Bashing and boosting micro-enterprise

We launched a new report today on the top ten ways in which councils are boosting – and bashing – micro-enterprises in their area. Whilst some areas limit ways of spending personal budgets or access to ‘approved provider’ lists to tried and tested large providers, others actively encourage creativity and have thought through the environment needed for successful start-ups. Some councils throw a bit of money at budding micro-entrepreneurs in the hope that some great ideas will stick, whilst others have used the learning from successful micro-enterprise programmes (eg 125 jobs and 40 volunteering opportunities created in three years by Oldham’s Community Catalysts programme) to create a really thoughtful support programme which gives entrepreneurs a fighting chance of success.

The variation in micro-enterprise support is huge. Even areas with expensive brokerage systems are often only able to offer people the option of a Personal Assistant or traditional services. The report suggests that most areas have some way to go to unlock local people’s creativity and to raise aspirations. But the rewards are huge, as Angela Catley of our sister organisation, Community Catalysts, points out in an interesting article about micro-enterprise, which includes a picture of the Green Team in Dudley, which was set up by three support workers to provide people with learning disabilities with an alternative to day services in the shape of meaningful work as part of a gardening team.

User-led brokerage

Here’s a guest blog from Simon Taylor (Simon@sharedlivesplus.org.uk),  who supports our micro-enterprise members:

“It’s sometimes hard to stay positive about the changes in social care, but meeting Becky Daykin from Notts Independent Living Consultancy ensures that you will. Despite the challenges, along with her business partner Sarah Moakes, Becky has stepped from the world of social work to be a part of the practical changes ensuring personalisation can offer real choice.

Together they now run a new micro-enterprise which combines their thirteen years of experience to assist people in setting up and manage Direct Payments. They offer support and advice on being an employer, recruitment, setting up payroll and employment contracts etc. They also offer training for personal assistants, organisations and corporate businesses about disability, equality and deaf awareness. All their staff are disabled and receive either Direct Payments, a Personal Budget or Disabled Students Allowance.

Becky herself is Deaf.  Others often see this as a barrier but it is not the barrier she is most concerned about when she speaks of her experience in running her business, where the real struggle is with Local Authorities to make better use of micro-enterprises in delivering small local services.

She commented, “Too often Deaf People are seen as not able to manage their own budgets and are directed by the social work professionals towards managed budgets

Direct Payments and care homes

One of the questions being considered for inclusion in next Spring’s social care White Paper is whether people should be able to use Direct Payments to pay for residential care, which at the moment is unlawful. The personalisation group of the White Paper engagement team is leading on this issue, so I’m very much writing about this with my own views, not in any way as co-lead of the prevention group.

My understanding of the rationale for excluding residential care users from Direct Payments, was that people may have been encouraged to buy the same old thing they were being offered before, which would not then amount to a radical change in the choice of provision out there. I’ve written a number of times about the ways in which the state and professionals have proved adept at assimilating the mechanisms of personalisation into their existing world view; I’m sure that having the option of transferring residential care users onto Direct Payments would have added to that problem.

I’m equally sure that the two-tier system which has resulted, with people who continue to use residential care excluded from one of the key aspects of personalisation cannot continue. It just doesn’t feel fair that I should lose a key route to choice and control when I move from receiving home care to a care home. However, I’m equally sure that opening up Direct Payments won’t by itself transform residential care. It will need to be part of re-thinking how care homes work. Community Care’s recent article on care provider Dimensions, which attempted to introduce more choice and control in one of its care homes, shows that addressing staff expectations and practice was more important than introducing an individual service fund approach to personal budgets.

It’s also worth noting that older people have been spending their own money on care homes for years, without the private care homes market establishing a reputation for forging ahead on choice, quality and value. As the Southern Cross debacle demonstrated, being an individual consumer of the product of an uncompetitive industry is not a very empowered place to be.

A colleague objected to a recent tweet in which I asked whether introducing Direct Payments for over and under 65s who use care homes would have very different connotations.

Time to ditch the RAS? Part 2.

In an entry a couple of weeks ago, I identified three problems with the current way in which an individual’s needs are assessed, then their ability to pay, and then their social care entitlement converted into a cash amount, which they are helped to spend. I suggested that, even done well, the system had these problems:

1. The assessment of your needs is based on you proving how bad things are. You might even have to wait for things to get worse before you become eligible for expensive support, when making cheaper, preventative support available would have been much more cost-effective.
2. The addition of extra assessment and planning stages to the existing system, in order to convert your needs into an appropriate cash personal budget, has added bureaucracy. There is actually more gatekeeping than ever in some areas.
3. The process focuses everyone on the money, which makes it harder to focus on outcomes and being creative.

I promised to think up some solutions to those problems, and asked you for yours.

The comments you were kind enough to post were very interesting. There was some consensus around the problems. No one believes that giving people the chance to control the money that is spent on them is the wrong aim, but lots of people would like it to be simpler, quicker and fairer to get to that amount of money, with fewer restrictions on what it is spent on. Several people feel that there is no way round the need for a RAS type system, and we should accept that reality and focus on making it work. If you put identifying the service first, you’ve returned to the old system; if you put identifying the budget first, you need to base that budget on costings based on a range of likely services. Few contributors, I felt, could articulate a practical third way.

Resource allocation systems build in two opportunities for professionals to exert control: first in setting an indicative amount, then in signing off (or not) the final budget. If it is never going to be possible for the state to relinquish budget sign-off completely, how could that control at least be eroded or tempered, without leading to bankrupt councils?

At a corporate level, council finance directors cannot relinquish overall control of budgets: it’s their job not to overspend. There is a tension between this need to exert control at a population level and the desire to relinquish budgetary control at the individual level. We could reduce that tension in a couple of ways:

First, and least likely, we could give council finance directors a breathing space where, if they can produce balanced budgets over five years, their budgets can be guaranteed for that period. This would allow councils to invest in prevention and to look more kindly on individuals who need to invest in non-traditional interventions which might prevent greater need later on. It’s hard to imagine this happening. The evidence base for many preventative services is weak and the government would need to find money up front and underwrite the losses if council’s plans didn’t work out.

Secondly, we could help people who use services act a little more like finance directors,

Time to ditch the RAS?

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:

1.  The individual is assessed to see if they are eligible for state support.
2.  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.
3.  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.
4.  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.