Thursday, 19 January 2012

Personalisation Risk and ResponsibilitySome interesting reports

Following on from my last post I've just happened across some reports from the Joseph Rowntree Foundation on the topic of rights an responsibilities. There is a particularly interesting discussion about risk in one paper which has actually pushed me a little closer to the pro camp on personalisation. Interestingly the paper draws a conclusion that under a system of personalisation;

Risk should be shared between the person who takes the risk and the system that is trying to support them. This has probably always been the case and in many ways the personalisation agenda simply makes this more explicit, shifting the balance of power and making genuine risk sharing more likely in future.

What of course is missing from the discussions is what such an overt cultural shift would be likely to mean. As I mentioned in the previous post the logical end-point is that there is a much reduced role for 'social services' as we know it today - particularly as a large part of care management is concerned with assessing for and managing risk.

Perhaps in terms of complex cases and at times of crisis there will still be some role, but for the rest of the time it is much diminished even possibly redundant.

Is this a good, or bad thing? In some respects it is good, it empowers individuals to make their own decisions and choices and yes, social care needs a cultural change. When I returned to university to study social policy I remember being sat in the canteen and seeing a social work student - discernable by the hoodie they wore. It is something of a fashion for people to wear hoodies with some kind of subject related double entendre on the back i.e 'Lawyers do it without briefs' or somesuch thing, but in this case it was a rather earnest 'Social Work; Be the difference.' Maybe I'm wrong, maybe its a noble sentiment, but for me it had a smack of arrogance and seemed to re-enforce the view of professional/service user divide. We should also not lose sight of the fact that the system is there to meet a need, i.e it is a means, not an end - therefore we have no interest in protecting the current system for its own sake.

On the other hand though there is an issue of the balance between rights and responsibilities which personalisation makes more clear. If we take a long-term view then it is possible to see a future in which it is the assumption that social care in most cases is largely a private matter, for individuals- a view which provides a platform for further retrenchment of the state from the social care sector. Maybe this too is a good thing; are private services more responsive to individuals needs, would the voluntary sector better anticipate needs and be better at providing innovative services, or would such a change be merely to abandon those in need to the vagaries of the free market?

I make no judgement on any of this at present. The debates are many, complex and fragmented (as my own dissertation on organisational mission across the three sectors finds), the key point though is that the debate on the future of social care needs to pay far more consideration to the likely implications of changes in assumptions around rights and responsibilities particularly around the movement of responsibility from the state to the individual.

Tuesday, 17 January 2012

Social Care: Rights and Responsibilities

So this week brings a few more stories about the search a funding solution in social care. We all agree(and have done for quite a while) that the present system is not the best, but often as is the way with these things there seems to be less appetite for proposing real alternatives.

When it comes to alternatives and reform of the system there is a clear direction which debate has been taking over the past two decades, consisting of two interrelated dimensions these being; just how much are we expecting people to A.) take responsibility for their care and B.) contribute financially towards it.

In terms of A.) the popular policy term these days used across all aspects of the welfare state is 'co-production'- one of the best examples of co-production being individual budgets where people take an active role in managing services, not just the passive role of recipient.There are, it is to be said, lots of good things about individual budgets, but I always felt this policy agenda amounted to a much bigger cultural change than most of my colleagues ever really acknowledged, one involving a fundamental rewriting of the contract between service user and the state (or social services department).

Having just read Tony Blair's autobiography it seems co-production fits snugly with the emphasis on 'rights and responsibilities.' Ultimately in social care we're not just in effect handing over rights of control of care packages to individuals, but along with it all the responsibilities in terms of managing risk and ensuring the appropriateness of services to meet needs. Whilst the state still funds services, particularly for those without the resources, the logical end-point is for it to play only a limited role in assisting individuals with making choices from the mixed economy of welfare - in other words guiding the purchase, or accessing of services from the private and voluntary sectors.

I was even involved a few years ago in a pilot self-assessment project which had the aim of cutting out the middleman completely - imagine a system where a person completes an assessment form this is then approved by the social services department and a budget allocated which is paid into the persons bank account allowing them to source their care individually.It was for many reasons a failure (though these were little to do with the principle of the plan) and eventually it ran out of steam, but it was I felt ahead of its time.

So we have here a future where we have moved from a pre 1990 ACT situation where Local Authorities controlled every aspect of care from funding, assessment, management, provision of and to an extent regulation of services to a fully post-90 world where it funds care (in some cases) but to which all other functions have been delegated to individual service users, the private and voluntary sectors and an external regulator.

It may seem something of a distraction to discuss all this in terms of funding, but the way in which social care is organised and funded are more closely aligned than has been credited. For instance in a system like the one set out above where individuals are agreed to have greater responsibilities and where social services departments play a limited role in facilitating choice, rather than actually assessing for, regulating and providing services this allows a greater scope for the development of private insurance as social care becomes largely a financial issue with individual budgets also providing fertile ground for the growth of a much more extensive market in care services to replace what were local monopolies of state provided services.

The question increasingly asked will be should individuals plan for care needs in the same way as they are expected to for retirement? should they for instance take out private insurance. If so what should be the role of the state in facilitating this - should it make such insurance compulsory (such an idea was in fact mooted a few years ago), should it subsidise, incentivise or regulate this market? Most importantly would such a market function? We know the case of pensions is just as problematic with many being unable, or unwilling to save.

It seems the debate is simple, but the answers are not.