In the last week I've reached a milestone. I now automatically write the date as 2010, no longer is my official correspondance besmirched by a scruffily scrubbed out 09.
Social care is also at something of a milestone. Twenty years since the last major piece of legislation the 1990 NHS and Community Care Act.
Interestingly major legislation appears to come neatly in two decade cycles. The 1948 NA act and 1970 CSDP act both preceding the 1990 act. In terms of adult services this previous legislation has remained on the statute book - there has never been a clean sweep of the legislative broom with the result that the legislative framework takes on a the architectural characteristics of Hampton Court Palace with wings added, rooms refurbished, new facades and repaired fire damage. Can we expect another addition to this mix in the next few years and if so what shape will it take?
There has been an attitude shift at the heart of the welfare state. Beneficiaries are no longer the passive recipients of the Beveridge era but are in policy terms becoming 'active' This is very much a rights and responsibilities issue and has been seen so far in unemployment benefit where recipients are expected to enter into a contract to actively look for work and update their skills. For social care it will mean a shift in emphasis from a care manager planning a care package and providing services contracted through the local authourity; instead it will mean an individual deciding on their own sources of support and managing this. In other words a person will have a right to care but the responsibility to plan and arrange it.
I also expect the way in which care is funded to change. My initial reading had been that there was an expectation that the cash locked in glacial-like block contracts would as they melted in the new climate mingle with funding streams from the voluntary and private sectors to create a fertile valley of healthy diverse services resulting in savings. This expectation was wildly optimistic. The cheapest way of providing services is by uniform en-masse block contracts with in-built economies of scale. I wouldn't be surprised to see a modified AA and DLA given more of a centre-stage role when it comes to funding care packages and longer term beleive there may well be a move toward a social-insurance type scheme with a degree of state and private sector involvement. I also expect the directly paid workforce in local authorities to be reduced to social workers focused on safeguarding work and a rump of care managers focused on auditing and approving care packages with activities such as setting up care, dealing with minor issues and completing assessment forms to be carried out by the voluntary sector.
It is impossible to predict however, whether these changes will be good or bad. There are certainly concerns. My biggest concern would be middle-class opt-out. Under personalisation the middle class who can top-up may opt out leaving those less well off or with complex needs in receipt of residual services - possibly offered by a local authourity as a 'safety-net'. In social policy there is a wealth of literature to suggest middle class opt-out has huge negative affects on services which become more succeptible to funding cuts. Just think about the arguements that schools fail when the middle class pull their children out.
This and other issues remain a question of government. Both parties favour personalisation. It is a curious issue where the critique of the right has informed the actions of the left. The parties will I beleive differ in their emphasis on elements of the policy with the Tories true to type favouring a more private sector based funding resolution wheras Labour will favour the road of voluntary sector partnerships.
1 week ago