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.

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.

Why the purchaser/provider split is failing

Well, It's been quite a while since I've posted anything.. my excuses...life has been quite busy starting a new job and am finishing a dissertation among other things.

I've just spotted an excellent article on the Guardian which seems to hit the spot over just what is wrong in social care - in fact it echos a lot of what I said today to a new colleague who as it turns out his wife used to do some of my training when I was still in Social Services. It has led to me to post a response which I'd like to share here...



This is the real scandal in social care

The purchaser/provider split which came in in the 1990 act (but which has really come to maturity in the past 5-8 years as LAs ditched functions like in-house care providers and res. care homes) allows LAs to focus on driving down fees without having to worry themselves about the details of how this is achieved, or what corners are being cut to do this.The problem as pointed out is that lack of money in the system turns the purchaser/provider split into a destructive force which eats itself; it's not about getting quality care for a competitive price, but just about securing the lowest possible price to protect the diminished budget.

What we have is a failing market which is seeing a race to the bottom in terms of care standards.


A massive, massive issue to me, as I was only talking about someone to today is that the purchaser/provider split allows LAs to delegate responsibility and accountability. For instance if there is a scandal in a care home operated by a LA then the head of service and cabinet member are directly accountable... if it's with a private provider then they can simply blame a greedy owner, or bad management and point to the role of CQC.

Being able to escape this direct acvcountability means LAs can turn a blind-eye to just how margins are being cut and the impact of real cuts in the cost of care.

And being cut they are. I can't speak for now, but I began in Social Care in 2004 when providers were being paid £15 per hour for care...... when I left in 2009 the avearage was more like £10-12 per hour.

The real scandal in social care

I've always thought that an essential in any good system of social care provision is content staff.

Too often we ignore their needs and treat them as if they are invisible even if we're in the same room and I'll admit here that I've been as guilty as anyone else on a social services training course when the room divides into carers on one side and 'professionals' on the other. A few ex-colleagues of mine had worked, or even continued to work as carers, but this aside there was always to my view an element of snobbishness and power imbalance present in the many interactions between ourselves and carers.

Though a few of us did speak out about the conditions faced by carers it was a topic well down the list for us, far below issues like personalisation, or even the personality politics of the department.


But the treatment of carers is so integral to the system it should be the only issue we're talking about. Why? Well we really need to look at this holistically. If we want a system based on dignity and respect then that standard needs to apply to everyone. If care staff are treated with dignity and respect then we can in turn expect service users to be treated the same. Turning an indifferent eye to care staff being paid below the minimum wage endangers our ideals as much as mistreatment in a care home.

Can the welfare state withstand the global storm?

Blimey! What is going on in the global economy? All this talk of double dips and lost decades (or is that just Shaun Ryder)is actually starting to make me worried now. No better make that terrified.

I'm also beginning to look for a job and have been astonished at the sheer number of people competing for positions. One recent post I applied for, nothing glam at all, had 180 applicants eagerly snapping away like some tabloid feeding frenzy.

What makes me worried is how will the welfare state, weakened by three decades of neo-liberal attacks hold out? Will it be shown to be woefully inadiquate and as easily overrun as the Maginot line?

Is the big society rhetoric like some eerie harbinger of a return to when Victorian liberal capitalism smashed its way unrestrained through lives as nonchelantly as the wind whipping autumn leaves into a swirling menace.

I suspect we'll be finding out soon.

PFI - Who didn't see this one coming?

I've just read a piece on the BBC website about the strain repaying PFI projects is putting on the budget of NHS Trusts.

There is of course some political point-scoring going on, but honestly who can say that they didn't see this coming? PFI was obviously an ill-conceived idea from the beginning with controversy engulfing one of the first PFI's the Skye Bridge project which George Monbiot pointed to in his widely read 2001 Book 'Captive State; The Corporate Take Over of Britain'

Now the doubters have been proved right, but governments and local authorities still shock in their ability not to take heed of the facts when it comes to policy.

RIP Local Government

I've just read in my local rag today that my local authority will be joining forces with another local council to provide services. Is this an issue? The reason is to save money, presumably through economies of scale so win-win?

What about local democracy though? The Authority I worked for only a couple of years back is barely recognisable today. Yes there's still a grand old building slap bang in the middle of the City, but it's emptying out fast. In Social Care the in-house provider has been scaled down and care homes sold off to BUPA, Housing benefit claims are now administered in Bromley, legal services and licencing are shared with a neighbouring authority and now there's plans on the table to merge services with yet another authority.

All this means people just don't know who runs what or who is responsible for what. In these new organisations opaqueness replaces transparency whilst democratically elected councillors seem increasingly irrelevant, just how much influence can they have over services in these public-private-voluntary sector hybrid super-councils? How much say do we have as voters? Or are we no longer voters, but simply customers?