Simon Duffy explores some of the problems involved in implementing personalisation and the fundamental question of entitlements that remains unresolved in England.
Author: Simon Duffy
In this essay the author explores some of the implementation problems that are currently limiting the successful implementation of personalisation and the use of Individual Budgets.
Is Personalisation Dead?
Well, of course it all depends what you mean by personalisation.
In fact the term personalisation, while potentially useful, is highly ambiguous. A cynic might even say that this was exactly why Charles Leadbeater chose the term - it seems so inoffensive and reasonable - Who could be against personalisation?
The term personalisation was applied backwards, to describe ideas and practices that have always been challenging and difficult, and all of which were developed before the term personalisation was used to describe them:
In fact what all these innovations have in common is that:
So while the term personalisation is attractive, it is also very dangerous, because it doesn’t help people really think things through.
One of the most important examples of this inability to think things through is the history of Individual Budgets. (See the note on terminology below.) Individual budgets were designed to give disabled people control of any support they need to achieve Independent Living. In practice I still think that their development, and their use by local authorities, has been broadly positive:
In fact this last point is important. In 2006 the typical response of civil servants to the idea of Individual Budgets was to argue that they would not work and they were against current government policy. At that point the consensus in the Department of Health seemed to be that in the future there would be:
Often, when we rightly criticise some of the poor practice in the implementation of personalisation, we can forget how negative Whitehall’s previous policy had been.
By 2007 government policy had made a 180 degree turn. Personalisation and the use of Individual Budgets are now taken for granted as central to any future policy-making in Adult Social Care.
Well - sort of.
And this is the great problem: the innovation has been accepted, but it is not always understood. This then leads to poor implementation in local areas and poor policy-making by central government.
The central problem is that there is no agreement about how to define the entitlements that are at the centre of social care.
Before I explain this point I want to share a little anecdote.
Shortly after Ivan Lewis took over as Minister responsible for Adult Social Care at the Department of Health I was asked to talk to him about Individual Budgets. Whilst sitting outside his office one of the senior civil servants rushed into the room to insist that I did not describe ‘Individual Budgets’ as entitlements. I was told the government were against ‘entitlements’ and that this was not how the idea was to be understood. Shortly afterwards we were ushered into Ivan Lewis’ office and Ivan began the meeting: "So let me get this straight - the basic idea is that people are told their entitlement up-front and then supported to spend it how they wish..." I smiled, "Yes,that’s right Minister..."
However the battle for a decent system of entitlements has not yet been won.
In England entitlement to social care is very limited indeed:
This last point may not seem important - but it is in fact vital - because it is only by having an entitlement to the budget that we can ensure that our right to support is compatible with our right to self-determination. If we are only entitled to services then we are dependent upon someone else’s decision about what qualifies as ‘legitimate support’. In other words the disabled person becomes subject to control by the professional.
An interesting way to illustrate this point is to remember how the courts, using principles of natural justice, determine compensation for victims of accidents. The courts do not tell people what services they require, instead the courts determine what is a fair allocation of resources, what is sufficient to enable the person to live independently, with dignity and respect. They settle on a cash sum and they, quite rightly, assume that the person (with any necessary support or representation) will know best how to spend this sum. The courts do not send people to residential care, day centres or respite services.
For a short period, under Ivan Lewis, there seemed to be an opportunity for England to move towards a more respectful model of social care. However, once Ivan lost his place in the Department of Health the old assumptions returned.
The current situation is not necessary and hopefully this government or a future government can be persuaded to revisit this issue.
If so they could choose to take one of the following options:
1. Reform the current adult social proposals to make clear that entitlements are to a level of resources sufficient to ensure active citizenship, or
2. Reform both health and social care law and end the false distinction between health needs and social care needs and in its place create a distinction between commissioned services and self-directed budgets.
Although it is easy to blame local government for problems in implementation the real problems starts with inadequate legislation and incoherent policy.
Not every local area is implementing Individual Budgets badly. For example, I am always impressed by efforts in Barnsley to maintain a genuine understanding of the core principles. However, in my experience, many local areas are struggling with Individual Budgets.
Amongst the many problems that exist are:
At times it is hard to stay positive. Much has been achieved; but so much more could be achieved.
The Centre for Welfare Reform continues to work with those who want genuine and positive change. For anyone interested in finding some practical solutions to these problems there are a range of resources available on the site and a list on the right-hand side of this page.
Most of these developments took place under the previous government. Instead of treating Individual Budgets (and the other associated innovations) as emerging innovations, that needed time to develop and better legal frameworks to support them, there was a ‘rush to implementation’. In my view this was a mistake.
I think much of the extra £0.5 billion given for the implementation of personalisation was wasted. It led instead to an over-dependence on consultants and increased bureaucracy. The real challenge was to simplify and clarify processes and to bring about the major legislative changes required for a fairer system.
And the situation is getting worse.
By 2014-15 the government will have cut over £11 billion from local government’s annual budget, and adult social care is the biggest element of local government spending. This is an unprecedented attack on the rights of disabled people - we have never seen anything like this. This attack is combined with an £18 billion cut to benefits for disabled people and people living in poverty. Together 60% of all government cuts fall on disabled people or people in poverty.
I cannot see how minor tinkering with systems will help. It is for this reason I have tried to give as much time as I can to the Campaign for a Fair Society. If now is not the time to stick up for citizenship, for Independent Living and the rights of disabled people when is?
I don't know if it's useful to think of personalisation as dead or alive - but the rightful demand of disabled people to live as citizens, with support that is respectful and under their own control is certainly not dead and will not go away.
Note on Terminology: I still prefer to use the original term ‘Individual Budgets’ rather than the later term ‘Personal Budget’. The reason why there are two terms for basically the same idea tells you a great deal about the power battles that go on behind the scenes in government. In 2006, when I was running In Control, a civil servant rang me up to tell me that we could no longer use the term Individual Budgets - it was now a government term. So we went through all the paperwork and replaced the term Individual Budgets with the term Personal Budgets. Paradoxically this then allowed the government to announce a policy of Personal Budgets for all adults using social care in 2007 - Putting People First.
The publisher is The Centre for Welfare Reform.
Is Personalisation Dead? © Simon Duffy 2012.
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