What would be better than the Resource Allocation System?

The Resource Allocation System (RAS)  in adult social care in England is the means by which local authorities determine the size of the ‘personal budget’ pot in social care and the money that will be paid (or services in lieu) to the recipient.

The ethos of the personal budget, whether delivered by a direct payment or a ‘managed’ budget or an Individual Service Fund is clarity. The user/recipient of the service knows how much ‘money’ is in the pot to spend – even if they aren’t making those spending choices directly.

So why is there a problem with the RAS? Lucy at The Small Places explains in her excellent and highly recommended post here. She has undertaken a piece of research asking various local authorities for details about their Resource Allocation Systems. What this means in effect is asking how the algorithms are calculated that assigned particular values (money) to ‘needing help with preparing meals’ or ‘having a family member to help’.  Lucy explains that two reasons she was given by different local authorities for not disclosing were that revealing the formula might ‘distort’ future requests (i.e. people could fiddle the system if they knew which questions were weighted in particular ways) or that the RAS is a commercially sensitive document.

Quite rightly these arguments are picked apart in the blog post referenced so I won’t go over that again.

I did want to consider a question that was put to me last night (via Twitter) namely ‘What’s the solution?’.

I’m sure I’d be in a position in a very different grade to the one I’m in now if I had a bullet proof solution but it raises some thoughts in me that needed longer than 140 characters.

Bye Bye Bower

Yesterday Cynthia Bower resigned at the Chief Executive of the Care Quality Commission. I remain amazed that she was ever seen as competent to run it in the first place but it’s easy to be wise in hindsight. Her departure is no surprise as the organisation has consistently been shown to be ineffective and unable to effectively or safely keep within its remit as the regulator of health and adult social care services in England.

As the Guardian states, at the time of Bower’s appointment by the Labour Government

Andrew Lansley, the then shadow health secretary, said at the time: “We have to ask whether it is right that the person in charge of the West Midlands strategic health authority at the time, Cynthia Bower, is now to be put in charge of the national regulator which heads up these investigations and which will be responsible for ensuring that this never happens again in Mid Staffordshire or elsewhere.”

Lucy at The Small Places refers to some of the closing statements at the Mid Staffordshire Inquiry which shine a light on the actions in the CQC at the time. She quotes Dame Barbara Young’s evidence – who had resigned as CEO of the CQC and was asked why – saying

I really believed strongly that we could only do a good job if we were on the ground locally inspecting with rigour and understanding what was happening locally in health core systems and in hospitals that were delivering services. And I knew that we were finding it quite difficult to ensure that that was the case with the resource we had. And I could see further restrictions in resources on the horizon, because by then it was clear that the service was going to share in cuts. And I could also see that that was going to happen at a time when the quality of care was going to be even more at risk than usual as a result of health core cuts in services.

So you’d be a regulator in a very difficult position, with government, accountable to government, but responsible really to the public, with less resource to regulate effectively, and services being more at risk And it just felt to me that that was not a job that my skills were best suited for.

Lucy, in her excellent post, points out, quite rightly that it was the Labour Government that was responsible for establishing the CQC in its current form. This goes beyond the party political. It is about creating a system which has allowed a more rigorous inspection regime to lapse faced with cost and faced with the potential to cause a political ‘stink’ when hospitals in particular might be found to be ‘failing’.

And where now for the CQC? Bower leaving was necessary but it looks as if the problems that run through the organisation are far more endemic than a change at the top. There needs to be trust restored in an organisation which is supposed to regulate services that we all depend on wholly.

My experience is more in the social care side than health and I see the dilution of regulation has happened over the years with poorer services, fewer inspections and inspectors with more experience in auditing paper records than inspecting care homes thoroughly ‘on the ground’.

Meanwhile, Paul Burstow calls for Dignity Codes for older people – who will be responsible for ensuring these ‘codes’ that apparently he wants care workers to sign up to are upheld? and his now cancelled so-called ‘excellence’ schemes which was unravelled and ratings sites – they all seem to be attempts to cover up the need for strong regulation and inspection because that would cost more money.

So Bower’s leaving is just an admission of failure and acceptance that she should never have been in that post to start with. She has barely displaying competence in ‘leadership’ but leadership is not just about one person and while the systems remain in place, we wait to be see if there will be any really useful changes in a regulatory body which has had such a difficult birthing experience.