In recent years the government has increasingly championed the ‘personalisation’ of social care services. While the vision is sound, is personalisation working in practice?
Recent months have seen the personalisation agenda accelerate as we head towards the publication of the Valuing People Now strategy. According to the Commission for Social Care Inspection, at March 2006 there were 32,000 using direct payments. A year later there were 40,600 and figures for 2007-2008 are expected to confirm this upwards trend.
In 2005 a Cabinet Office report, Improving the Life Chances of Disabled People, talked about increasing the ability of disabled people to live independently through individual budgets. Since then, a raft of government documentation has promoted personalisation as a key plank of the modernisation of the social care sector.
Independence, Well-being and Choice, the 2005 green paper on adult social care, recognised that social care had traditionally fostered dependence on its services. To promote independence, it proposed the piloting of individual budgets.
Taking its lead from in Control – a personalised model for social care initially trialled with people with a learning disability – the pilots were conducted across 13 local authorities in England. Individual budgets combine the resources from a range of funding streams to provide an individual with cash, service or a mixture of both.
The pilots took place between November 2005 and December 2007, but their evaluation was only published this October. The Individual Budgets Evaluation Network, which carried out the research, found that people with a learning disability using individual budgets are more likely to feel in control of their lives.
The Department of Health said that the evaluation “confirms to us that the introduction of personal budgets in social care is the right approach.”
While disability charities broadly welcome the vision of giving people more choice, there are concerns about how personalisation will be implemented and properly funded.
Personalisation has been touted as a win-win idea – a better care system for less money. But Heather Honour, director of the Learning Disability Coalition, said: “There is concern that cash-strapped local authorities are seeing the move to individual budgets as a way to reduce their social care spend. However, the evaluation report makes clear that a system of individual budgets will only meet its goal if it is properly funded. This must be fully debated in the context of the green paper on the future of social care.”
There is also concern surrounding the local authority resource allocation systems. “Anecdotal evidence suggests that some local authorities set an upper limit of around £50,000 for an annual individual budget,” says Beverley Dawkins, Mencap’s national officer for profound and multiple learning disabilities (PMLD). “Besides being illegal, this means that in some areas, people with higher support needs or PMLD cannot afford to enter the world of personalisation.”
Speaking at a recent conference on personalisation, national director for learning disabilities Anne Williams, said: “The rush to close day centres has left some people with a much more limited support than they had already.”
Another concern centres on the safety of vulnerable adults. Following the murder of Steven Hoskin, a serious case review listed failings by agencies to spot signs of abuse and share information. The finger was pointed, by some, at personalisation, as he had been receiving services to live in his own home.
This October the government launched its consultation on the No Secrets guidance on adult safeguarding. Care services minister Phil Hope said that the issue was particularly relevant in the current climate of personalisation. “I want to help people maintain this control and independence, free from fear of abuse,” he said.
Don Derrett is former business manager of in Control and the director of self direct, a new social enterprise. He says that scepticism and resistance to personalisation remains. “Of course there are fears for people who are vulnerable,” he says. But Derrett says that Steven Hoskin fell into the hands of his abusers not because he lived independently, but because he lived in isolation.
Derrett says that while a handful of local authorities are leading the way, in many places people have to fight for their allocation and face restrictions on how they can use individual budgets. It is only when local authorities, commissioners and providers fully embrace systems for personalisation that it can work to its potential. “There’s still a long way to go with this.”
This article appeared in the November/December 2008 edition of Viewpoint