4. Colin Slasberg - Personalisation

Report
SWAN CONFERENCE 2013
Learning from the failures of the
Government’s self directed support
and personal budget strategy – the
need to re-assert social work skills
and values
Colin Slasberg
What is meant by personalisation
• Personalisation is taken here to mean having supports that fit
around the person in contrast to the person having to fit within
services
• Whilst not a sufficient condition to enable all older and disabled
people to have the independence and well being they can
reasonably expect as it also important to have sufficient resource, it
is a necessary condition for three reasons;
• even if resources are sufficient, they must function correctly
• personalisation ensures the best possible use of limited
resources
• it will generate information about the gap between needs and
resources to inform the democratic public spending decision
making processes
The need to learn from current failures
• Personalisation, with different words, has been a policy
objective for over 40 years, from Care in the Community, to
Community Care and now Self Directed Support. However,
success on anything other than a small scale has not been
achieved
• If we learn the right lessons from the failures both of
Community Care and Self Directed Support, it will be possible
to achieve sustainable personalisation
• The following sets out why building on the right lessons from
past and current attempts it will be possible to build a
sustainable strategy
The evidence of failure of the government’s SDS
strategy
• Up-front allocations, the cornerstone of the policy, need to be close to
what people actually get. In reality, the two bear no relationship to each
other;
•
A large number of FOI’s now show that they differ by between 2 and
3 fold
•
The RAS is like a “cog spinning within a machine with which it does
not connect” – Clements and Series
• A massive cost in bureaucracy. Since 2007/8;
•
8.6% increase in staffing
•
16.5% loss in assessment and care management activity
•
47% loss in people getting ‘professional support’
• Outcomes have not been improved. An impression of success is sustained
through publicising the success of small numbers able to use a direct
payment and re-labelled a personal budget.
Why is SDS failing – one
Objectivity versus accuracy
• Social care needs arise from the complex interaction of a number of
highly variable factors. This makes them and their story unique to each
person.
• Up front allocations rely upon categorising needs, and then attaching
average costs to each category. This formulaic approach gives an
appearance of objectivity. However, it inevitably contains error, the
only question being how great is the error.
• Social care works in an environment where deliberate error is not
acceptable. Instead, the greatest possible accuracy is required to
ensure;
• support plans are personalised
• resource allocation decisions are lawful
• scarce resources are used well
Why is SDS failing – two
Contradictory meanings of choice and control
•
The 2010 Vision for Social Care makes the following, contradictory,
statements;
1. “People, not service providers or systems, should hold the choice
and control about their care”
2. “We want people to have the freedom to choose the services that
are right for them...”
• The first belongs to a consumerist view, the customer is ‘always right’
and their control is absolute. The second acknowledges there are good
and bad choices. Its core is flexibility of options with control shared
between State and individual. The key issue becomes not the fact of
State power, but how it is delivered. SDS left that unchallenged.
• Ferguson discusses how there are two narratives re empowerment, and
citing Beresford and Croft, a consumerist and a democratic model.
The parallel strands in resource allocation
Category
of
need(s)
Indicative
budget
Person
chooses
supports
Personal
budget
Resource
required
Amount
If we are back to square one – what needs to be
different to ensure personalisation of support planning
1. Free up resource base as cash to allow flexibility of options for all,
notwithstanding that most will choose collective, mainstream services
2. Abandon assessment regimes based on categorising needs and create
a new approach to ‘need’ that supports individual uniqueness whilst
also enabling comparability for the purpose of equity,.
3. A new approach to addressing the tension between needs and
resources to replace FACS. Dowson discusses the need to separate the
State’s responsibility to ration resources from the support planning
process, and a need to negotiate between the two.
4. Partnership between a reformed State and individual to replace self
direction
A new approach to identifying and prioritising needs to
support person centred practice
STRATEGIC
OUTCOME
LEVEL OF INDEPENDENCE AND WELL BEING IT IS
REASONABLE FOR THE PERSON TO EXPECT GIVEN
THE LEVELS AMONGST THE BROADER COMMUNITY
Increasing priority
PERSONAL
NEEDS
Personal needs derive from identifying the issues that prevent the person from
enjoying the strategic outcome. Each personal need is unique. Priority is established
by mapping each personal need to the appropriate universal need.
