Are big centralised services so bad? The Conservatives seem to beleive so. Policy developments like Foundation Hospitals and Individual Budgets also suggest Labour feel the same so whatever the result of the forthcoming election we can expect the move towards smaller, localy planned and delivered services provided by a rang of providers to continue at either the same pace or an accelerated pace.
I'm uneasy with this development. On one hand I recall a conversation with a person from a Third sector organisation who talked about the ability they had to be able to provide services such as aromatherapy which their service users found valuable, but which would be unlikely to be made available by the authourity. This was clearly a prime example the benefits of the sector: closeness to service users means more responsiveness to their needs coupled with the ability to innovate free of burcratic controls.
The organisation was however, highly dependent on Local Authourity funding to provide itsservices and interestingly bemoaned the cutbacks which had been made within their service area in Local Authourity that had ironically been used to provide a chunk of their funding. The point of stating this is that the Third Sector is not a stand alone sector staffed by volunteers but is a sector dependent on funding which has been diverted from previously centralised services.
The experience of the last few years has been that the more involved Third Sector organisations become with service provision the more they need to dedicate time to funding bids, planning and reporting. This has led some to argue that the Third Sector has lost its distinctive character and now effectively many organisations ape the centralised, buracratic state bodies they are replacing. The opposing view is of course that closer working means more opportunity to influence the system (not disimmilar to the point made by Ben and Jerry's founders in the face of their take-over by Unilever that they hoped Ben and Jerry's distinctive values would influence the multinational rather than erase their own)
This leaves us with the disadvantages. Producer interest has been cited as becoming a problem in the Third Sector, increasing professionalisation means more professionals and more buracracy invariably increases distance from service users. The sectors advocacy function also becomes problematic in the context of closer working with state bodies. Most challenging though is the problem of inequality. The modern Third Sector has since it's emergence in the 1970s been a very middle-class animal, drawing on middle class volunteers and now professionals leading to accusations that it exasperates rather than releives inequality.
Of course many of these accusations can also be levelled at centralised state services. I do however, feel that rather than charging headlong alsong the course plotted for the past decade is dangerous, rather we need a period of soul searching in which we are realistic about the costs and benefits of all forms of welfare provision.
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I have worked in adult services for four years now. In this time I have done a full transition from post 16 of a young man with challenging behaviour and severe learning disabilities. As a key worker I've challenged and been able to secure several different levels of funding to help support him from additional hours to walking aids and adaptations.
ReplyDeleteI have taken an active interest in Individual Budgets for some time now. I currently work in a Government day service which with the introduction of Individual budgets will more than likely close. This however is not my concern I believe like many others that this is all just a massive cost saving exercise dressed up as promotion of choice and control for adults with learning disabilities.
My concern also is how will adults with complex learning disabilities be supported with individual budgets. I really doubt that for example the person I support will be given anywhere near the same amount of money as his existing care package is worth. Where as his needs are extremely high. Will this lead to him only being able to purchase cheaper options which in my opinion will lower his quality of care?
In addition this, how can individual budgets be so close to being implemented when 99% of adults with learning disabilities that I have spoken to and their families have not even heard of them.
The entire exercise I think is bordering on a human rights issue.
For IB's the 64 million dollar question is concerning the governments funding commitment. I actually had some training on assessing for IBs and the example care plans we were given appeared to be far, far more generous than what we were used to. It was tempting to beleive that this was just a short-term strategy, basically an 'introductory offer' and once you'd signed on the dotted line the charges would suddenly rise rather steeply.
ReplyDeleteThere was some optimism initialy that IBs would make savings, so service improvements could theoretically be made without increasing expenditure levels, but I beleive that most authourities (certainly mine did) involved in the early piloting of IBs revised these estimates and estimated IBs would require the same expenditure.
There is a strong case for IBs in terms of service user empowerment, going even further than DPs to break down segregational barriers and acting as an impetus for innovation in the third and private sectors. I do feel though, like you say, that to an extent government were attracted to the policy to make cost savings. Either by efficiency savings, by encouraging growth in the social enterprise/third sector or whether it is to shift peoples assumptions of state welfare provision, making individuals responsible for organising their care today will make it easier to then make them, particularly in the case of the elderly, responsible for funding it tomorrow through some sort of private insurance scheme.
The benefits of IBs also need to be balanced against the very real dangers. Firstly inequality. IBs bring topping-up into the realms of non-dom care which has some big implications. The arguement from authourities is that they will still provide services for those who need them, but in the main state services aimed at only a small segment of the population tend to be of a residual nature and very poor quality, as is the case with free healthcare in the US; there is a free service for the very poorest, but it is very poor qwuality. Our own NHS's strength is in its universalism; any mention of cuts arouses indignation from the middle classes. So much so that even Thatcher was very wary of tinkering with it - her first peice of legislation ironically being the 1990 NHS and Community Care Act, that's 11 years after taking power.