Personalisation , Personal Budgets and Demos

I have a lot of thoughts on the push towards the personalisation agenda in general, unsurprisingly as care and support planning plays a large role in my job.

Over the last week, a variety of meetings that have taken place which have pushed this issue to the forefront of my mind locally and have given me time to pause and think, not only about the focus of the agenda and where we are along the path but also where we are going.

It has been frustrating. As I noticed in a Twitter-related conversation yesterday, the language almost seems to have a form of it’s own. I start mentioning PBs, IBs, SDS, RAS, ISF, SSAQ, DP (see Glossary below)  assuming the person beyond knows exactly what I mean in each of those circumstances and you realise how over-complicated what should be a fundamental principal about putting the keys to the power dynamic into the hands of those who use the services.

Rumbling in the background is the government agenda to push personal budgets (PB) as a way to deliver ‘personalised’ care and a push into ‘health budgets’. I think there have been a number of issues that have either not been addressed or pushed under the proverbial carpet in the meantime.

I have tried to express some of my frustrations internally but often came up against the ‘you are either for us or against us’ mentality to those promoting the push towards personal budgets for all at any cost – so by raising criticisms and concerns, that automatically seemed to push me into the ‘controlling professional’ category who obviously just didn’t want to relinquish what I saw as my ‘right’ to dictate forms of care to service users and carers. I dispute that of course. I was one of the few care managers who actively moved many people onto direct payments historically. I am very well aware of the benefits of direct payments but the move towards direct payments for all I felt, was pushed by a few particular groups of people and I was concerned that it was moving the universality of self-directed support away from a large group of people I work with who do not want direct payments regardless of how much support is offered.

I was delighted to read over the past day or so, a report by Claudia Wood called Tailor Made – it’s a long document and my reading has so far been on a superficial level (warning – um. if you are going to print it out  be aware that it’s.. er.. well over 200 pages.. )

It is a document that almost made me cry with joy because it addresses in a more coherent and less histrionic way than I have, exactly my concerns about the way the personalisation agenda has been couched while remaining (as I am) absolutely positive about the process and idea.

We have been too fixated (and Paul Burstow is guiltiest of this) of pushing personal budgets delivered through direct payments as the ‘gold standard’ option of providing self-directed support.

As Wood says in the executive summary

‘The emphasis placed on direct payments as a primary form of personal budget is too restrictive and risks excluding large numbers of people who do not have the capacity or desire to use a direct payment. No one should be excluded from having a personal budget if they wish , but to make personal budgets as accessible as possible for all groups and in all care contexts, we need to think beyond direct payments as the only, or even the preferred, form of personal budget’

For me, Wood expresses clearly my own thinking on this matter. So much energy has nationally focussed solely on direct payments as a delivery mechanism (which is fantastic for some) that local authority managed budgets have become a second-best, second-class service and ‘transferring’ support from standard support to a ‘so-called’ personal budget managed by the local authority has been a fallacy and a lesson in tick box culture at its worst. The issue is that it is  social workers, yes, like me, who have been complicit in this deception. I tick a few boxes and automatically Mr Smith has a personal budget managed by the LA where previously he had a directly provided care package. The delivery is the same service, by the same people in the same way,  but now, after these boxes have been ticked (because he expressly does not want a direct payment) – he is suddenly on the local authority ‘figures’ as having a managed personal budget.

Whereas Mr Brown next door, who has a service of the same cost but a direct payment, is able to access a personally chosen personal assistant and goes to a sports centre instead of a day centre etc etc.

This seems inherently wrong but it is merely because the managed support is so poorly serving Mr Smith. The answer isn’t to give Mr Smith a direct payment because – and this is the issue that Burstow seems to ignore – he doesn’t actually want it.

Wood writes

‘Local authority commissioners… must.. scrutinise their ‘managed budgets’ processes, to ensure they deliver choice and control and are not part of a tick box exercise’

Finally, it feels that someone ‘out there’ is listening to our worries and genuine concerns about a system that seems to have been designed to deliver inequity.

She goes on to say

‘An inclusive personal budget strategy is… one where more innovative uses of personal budgets are developed’

And that, I think is the key. We have had direct payments for a long, long term. Where the real innovation is needed is on pushing out new ways of delivering personalised care within the context of managed budgets.

Wood helpfully specifies the different ways that personal budgets can be used saying

‘There are six forms of personal budget used in social care in England

– a direct payment (held by individual)

– an indirect payment (held by a trusted other – eg a friend of family)

– a trust fund (held by a trust of people)

– a brokered fund (held by a professional broker)

– an individual service fund (held by a provider)

– a care managed fund (held by local commissioners) ‘

and then goes on to say

‘There is a danger.. that as the Scottish and English governments focus on direct payments as the default and preferred modus operandi for personal budgets (in social care at least), people may assume these other forms of personal budget are not capable of ‘real’ personalisation.

This can become a self-fulfilling prophecy, with providers spending less time developing their systems for these other forms of personal budget and them becoming tokenistic forms of personal budget, which do not offer real control’

If Claudia Wood were in the same room as me, I would applaud her. THAT for me is the crucial point in all of this. I want to deliver more personalised services but the only tools I have been given within my local authority are direct payments (or indirect payments)  or care managed fund. All these other options have been theoretical and none have developed any flexibility.

I want to see as much effort nationally in developing new ways of delivering services through all these methods and I want Burstow to at least read this report to have an understanding about why he seems to be fixated on the ‘direct payment or bust’ preferred model.

Of course, when it works, it is fantastic but we need more work on the other models too to ensure an equitable system for all needing care.

As for the report, there is so  much more in it than I’ve touched on about personalisation in residential care particularly. If you have any interest in the subject read it.

GLOSSARY

PB – Personal Budget (delivered by social care – (or health in the future)

IB – Individual Budget (envisaged to include different income streams eg health + social care budget)

SDS – Self Directed Support

RAS – Resource Allocation System (‘points’ that are translated into cash to make an ‘indicative budget’ after an assessment)

ISF – Individual Service Fund where a provider holds the budget on behalf of a service user

SSAQ – Supported Self Assessment Questionnaire – the way that needs are often assessed initially.

DP – Direct Payment