Is there a future for building-based services

A colleague recently posted a question on a LinkedIn personalisation forum about whether there is a future for building-based services.

I think we are too simplistic when we come to make decisions about building based services, particulalry when it comes to whether to keep or close them. Such services actually have three distinct parts to them, and we need to make at least three separate decisions about them:

1. There is the building, which could be used in all kinds of ways by all kinds of people, including some of the people who currently use it, but also others in the community.

2. There is a set of services, some of which may be excellent, others less so. Some may be valued by some, but not all, of the current and potential users. Some may be best provided in the current building, others better provided elsewhere.

3. There is a set of relationships, some of which may be lifelong.

It is these relationships which are most often overlooked in decision making. This is why there are supermarket cafes which have become de facto day centres for people who are bored and lonely and missing their friends. People should have choices over their relationships. Day centres and the like reduce those choices by lumping everyone together, but so do approaches which assume that everyone is always best off doing everything on their own, or in ‘the community’, particularly when the community proves hard to find, or not very interested in them. There is often a lot of work needed on finding and forming people’s networks and communities, not just a ready-made community out there for people to slot neatly into.

People who use services and potential service users, and their families, should all have a say in planning to maintain and develop all three aspects of existing services, not just the most obvious aspects of them.

Care: industrial scale or cottage industry?

There are, we are often reminded, 30,000 residents in Southern Cross’s care homes. There is an argument about to what extent it would affect those residents if Southern Cross’s approach to funding its expansion, which relied heavily upon property speculation during the boom, ultimately led to its demise as a company.

Some people say it wouldn’t make any difference to residents – if a care home is viable it will simply be sold on to another provider. The Association of Directors of Adult Social Services have emphasised the need for councils to continue sending residents to Southern Cross homes to keep the company afloat.

But if it makes no difference to residents whether or not the company stays afloat, then why does it matter if it continues to have enough ‘customers’? Whereas, if Southern Cross going bankrupt will make a difference to them, then it cannot be in an individual’s interests to be “sent” to one of their homes. 

Individuals are not commodities, to be traded by councils and care providers, even in the interests of what might be considered the greater good. Councils are under an obligation to individually assess older people and to support them to make the best choices about care for them. A blanket recommendation to push people towards a care provider which may not be able to offer stability is unacceptable.

I think it’s hard to maintain the argument that residents have nothing to fear from Southern Cross going bankrupt. In order to attempt to stay afloat, the company has just cut 3,000 front line caring jobs. In other words, here we have yet another situation in which rash decisions made in order to maximise profits result in negative consequences for people who had no part in those decisions. It was of course, those residents’ money (or in the case of those whose care was state-funded, taxpayers’ money), which was hived off in the good years into the pockets of bosses and shareholders.

The Southern Cross crisis, coupled with the Winterbourne abuse scandal uncovered by BBC’s Panorama, should initiate a pause for thought about the relative risks and benefits of industrial scale care and support Continue reading

Alternatives to PAs

In my blog below, I outlined some pernicious myths about personalisation. One of them is that personalisation is all about giving people Direct Payments, usually to employ a Personal Assistant (PA). This myth is important: if we don’t address it, it has the potential to do real damage to the goals of personalisation, which are that people will have a real choice of how they are supported and by whom and that they will be able to build a life where they feel in control and like they belong.

We are seeing an increasing number of cases where an individual is supported by a Personal Assistant (PA), but does not want the responsibilities of being an employer. Sometimes individuals and PAs are encouraged to treat the relationship as one in which the PA is self-employed, in order to avoid the budget holder having to take on the tax and employment liabilities of being an employer.

This is dangerous. The Revenue have pursued disabled people for thousands in unpaid National Insurance contributions and tribunals have found that people who were treated as self-employed were nevertheless employees, entitled to sick pay, holiday pay and so on. Cases like these add the perception of personalisation as risky and badly thought out. There are three things we need to do to address this situation Continue reading

Too late for Big Society? Too late for personalisation?



This blog doesn’t get thousands of readers, so I’m hoping that blogging about the Big Society doesn’t see off those readers I have! It’s rapidly becoming a tiresome subject, with lots of hot air on both sides. But I’ve been drafting our response to the Public Accounts Select Committee’s inquiry into the Big Society and I was struck by the similarities in the debate about the Big Society and the debate about personalisation in social care.

It says something about the policy that the first question the Select Committee asks about the Big Society is: What the hell is it?

I think the Big Society combines two ideas, one uncontroversial and one political. The (hopefully) uncontroversial idea is that it would be a good thing if it people found it easier to help each other more and to contribute to their communities. The party political idea is that the state inevitably gets in the way of people doing this, and so we need a smaller government. Whether one agrees with this point or not, the big state/ small state divide is one of the few remaining clear divides between ‘left’ and ‘right’ in mainstream politics.

At a time of public service cuts, it is understandable that in the minds of many people, “smaller government” and “shrinking public services” seem like the same thing. But small government describes the aspirations of government and its decision-making powers, particularly the extent to which central government controls local government, and local government controls communities. Whilst cuts are a question of how much is spent providing or funding local services.

The view in our draft response to the Inquiry (it’s not been sent in yet, so your views are welcome!) is that it would be a great pity if the debate about cuts precluded a sensible discussion of where the state should draw back, move sideways, or indeed step forwards and intervene to help. Whilst the overall size of the state is a party political issue, there are undoubtedly areas in which there could be cross-party consensus on the desirability of the state drawing back, or operating differently. And even the most “small state” and localising of politicians do on occasion advocate central government action to promote their preferred local approaches. For instance, the Secretary of State for Communities and Local Government, Eric Pickles, suggested to delegates at an NCVO conference that councils could be Continue reading

Making cuts or Putting People First?

With everyone braced for cuts in support services and a fair few scratching their heads about the idea of “the Big Society”, we thought it might be a good time to release our new report, Cuts or Putting People First? The report shows you that even when budgets are being cut, disabled people, families and front line workers are achieveing some pretty extraordinary things.

The report was welcomed by ADASS President, Richard Jones, who is the keynote speaker at the NAAPS national conference in November, said, “I welcome the challenge laid down by this report. It shows that highly personalised services such as Shared Lives, not always offered as a choice to older and disabled people, can make a real difference for individuals with needs which other services may not be able to meet affordably. This can mean savings for councils but more importantly can achieve better outcomes for older and disabled people and enable them to live their life the way they want. It is our responsibility as social care leaders to ensure that people not only have control over social care budgets but also a wide menu of services from which to choose which enable real choices to be made.”

The report is at http://www.naaps.co.uk/downloads/Cuts_or_personalisation_NAAPS_Sep_2010.pdf

A million micro-enterprises

Greg Clark MP, Minister for decentralisation at Communities and Local Government, has been talking about what The Big Society means: http://bit.ly/c4vjiN . He says it has three strands: public sector reform, community empowerment and philanthropic action. NAAPS believes that micro-enterprise is a blend of all three.

We are often asked by policy makers how to scale up micro-enterprise. Continue reading

In-house or out-sourced?

I really enjoyed visiting ASA (Adults Supporting Adults) Lincolnshire this week (www.asaorg.co.uk). ASA has 60 Shared Lives carers offering long term and respite support to around 70 people. They also provide 4000 hours per month of support for people wishing to remain in their own homes or develop new independence. 12 of the Shared Lives carers just support people with dementia. As usual, meeting the people who use Shared Lives and the Shared Lives carers was the highlight. Continue reading