The failure of FACS - rationing resources through the
assessment process
Needs are divided into two
groups – eligible/affordable
and non eligible/non
affordable. With the cost of
meeting needs highly
variable, and a weak
definition of priority bands,
the definition of ‘critical’ and
‘substantial expands and
contracts depending on size
of budget
Key
Needs
funded
Needs 'lost to
the
system'
Henwood and Hudson
Council
one/user
group one
Council
one/user
group two
Critical and
substantial
needs
Critical and
substantial
needs
Level of resource, not
eligibility criteria,
determines how many
needs are met
Equity is spurious, hiding
major inequities
between user groups
and councils
Assessments are limited
only to needs likely to be
funded
People are told that
needs they believe they
have are not needs at all
Sensible, value for
money spend on lower
priority needs is not
supported
Allocating resources and person centred working
Council/user
group one
Council/user
group two
Key
Needs met
Survival
DUTY
Needs not met
Keeping safe
Needs
eligible for
public
funding
Self worth
DISCRETION
•
Equity is measured
by the proportion of
eligible needs met at
the discretionary
levels
•
The level of equity
sought is secured
through adjustment
of budgets
Self fulfilment
Needs not
eligible for
public
funding
Needs that would enable a level of independence and well
being above what would be expected by most people
Needs that would fall to be eligible but it is appropriate
and reasonable for the person or those around them to
meet
A new partnership - the individual, skilled practitioner
and resource allocator
COUNCIL CONTRIBUTION
Decides 1) if plan is fit for purpose 2) how much of it to fund within cash limit
PRACTITIONER CONTRIBUTION
Practitioner
articulates the
person's thinking
develop their
person's
thinking
thinking is
purpose and
able to
articulate
their plan
supports the
person to
The
fit for
Practitioner
The person's
Practitioner
develops plan
using messages
the person is
thinking is fit
able to
for purpose
communicate
but cannot
articulate
their plan
A plan is fit for purpose if it
will enable the person to
meet their reasonable
expectations of
independence and well
being and does so in the
most cost effective way
The balance of contributions
of the person and the
practitioner is determined
only by how able the person
is to create their own fit for
purpose plan
The person's
thinking is not
fit for
The person
purpose
does not have
the capacity to
SERVICE USER CONTRIBUTION
plan their
support
The practitioner can be
directly employed by the
council or work from an
independent organisation
committed to working to the
agreed standards
Securing better funding levels
• The judicial system is not going to deliver changes to political
commitment to fund social care. Despite Human Rights and
Equalities legislation, neither the UK Supreme Court nor
Strasbourg has any appetite to challenge democratic decision
making processes. Direct engagement of the democratic
process is the surest route.
• The new approach to needs and resources will create
information about the extent to which resources fall short of
enabling all to meet their reasonable expectations of
independence and well being.
• This creates an opportunity to transform the politics of how
needs and resources are matched strategically
The prevailing strategic process of matching needs and
resources
This process applies under
both the Community Care
and the SDS regimes
Govt
decides
tax levels
and
priorities
for public
spending
Grants to
council to
fund social
care
Council
decides
tax levels
and
priorities
for public
spending
It is a process that
might be better
described as the
‘political gift’ than
the ‘professional
gift’.
Budgets
for social
care
It is an oppressive system, with knowledge of the actual
extent of need repressed. Un-met need is hidden from
view and not fed back to the decision making system
Support
Plans
created
based on
assessments
constrained
by
affordability
A new process that engages the democratic process
Government
decides tax
levels and
priorities for
public
spending
Grants to
council to
fund social
care
Aggregated
information
about unmet
needs inform
decision
making
process about
funding levels
Council
decides tax
levels and
priorities
for public
spending
Budgets for
social care
Support plans that offer the best
quality of life for all SU’s within
available resources
Further levels of resource
required so all SU’s can have a
quality of life comparable to the
majority
Support planning
process identifies
resources for each
person to have a
quality of life
comparable to
the majority
Council decides
how much to
fund with regard
to priority and
seeking highest
level of
outcomes from
limited resource
The essential building bricks of personalised support
planning on a sustainable basis
• Partnership between State and individual, not self direction,
with the State transforming its policies so it will be fit for the
partnership
• Intelligent budget holding
• Skilled practice, whether provided directly by the State or on
its behalf, rooted in social work skills and values
The essential building bricks of independence and
well being for all
• All the evidence is that most people will continue to want to
use collective and mainstream services. Therefore, full
personalisation will call for two strands;
•
Personalised support planning
•
A network of providers commissioned to deliver
personal outcomes through flexible and responsive
operational capacity
• Political integrity in addressing the balance of needs and
resources
Social Workers as activists
Social Workers should seek opportunities to;
• accelerate the demise of the era characterised by a ‘social care by
numbers’ approach to assessment and by consumerism on the basis
of its failure serve the interests of older and disabled people or
deliver key policy objectives.
• re-claim the territory from which their skills and values have been
forced out by these strategies, but for pragmatic, not idealistic or
self interested, reasons
• Insist that their assessments address the whole person, and that
there is honesty and transparency about how far resources fall
short of meeting people’s reasonable expectations of quality of life.
References
•
Clements and Series - Putting the Cart before the Horse: Resource Allocation Systems and
Community Care
http://www.academia.edu/2426190/Putting_the_Cart_before_the_Horse_Resource_Allocation_Systems_
and_Community_Care
•
Slasberg, Beresford and Schofield, How self directed support is failing to deliver personal budgets and
personalisation ssrg.org.uk/wp-content/uploads/2012/01/Slasberg-et-al.pdf
•
Ferguson, Personalisation, social justice and social work: a reply to Simon Duffy;
http://www.tandfonline.com/doi/abs/10.1080/02650533.2011.623771
•
Dowson, Its not just about the money, www.ndti.org.uk/uploads/files/NJAMALL.pdf
•
Slasberg, Towards an eligibility framework that serves the interests of service users and councils,
http://www.scie-socialcareonline.org.uk/profile.asp?guid=4c547abb-e747-4e4b-bad0-b28a96450fcb
•
Henwood and Hudson, Lost to the system,
http://www.scie-socialcareonline.org.uk/profile.asp?guid=8246367e-05c4-46a9-86ad-78f0d74f0dc9

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