‘P’s in our time – a vision for social care

There are 7 of them, and they all begin with P. They are the Government’s principles for social care, as presented in the new ‘Vision for Adult Social Care; Capable Communities  and Active Citizens’. The 7 principles are; prevention, personalisation, plurality, partnership, providing protection, productivity and people.

The vision is accompanied by an outcomes framework and by a number of supporting papers. These are ‘Practical Approaches’ to building stronger communities, market and provider development, co-production, and safeguarding and personalisation, one called ‘Personal Budgets, checking the results, and one which doers not begin with P, called , ‘Enabling risk, ensuring safety – self directed support and personal budgets’.  Together they represent a continuing roll out of existing policies on personalisation, rather than a revolutionary new direction. 

The most significant difference between this vision and one which the previous Government might have published is the emphasis on localism and community. The former is apparent in a marked shift from accountability to central Government towards accountability to local communities. The latter is demonstrated by the ubiquitous presence of the ‘Big Society’.

Big Society approaches are seen as making important contributions towards preventing and reducing the need for services, to mutual or collective approaches to using personal budgets, and to safeguarding. The ‘Big Society’ will also be the ‘vigilant community’. Social enterprises, set up by the community, service users or groups of professionals, also feature prominently.

The launch of the vision also included an announcement of new money for respite services to support carers. This is particularly welcome as it originates in a Liberal Democrat manifesto commitment that did not make it into the Coalition Partnership Agreement, so there were fears that it had fallen off of the Agenda. The new funding, £400 million a year, announced alongside the vision, falls slightly short of the Liberal Democrat plan, but is still very welcome. A revised Carers’ Strategy, to be published shortly, will give further details of how the money should be spent.

The immediate practical significance of the vision itself is that it is intended to give a steer to both the Law Commission review of adult social care law and to the Dilnot Commission review of long term care funding. In particular, the vision contains several clear messages to the Law Commission.

The Government is willing to consider strengthening safeguarding legislation, as proposed by the Law Commission, and would like legislation that would enable assessments to be carried out independently, either by people themselves, or  by user led or community organisations. The law should also enable assessments to be more portable so that people moving from one local authority to another would be able to take it with them.

The vision also flags up this last point as one for the Dilnot Commission, presumably because it will bear on whether recommendations involving a national system of assessment would be a realistic option. People should also have a right to have care and support offered as a personal budget or as a direct payment, and the vision is supportive of the Law Commission’s proposal for statutory principles which will underpin the new legislation.

There is not too much in this programme that merits serious criticism. There is however a growing gulf between aspiration and reality as local authorities make savings by tightening eligibility criteria, reducing preventative services and withdrawing funding from community organisations that would be able to make a significant contribution to the growth of the Big Society.

The vision also avoids tackling difficult or inconvenient contradictions. For example local authorities are told they should move away from large contracts and instead encourage a thousand diverse flowers to bloom. At the same time they are told that they should join with neighbouring local authorities so that they can contract more efficiently. One example of local authorities doing this is the West London Consortium, which seems to be devoting it’s energies to exactly the kind of large scale contracting that the Government thinks local authorities should abandon.

The vision also wants to give professionals such as social workers greater autonomy and scope for the use of professional judgement. At the same time personalisation, and much of the personal budgets model, especially as propounded by In Control, is based on opposition to access to support being mediated by professionals (the so called ‘professional gift’ model). The vision therefore leaves considerable scope for local conflicts between entrepreneurial professional groups and the advancement of control by service users.

Perhaps the  main issue that gives cause for concern is the extent to which the Government favours direct cash payments as it’s ‘preferred option’ for delivering personal budgets – rather than, for example, the person opting to have their support arranged on their behalf by the council. Personalisation should mean people should have a choice of how they want services their services arranged, so what should matter is the person’s preference, not the Government’s.

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