User-led organisations: endangered species?

I do my best to remain optimistic during these too-frequently grim times. One of the determining factors of what the sector achieves on much diminished resources, will be what we continued to believe was possible. Our public finances perhaps haven’t been this bad since about 1948. But in that year our grandparents looked around at the post-war wreckage and decided that a National Health Service was possible.

Of course, those were the days of when big national infrastructures were created from Whitehall (casual observers may be surprised to hear that the current NHS Bill, with its thousand amendments, is an example of ‘bottom up’ change). Social care has been re-shaped to give more control at the level of the council, the community and the individual.

So User-Led Organisations (ULOs) should be a key part of ‘personalising’ social care. After all, they embody the idea of individuals who use services being in control, and their work is often about people having a voice in local decisions, or being able to shape their own care package. They are also typically small and local, forming a bridge between councils and the people who are most affected by their decisions.

So I couldn’t help my heart sinking when, on the same day, I heard about two areas which were planning sweeping cuts to their ULOs. Had those areas completely misunderstood the basics of personalisation? Apparently not: at least one was an area with leaders who are advocates of personalisation. So what was going on?

It’s always risky to comment on local changes from a distance, but my impression is that cuts to ULOs are far from isolated (please let me know what’s going on your area, by commenting below) and that they are not unrelated to the tendency in some areas to see the role of ULOs as being largely focused on consultation. When there’s lots of money to invest in services, it’s nice to find out what people think about how you’re spending it. It’s not so nice when money is tight and most of the decisions are about cuts, not investment. It’s also hard to justify spending money on finding out what people think of your tough decisions, rather than spending money on support services themselves.

In other words, consultation is not a core function, it’s a ‘nice-to-have’. Increasingly, the core function of councils is commissioning: understanding a population’s needs and potential and shaping the local market of services accordingly. Consultation is an aid to commissioning; but it doesn’t put ULOs at the heart of commissioning, which is where they should be. Some councils have taken the decision to replace consultation with genuine ‘co-production’: the current jargon meaning that core activities are carried out by an equal partnership of citizens and professionals. Arrangements of that kind are less likely to be cut, not just because service users and other citizens are making those decisions themselves, but also because those people are involved in the core business, not commenting from the sidelines.

In Lambeth’s ‘co-operative council’ model, for instance, the council is creating a network of community services owned and controlled by local communities, which have taken charge of £3.5m over three years.  Council ‘entrepreneurs’ help organisations to develop and become a sustainable part of the local market place. 

On a much smaller scale, some micro-enterprises are set up and controlled by service users and family carers and deliver support services, which stand or fall not by the indulgence of councils, but by whether individuals spend their personal budgets or their own money on buying what they have to offer. I’ve blogged about examples of these enterprises below.

So perhaps those councils cutting ULOs did misunderstand personalisation. They thought they needed to know what people thought of the decisions they would continue to make, instead of understanding that their job was genuine power-sharing with citizens, in good times – and in bad.

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