I’m grateful to Social Business Brokers’ Rob Greenland for drawing my attention to last week’s session of the House of Commons Public Accounts Committee devoted to ‘Care Markets’. During the session, MPs quizzed leading civil servants responsible for the personalisation agenda, Putting People First, on how implementation is (or, in many cases, isn’t) progressing.
The discussion of personal budgets – beginning at question 50 – focuses on a number of key problems with roll out of personalisation across England so far. One of the biggest, highlighted in the initial question from Anne McGuire MP, is that the extent to which local councils have followed government instructions to implement personal budgets in social care varies, despite the April 2011 deadline, from enthusiastically and with gusto to not at all. Ms McGuire quotes the delicious bureaucratic euphemism: “14 authorities…reported that they had not ‘mainstreamed’ personal budgets as part of their operational business as usual.”
The interaction that follows reveal that a key reason why national availability of personal budgets is so sporadic is that while the government has offered financial incentives and strong encouragement for local authorities to introduce a system, it has not included any provision to make it a legal obligation in the current Health and Social Care Bill. That effectively means that if your council has decided it doesn’t fancy doing personalisation then for the foreseeable future there’s not much you (or the government) can do about it.
Aside from the minority of areas – an embarrassingly sizable minority – where personalisation is not being mainstreamed into the business as usual, there’s also clearly plenty of challenges in those areas where people are now receiving personal budgets. Anne McGuire MP (question 59) asks David Behan, Director General, Social Care at the Department of Health the inescapable question that all discussion of personal budgets keeps returning to and failing to resolve: “Are you aware of any restrictions that local authorities are putting on individuals concerning how they spend their personal budgets? Are local authorities being overly prescriptive concerning how individuals can spend their personal budgets? I will rephrase that another way. Do you have any recommendations about what is, or is not, acceptable for people to spend their personal budgets on?”
Mr Behan’s response concludes with the point that: “Most local authorities are trying to strike a balance between encouraging flexibility and creativity on the one hand, and being equally clear that the money cannot be spent on things that would be illegal.”
The problem is that having discarded the possibility of spending their personal budgets on things that are literally illegal, people are confronted with a reality dictated by the interpretation of their local authority. The Chair, Margaret Hodge MP (question 60), raises an example of a lady who was initially told by her social worker than she could spend some of her personal budget on furniture but having done so, was then told that she had to pay the money back.
Social Spider CIC‘s local MP here is Walthamstow, Stella Creasy, then offers this example (question 61): “May I tell you about a case that you should be familiar with, because I wrote to the Minister about it from my constituency? It is that of a woman who had 18-month-old twins. She was told that she could not spend her direct payments on child care for the twins because the money was for her because she was disabled. Clearly, respite care for her was about not having to have 18-month-old twins around all the time.”
Ms Creasy adds: “You paint a great picture of where some local authorities are being very innovative and recognising the needs that people have, and attesting to, as Anne says, independence of choice and control, and yet on the ground the reality is very patchy. What are you doing to overcome that, and to help local authorities to help people in the way that direct payments are intended to?”
The underlying point here is not that personalisation is failing, it’s that in many areas it is not being the given the chance to either succeed or fail. While the government is ‘disseminating best practice’ to local authorities there are not currently any mechanisms to ensure that they follow it. The worry for those of us who see personalisation – in the best case scenario – as being a mechanism to enable people to take control of the services and support provided to them, is that genuine personal choice may only be offered in those local authority areas where council leaders and officers are specifically enthusiastic about the agenda. Elsewhere, where councils are (to be charitable) confused about the purpose of personalisation or even whether it should be implemented at all, people relying on social care services are currently faced with an unholy mess.
As with the Big Society agenda, the danger with personalisation is that the government’s approach will not extend beyond making some suggestions and then hoping that other people whose actions they are not directly responsible for decide to follow those suggestions. Given the number of vulnerable people relying on social care services, we have to hope they’ve got a slightly better plan than that.