Green paper rings with past echoes

At first sight there is little in the green paper Independence,
Well-being and Choice that is
surprising or visionary. But it would be a mistake to dismiss it.
Yes, there is much here that is familiar, but that is not a
criticism in itself and translating the aspirations into reality
would be truly revolutionary.

What is depressing is that the wish to see services that are
“person-centred, seamless and proactive” could have been stated as
an objective at any time in the past decade or so. These objectives
are strikingly close to those set out in the 1989 white paper
Caring for People, which stated that “promoting choice and
independence” underlay all the government’s proposals. The fact
that 16 years on these issues are once more on the agenda indicates
the difficulty in moving from aspiration to reality.

Putting people in control of their lives and enabling them to
make choices about what support they need is a big challenge. The
main vehicle for bringing about these improvements will be the
creation of individual budgets. The foundations are already in
place in the form of direct payments, but despite a duty on
councils to offer them, take-up has been disappointing. Fewer than
13,000 people use direct payments compared with almost 1.7 million
who use community care services.

Some people are reluctant to use direct payments because they do
not want the hassle. But individual budgets are to offer the
“benefit of choice and control of direct payments, without the
potential burdens”. Councils would hold the budgets on behalf of
individuals and allocate resources accordingly.

The green paper recognises that developing services that help
people develop their independence involves risk. But it is vital
that vulnerable people do not have to carry all the risks if they
opt for more autonomy.

It is a big task to move from the everyday experience of most
users of social care to the vision outlined in the green paper. It
is realistic to expect it to take 10 to 15 years to achieve, and
only if it is accompanied by significant investment.

Melanie Henwood is an independent health and social care
analyst.