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.

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