Star ratings fail to impress service users

Most good ideas tend to be simple. But not all simple ideas are necessarily good. The star system in social care is a case in point. The appeal of star ratings lies in their absolute simplicity. Rate something with stars from zero to three and you have an instant indicator of quality. Failure, deterioration or improvement can be spotted at a glance.

The problem is how much better can things improve when there is no fundamental change underpinning them. Or put another way, how much can social care improve so long as it continues to be chronically underfunded and treated like a Cinderella service so that both service users’ and workers’ experience of it is negative?

This all began with Margaret Thatcher’s insistence – for which she failed to produce evidence – that the private sector was much better at delivering quality services than the state and that the state had to be brought into line through quality controls. The truth is that the market is governed by supply and demand and that only the strongest state legislation seems to safeguard the rights of customers and consumers. Service users carry little clout as consumers and any service user can tell you that the private and charitable sectors are just as capable of providing poor quality  services as the state.

So as Thatcher removed a key condition for decent provision – adequate funding – she began the process of laying down paper requirements for improvement. Let us be clear though; no one is saying that throwing money at services is enough or that good quality isn’t important in social care.

When I was a member of the National User and Carer Group set up by government to monitor the implementation of the community care reforms in the 1990s, we had to listen to government and councils blaming each other for problems we encountered. Service users and carers were caught in the middle. We need to move on from there. It is difficult to see how the star system can help someone who lives in a poorly performing area. How can it counteract rather than reinforce “the postcode lottery” associated with social care and other services?

Service users have made it clear what they want in this year of repeated consultations over green and white papers. They have said it individually and collectively – over and over. They want reliable, good quality support; free at the point of delivery, culturally appropriate and which challenges discrimination and is based on equity and enables them to live their lives on as equal terms as possible to other people. Sadly we still seem to be a long way away from this being a routine reality for people. If policymakers want to see this happen, then as well as coming up with ideas and rhetoric, they will have to bite the social care bullet. This means radically reviewing the funding and priority of social care.

We now have a chance to rethink the star system in the light of this need for broader change. The old bureaucratic system just doesn’t seem to work. It can show up appalling services, committed staff and those who are good at tick box exercises. But in isolation it cannot improve levels of support. Indeed it can even sometimes make things worse for service users, where regulatory criteria unintentionally inhibit their lifestyle, choices and opportunities.

We need to move to a different system for improving the quality of social care, relying less on managerialist approaches and more on user involvement. It needs to prioritise entitlements and the meeting of needs. It needs to be based on goals of independent living and user-defined (and evaluated) quality measures.

There are already commitments to such an approach in key places. Let’s hope that there is also the political will at the highest level to help take it forward.

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Peter Beresford is professor of social policy at Brunel University and is involved with the psychiatric system survivor movement

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