Demos have published a new report, Tailor Made. It discusses how far personal budgets deliver personalisation and concludes it is not a silver bullet for empowerment of service users. It does have some good suggestions about how to empower people. I have always been a big supporter of Direct Payments and Personal Budgets and set up the first Direct Payments scheme in Sussex in partnership with the Federation of Disabled People. I argued 20 years ago that “key quality standards” should be set by service users and not professionals. There is no doubt that giving people control over their own resources, thereby turning them into mini commissioners, will give them the potential to have far more say in the way those services are delivered. This argument has now been won and is enshrined in legislation and practice. However the Tailor Made report does qualify the optimism and quite rightly so. The partnership that Adult Social Care has with the Federation for Disabled People is a good example of how service users often require appropriate support to be able to use direct funding properly.
I would add another note of caution. This government have announced this week that they want all Adult Social Care services delivered through personal budgets. This is not an enabling approach and smells of neo-liberalism to me. I suspect that the motivation is that Personal Budgets are proving to assist with cuts in public spending. It does not take a great deal of imagination to work out the dynamics of how that could happen. Regardless of your take on that issue I would raise another real concern. Domiciliary care purchased under contract by the local authority is approximately 1/3rd of the price of care purchased independently. Without the purchasing power of block contracts will people on Personal Budgets find themselves having to pay far more for the same service?
Market mechanisms have made home care cheaper to public authorities. I was involved in the best value revue on domiciliary care a number of years ago. The way it has done this is primarily by reducing the salaries and service conditions of the carers. At one time this resulted in a serious shortage of staff. It has not driven up quality or driven down price by giving service users more choice because service users do not get more choice. As staff are not paid for their travelling time service users have to have the provider that covers that locality. After all is said and done the quality of care is generally very good in the City although it does vary from provider to provider.
My other concern is for preventive services. Our Neighbourhood Care Scheme has a significant preventive impact on domiciliary care services. Isolated people who receive a volunteer befriender will have better mental and physical health and this will put off the day that they need greater home support. If the emphasis in the future is to put all resources for this group of people into Personal Budgets preventive funding and services could suffer.
One to watch I think.
