did a podcast on personalisation, if anyone's interested.

Time and motion / work study.

What separate tasks are performed?  Do we need a QSW to do this or can a less qualified person do this? Lets set benchmarks or targets or other (anally-retentive?) quantifications on how much time devoted to paperwork, what caseloads are and should be, etc, etc. 

These are the manifestations of social care policy in which the 'personalisation' agenda is high up the agenda at present.  Tie this in with the new context of the Mental Capacity Act and we see the concept of working 'in the best interests' of vulnerable service users - the position before - being eroded, and we see a thinly veiled attack on the professionalism and expertise of social care staff wrapped up in the guise of removing discretion and the risible concept of increased user choice.

The above are the views one may say of a Luddite, a reactionary or a died-in-the-wool socialist even.  But not the views one would expect from a consultant in the social policy field, which I am.  I also agree with the above views on balance, and balance is the issue.  Social policy since 1997 has been characterised by an obsession with measurement of which PIs and league tables (in education) have been to the fore, together with extremely clever spin.

The obsession with quantifying what is essential qualitative activities has gone too far.  There is an entire academic sub-discipline of the problems of quantifying qualitative data which in lay terms has been put an economic figure on activities - a gross and erroneous distortion of work study which is being used throughout social policy and especially so in the 'personalisation agenda.'

Work study - as a discipline - is useful and can help to look at matters of operational policy very effectively.  But when it is solely driven or majority driven by the imperative of cost it produces distorted figures that may show immediate terms cost savings that inevitably lead to medium and longer term cost increases.  The same can be said of quality. 

If the obsession with cost continues, there can be no doubt that experienced and therefore higher initial cost of experienced workers will suffer with many such workers leaving the sector or being forced to leave the sector.  These will be replaced by less skilled workers - of whom no cost benefit analyses have been done and who will deliver a less qualitative service to service users.  Will this no simply lead to (a) existing issues with service users taking longer to resolve (and therefore most costly) and, (b) other service user issues becoming more intensive and again more costly.  What will this lead to - increasing the eligibility criteria again leading to - oh yes - less people receiving a service and a service that is also lesser in quality given that experienced workers have left the profession.

All of this caused by an obsession with measuring very simply what is very difficult to measure all in the name of short-term economic savings - but wrapped up in the name of increased service user choice.  This is the nonsensical reality that describes the entire context of social policy and the balnce of quantity (in this case almost synonomous with cost) over quality has gone too far. 

If that balance is not arrested and quickly it will lead to increased cost and reduced quality of service being delivered to less people than now.  Then again one has to admire the likely response when this comes to fruition - this was the service users personalised choice.  So when the proverbial hits the fan, that fan is clearly pointed away from central government - the obsessive drivers of the personalisation agenda.

Then again the principal lobby for the SW profession is the local government bureaucrats in ADSS who are being forced to implement these obsessive nonsenses, who fail to see the black comedy / whitehall farce this is.

 

The original Community Care and National Health Services Act was a very elegant piece of legislation for addressing several different social policy objectives simultaneously (without most folk even noticing some of them) and I suspect the individualisation agenda has similar covert intent. Up here in the frozen North this is gathering momentum under the “InControl” bandwagon but local authorities getting behind this are invariably mentioning “user directed support” in the same sentence as “25% reduction in hourly rate”.

I work for a long established 3^rd-sector provider of accommodation and services for folk with learning disabilities. In times gone by (and no, it wasn’t the good old days, there were lots of drawbacks – inflexibility, lack of choice, institutionalisation, etc.) we could employ the pick of staff, we could supervise them properly because we had sensible spans of control, and we could hone worker skills continuously as a result. We try to behave as if all service users have Direct Payments anyway, that they could take their business elsewhere if we don’t do it right for them anyway. We’ve worked over our housing stock to ensure that folk live in households of choice. We have a huge user involvement agenda.

 

Over the past few years, the amount of bureaucracy from outside in the shape of 2 layers of Contract Management and the Care Commission has meant an explosion of monitors and statisticians; upsizing of local services to reduce % management costs has coincided with this explosion of bits of paper for local managers to submit to this machine, at the expense of their relationships with service users (still good, but not nearly as close); their command of the person centred planning process; and their availability to model good practice. Although there is much to be said for good monitoring these are the unintended bad outcomes.

 

As a result, with staff turnover increasing and many aspects of the job enrichment process in reverse for support workers, service users’ experiences of support are more than ever dependent on the skills and motivation of individual workers many of whom have very limited experience and whose managers have very little chance to witness their performance live.

 

A major outcome of Authorities using user directed support to drive further budget reductions will be further compromise in the quality of services; less resources to back up workers, less chance to improve performance, less chance to speak up for service users who can often be far too forbearing (unassertive) with workers.

For the majority of folk with a learning disability, I can’t see this as a step forward, it seems to me it is being fiscally driven and it will seriously damage a lot of the checks and balances in disadvantaged people’s lives which are already under a lot of pressure.

 

I think that it's interesting that half the people I hear think that personalised budgets, direct payments, or equivalent, are about a drive to save money - and half the people I hear of think that it will cost too much...

That suggests to me that the money thing is a distraction - an indication of the difficulties that change brings - not something at the heart of the issue.

When I think about this a particularly strong memory comes to mind: I attended a conference about direct payments a good few years ago (perhaps 7 years?) where the essence of what most people were saying was: "We're all in favour of direct payments, and at first when we tell a client about them they think it's a good idea, but unfortunately when we tell them all about how hard it will be for them to manage the money and staff, and about all the problems that might crop up, they just seem to back out and change their minds."

What stood out was that the result of lots of individual (well meaning) interactions at a local level meant that at a 'system' level direct payments were being strongly resisted. The country was full of workers offering direct payments, and then offering every possible discouragement to their uptake - so not surprisingly there was almost no uptake of them.

What was really really interesting about this was that those at the conference didn't and couldn't see it like this. They couldn't get free of their own local viewpoint to see things in a wider perspective. People had almost all learned to see that the problem was something like "disabled people just aren't ready for taking this on, so no matter how good an idea we think it is it just isn't going to work". NONE of the people I spoke to or heard from seemed to be thinking "the problem is that we aren't very good yet at supporting people to manage direct payments" (really, not even one person that I spoke to was thinking from this perspective).

I've worked with many people trying to support change - and what I've learned is that with a change like this two things happen:

The first is that some free-thinking, courageous, determined people use the change to enable them to make the difference they have always been working for. The new language and new thinking and new vision allows them to justify breaking boundaries, to step out of line (i.e. not doing things the way things are done around here), and to reconnect with what's really important.

But the second thing that happens is that 'the system' finds a way to enable the old practice (the way things are done around here) to continue. Words change, forms change, proceedures change, job-descriptions change, the flow of money changes, but the fundamentals don't change (when I speak about 'the system' I'm not meaning 'the managers' or 'the government' or 'those at the top' by the way). 

So I suspect that if we're brave enough to use this as an opportunity to make a difference in people's lives then we will be able to do great things. And if we don't see what's wrong with the current 'how things are done around here' then we'll be able to find a way to work around this change.