While social workers fear personalisation may be at risk from impending government cuts, our survey finds the agenda is already facing pressures. Jeremy Dunning reports
With the new government braced to announce huge cuts to public services over the coming years most adult social care practitioners fear this spells trouble for personalisation.
Four-fifths of respondents to our survey, all of whom work with adults and are employed predominantly by councils, agreed that cuts will impede the progress of personalising care.
Our survey, carried out with Unison, also found that 36% of practitioners saw a lack of resources as the greatest barrier to forging ahead with the transformation agenda, up from 33% in a similar survey we conducted last year.
The Department of Health estimates personalisation will be cost-neutral in the long run. It is expected that clients using personal budgets will spend less on care than councils commissioning services traditionally, but these savings will be cancelled out by the training and infrastructure costs of personalisation.
But with councils still rolling out personalisation, they are facing cost pressures from having to run traditionally-commissioned services alongside personal budgets, a situation that could be exacerbated by central government budget cuts.
Des Kelly, executive director of provider umbrella group the National Care Forum, says saving money through personalisation is difficult because “so many of the resources are tied up in the way we run services at the moment”.
Another danger for personalisation stems from it being associated with cuts to traditional services such as day centres, especially where alternative provision for users is not properly embedded.
The charity In Control, which has pioneered personalisation, has come across some senior managers using the agenda as a cover for cuts to services people want.
Andrew Tyson, policy and communications lead for In Control, says: “The worst thing for personalisation is that it’s used as an excuse to cut services. Personalisation is about choice. We know a lot of people are still choosing day centres and, if day centres aren’t there, people won’t have choice.”
The government set aside £520m to help transform social care services from 2008-11.
But In Control believes that too many councils used the money in the wrong way, to set up administrative systems rather than to stimulate the social care market to deliver a choice of services.
There is also the issue of staffing cuts. The personalisation agenda was always expected to change the skills mix of council social care teams, and our survey shows that this is already starting to happen.
However, there are concerns that some staffing changes are driven by the need to save money, and that this is impacting adversely on the delivery of personalisation.
Tyson says: “In south England the pressures are so enormous that vacancies are being held open. You look at people’s faces and they are so tired all the time.”
Unison national officer for social care Helga Pile says vacancy levels in some council adults’ departments are “unacceptable”.
“If your approach is about squeezing more from less money, the only way you could do that is to reduce the time staff have for clients and for training,” she says.
Beverley Latania, 34, works for an east London primary care trust as a senior practitioner and deputy manager of an NHS-led multi-disciplinary mental health team.
It has been the subject of budget cuts over the past two years with the team reduced from 21 to 18 members of staff and funding for an activity group cut.
Latania, who responded to our survey, says: “We used to go off to the gym with service users, there used to be gardening, they used to go on trips, swimming, arts and crafts and that’s all been cut. The funding has been cut and it’s been getting worse over the last year and a half.”
Emma (see below), a frontline social worker in an adult community services team from an inner London borough, says users in her area are already being asked to make bigger contributions to their personal budgets.
Richard Jones, president of the Association of Directors of Adult Social Services, admits there would be a “whole lot of tough times” to work through but this could allow for innovation to produce better outcomes for users.
“We will never have enough resources,” he says. “Personalisation is a way of working and a model that will have to adapt to the level of resources available.”
Amanda Kelly, who leads on social care at consultancy PricewaterhouseCoopers, where she is a partner, says personalisation could stimulate more early intervention work across health and social care and help reduce inefficiencies between the NHS and local government.
“We should be thinking of an end-to-end care economy and health should be involved at the front,” she says.
The man who is charged with helping councils implement personalisation is not impressed by arguments about resource scarcity.
National director for social care transformation Jeff Jerome says the size of the transformation grant means there should be no excuse for holding up the roll-out of personalisation.
Jerome admits resource strains could cause a problem in the future, but says councils need to look to other sources of funding to make up the gap.
He adds: “What we need to make sure of is that the programme is able to move forward in a consistent way and increasingly bring forward other aspects of resources such as social capital and community organisations that enhance and support the personal budgets that people might receive.”
DayBreak centre, Sheringham, north Norfolk
‘You could see this cynically as a cost-saving exercise’
Day centres are a key casualty in the move towards personalisation. Several have been closed down on the premise that users given personal budgets would use them less. However, there has also been criticism that closures are designed primarily to save councils money.
The charity Break is due to close its DayBreak centre in Sheringham, north Norfolk, after the end of its block contract with Norfolk Council.
The centre is used by up to 50 adults with learning disabilities who have been found alternative services by the council, more suited to personal budgets.
Break felt other services could better meet users’ needs and that it could not take the economic risk of continuing to run the centre without the block contract.
Director of corporate services Don Evans says: “You could see this cynically and say it’s a cost-saving exercise by the council and clearly [giving people] personal budgets is less than the cost of providing a day service because that’s a high-cost model. But you are also looking at corralling people in together with similar issues and limited opportunity [in the day centre].”
Evans admits that users might find the transition to new services unsettling but says this would help them grow personally.
Norfolk Council says it is committed to allowing users to lead active lives in the community. But Debbie Olley, assistant director of safeguarding at the council, says it would still look to provide some buildings-based services for users with complex needs who would choose to use them.
These may include people with learning disabilities who are aged over 40 with parents in their eighties. Day centres are all they have ever known and the parents would be in need of short breaks, she says.
The impact of cuts
Emma*, 56, who works for an inner London borough in an adults community services team, is a supporter of personal budgets but has seen the impact of cuts.
“I think the momentum of the personalisation agenda is impervious to the economic climate, so we are going to be cutting back people’s budgets or reducing people’s allocation as the economic situation dictates. In our area, the contributions that are expected from users to their budgets have risen significantly this year.
“As the size of the personal budget is calculated according to a standardised formula, there is no adjusting for the fact that the service someone uses may be more expensive, and these charges are often unrelated to the quality, more to do with the provider: in-house home care is much more expensive than agency, private providers for training courses or leisure activities are more expensive that those provided by voluntary organisations or the local authority.”
*Not her real name
This article is published in the 20 May 2010 edition of Community Care under the headline “Cuts threaten transformation agenda”