Giving individuals the option to control the money which is spent on meeting their needs feels to me to be self-evidently a good thing. There is great – and massively undervalued – expertise in the social work profession, but social care is not like, say, heart surgery, where I would probably be happy for most decisions about my care to be taken by the experts. Social care is more ambitious than heart surgery. It doesn’t just want to help your body function, it wants to be a route you can take towards living a fulfilling life. A surgeon knows a lot more than I do about how my heart works, but even the most skilled social worker will only ever have a rough idea of what makes me tick.
So if putting me in charge of the social care resources attached to me makes sense, and it’s also a given that budgets are never going to be infinite, what is the simplest, clearest, fairest way of allocating a budget to an individual, which recognises that there have to be some limits on how much people can spend?
The current process in most areas is a little like this:
- The individual is assessed to see if they are eligible for state support.
- They are also assessed to see if they are eligible for that support to be provided free, or if the state will charge them some or all of the cost, according to their income and savings.
- A system (a Resource Allocation System or RAS) is used to give people a rough estimate of how much money they are likely to be entitled to spend on social care. This estimate is proportional to their level of need.
- The individual is helped to plan to spend that money. The RAS is only (in theory) used to produce an estimate, so it might transpire that the individual needs more, or less, than the estimated amount, in order to meet their social care needs. When this happens, the amount allocated to them can be changed to ensure they can afford to purchase the support they need, and that they are not given more money than they need.
Let’s assume that that process happens fairly and transparently and that the professionals involved don’t take short cuts, such as treating the initial budget estimate as the final figure, or giving you a limited list of the services you can purchase, rather than helping you to think creatively about the best intervention to meet your particular needs and wishes. Even done properly, this process still contains three major problems.
The first problem is that you have to prove how vulnerable and helpless you are, before you get anything. You may actually have to wait until your health or wellbeing deteriorates before you become eligible for expensive state support, when a much cheaper preventative intervention could have avoided that need if it had been available at an early stage
The second problem is that it contains an extra step or two of assessment and planning. Those are the steps which translate your needs into an estimated cash total and then into a final cash total, which then still has to be signed off by your council. It’s possible for there to be several rounds of negotiation, as the council and the individual try to compromise between what the council sees as a Rolls Royce solution and what you see as more like a second hand scooter. These extra steps are there because turning needs into resources is an add-on to the existing social care system, rather than a replacement for it. It’s possible that the forthcoming social care Bill will find a way of replacing our cobbled together social care system with one streamlined process which will significantly reduce that bureaucracy.
The third problem is that the system is supposed to get everyone thinking creatively about how to achieve outcomes, but it starts and ends with a focus on money. There is a huge difference between saying, “What ways can you think of to move towards some of your goals in life?” and saying, “How would you spend up to £10,000 a year?”
Ironically, in the old system, really good social work perhaps had more opportunities to focus on outcomes, because it didn’t involve a conversation quite so focused on money. The problem was that there were only a few routes available to achieving those outcomes (council-run social care services) and they weren’t always very good at doing so. If you want there to be more ways for people to achieve their outcomes, including making available interventions which don’t even look like traditional support services (such as the famous season ticket to a football club for an isolated young disabled man, or support to set up your own enterprise as a route into employment), then you need individuals to be able to take resources and invest them as they want, rather than only within the boundaries of a council employee’s imagination.
So what to do? Before personal budgets, the culture of social work was changing, but nowhere near fast enough. It needed a major shake-up. Giving people control over at least some of the money has without doubt positively disrupted the system, changing many people’s lives and giving a large chunk of the sector a new set of ideas about what is possible. But the old system and to some extent the old ways of thinking, were resilient. Never underestimate the ability of an established order to absorb and neutralise radicalism. Councils have been told to give individuals control of their budgets at a time when they have less and less money to spend, so they have asserted control in other ways. I suspect some councils spend more money on gatekeeping their resources than they do on helping people to plan to spend them. We need to find some way of striking a deal between citizens and the state, in which the citizen (and their family and advocates) say, “I’ll be as creative and as frugal as possible in meeting my current support needs and achieving greater independence” and the council says “In return, we’ll trust that you are not fraudulent or extravagant and we’ll keep assessment and approval processes to the minimum.”
Hopelessly naïve? I don’t believe so. I think we just need a different starting point. This blog is getting way too long, so in my next one, I’m going to take those three problems and try to suggest some solutions. In the meantime, I’d be very interested to hear your solutions. Have I even identified the right problems? How are personal budgets and Direct Payments managed in your area? Comments please!