It’s not rocket science

The adult care green paper has boosted the modernisation of social
care services. With a focus on individualised budgets, the
extension of direct payments, more emphasis on prevention, new
technology, local partnership working and new roles for care staff,
the choice agenda in social care is really taking off. An overused
word in recent years, “choice” has come to mean many things for
those involved in the public policy debate. What it means for those
in need of care is clear: greater independence and autonomy over
vital life choices.

But do people really care about choice, asks the cynic. Aren’t they
overwhelmed by what’s on offer? Don’t they just want good services?
It is exactly those well-meaning but patronising assumptions that
need to be challenged within the social care profession and the
wider public. Of course, people want good services more than
anything, but we know from our research that many users also want a
greater say and decision-making power over the services provided
for them and that what they receive is often not adequate.(1) Users
are mostly quite capable of assessing their level of need, but too
often this is done on their behalf. The green paper’s proposals for
more self-assessment are thankfully addressing this imbalance.

The social care profession has witnessed significant change over
the past decade and the proposals will hopefully do what they so
boldly promise: provide Independence, Well-being and
Choice. Instead of being locked into an inflexible system of
provision, many social care recipients can now live more
independent lives by employing personal assistants through direct
payments.

Of course the system is not without flaws and we know that the most
common criticism of direct payments is the low take-up, with most
recent figures somewhere around 18,000 (even though this is an 80
per cent rise on the previous annual figure). Many adopt this as
the main argument against direct payments. Yet the figures are
misleading as they don’t include the many children now receiving
direct payments. Nor do they tell us anything about lives that have
been changed for the better. We need therefore to think much harder
about how we can ensure higher take-up across all user groups and
how we can improve implementation. In places where implementation
is well handled take-up is high, for example in Essex Council,
which has more than 1,000 direct payment users.

Research evidence reveals that the main barrier to success is
generally care staff’s reluctance to offer direct payments to the
user in their care assessment. The main reasons for this are that
workers are making the judgement that many users will be
overwhelmed with the task of being an employer, or that staff
themselves have difficulty understanding how the scheme works. Too
often assumptions are made about people’s ability to manage. Both
reasons highlight the need for more and better social care staff
training if we are determined to make direct payments a success.

The introduction of individualised budgets in the recent adult
social care green paper is of course a further step in the right
direction of greater choice and independence and might counter some
people’s genuine fears about being employers through direct
payments. Individualised budgets would leave as much risk or budget
management with the local authority as the service user prefers.
However, we have to be careful that they will not be used as a
compromise and curtail people’s choice. They should not replace
direct payments, which might have more transformational potential
as they give those users that want them even greater freedom and
independence.

Individualised budgets might limit the risk factor for users, but
they might also mean less empowerment. And again some users might
find themselves in positions where professionals give well-meant
but biased advice because of their lack of faith in disabled users’
ability to manage.

The paper’s recommendation of an increased role for the voluntary
and community sector (VCS) to provide social care and advocacy is
an important one, but it remains to be seen whether this will be
successfully implemented, as many local authorities continue to
struggle to accept the VCS as an equal “partner”. The fragmented
nature of the sector further adds to the challenges to increase
their clout.(2)

New localism, the devolution of power away from the centre to a
more local level, is another of the recent agendas that is likely
to have an impact on the future of social care provision. However,
so far there has been little evidence in this field. A recent New
Local Government Network research project that evaluated three
councils’ differing approaches of devolving power in some service
areas to sub-authority level found that none had attempted to
devolve social care. Although all planned to devolve some aspects
at some point, they had all begun with comparatively “easier”
services like environmental services.(3)

A project that examined Lancashire Council’s locality programme
found some limited outcomes where aspects of its social care
service had been devolved.(4) However, the council is doing so from
the perspective of an excellent local authority with two stars (and
improving) for its social care service. It almost works as an
add-on to the existing service and the council does not use
devolution to improve service delivery per se. The overall evidence
remains very thin and there will continue to be a need for
centralised social care delivery at local authority level. There
are also obviously other implications if social care is devolved as
this is likely to have an effect on the council’s social care star
rating.

And than there is the government’s efficiency agenda that might be
at odds with the modernisation plans for social care. Greater
personalisation and choice through enhanced direct payments and
individualised budgets conflict with the drive for more efficiency
and savings and the common route of block contracts to deliver
social care services. The mixed messages from government in this
area need to be resolved.

However, the fact remains that personalised and tailored services
are definitely the future and the government’s green paper gives us
hope that the tide has turned. No longer can we get away by
offering “one-size-fits-all” social care services. If we want the
unprecedented investment in public services to have an effect on
the perceptions of users, we need to rethink and truly put them at
the heart of the service. We need to pay more than just lip-service
to “voice” and give people a real say over social care provision.
No longer can professionals assume that they know what is best for
individual users. If we want people to live independent lives, we
have to let them choose. 

Natalie Tarry is research manager at the New Local
Government Network (NLGN), with responsibility for many aspects of
its work programme including partnership working, city regions,
user choice and innovation. Before joining NLGN in January 2002,
Natalie worked at the European Parliament and at a consultancy in
Frankfurt.

Training and learning
The author has provided questions about this article to
guide discussion in teams. These can be viewed at
www.communitycare.co.uk/prtl and individuals’ learning from the
discussion can be registered on a free, password-protected training
log held on the site. This is a service from Community Care for all
GSCC-registered professionals.

Abstract
This article looks at the impact of the public service
modernisation agenda on social care services, including new
localism, more user choice, the increased use of partnerships and
greater involvement of the voluntary and community sector. It
concludes that recent and proposed changes in social care, such as
individualised budgets and the extension of the direct payments
scheme, are exciting and transformational.

References
(1) A Lent and N Arend, Making Choices: How can Choice
Improve Local Public Services?, NLGN, 2004
(2) National Audit Office, Working with the Third Sector, NAO,
2005
(3) A Randle, Councils Embracing Localism, NLGN, 2005
(4) A Randle and E Robinson, Evaluating the Locality Focus
Programme, NLGN, 2005, forthcoming

Further information
Improving the Life Chances of Disabled People,
Prime Minister’s Strategy Unit, 2005

Contact the author
E-mail: Natalie.Tarry@nlgn.org.uk