This blog was contributed by Clive Newton, Age UK’s National Development Manager – Care and Communities.
Five years on from the publication of Putting People First and Transforming Social Care, it’s time to take stock. Have older people entered the promised land of choice and control? Are they receiving personalised services, tailored to their individual needs and preferences? Did the £520m Social Care Reform Grant deliver the intended transformation in the way care and support is designed and delivered?
Unfortunately, from the point of view of most older people with care and support needs, the answer to all these questions is a resounding ‘no’. There hasn’t been a ‘strategic shift to prevention and earlier intervention’. The system remains crisis-driven, with ever-tightening eligibility criteria. Self-funders receive little or no support. And even those older people who are eligible for a personal budget rarely experience any real sense of choice and control. What went wrong?
Part of the problem is that the system of personalisation based on direct payments and employing personal assistants was designed, first and foremost, with and for younger disabled people. Older people therefore face a system that is insufficiently flexible to meet their needs and preferences: a profound irony, because above all personalisation is meant to be about moving away from one-size solutions. Some older people welcome direct payments, but most don’t. Managing the money isn’t liberating and empowering for them – it’s just another hassle on top of all the hassles they’re already dealing with.
So most older people eligible for a personal budget – about 85% – end up with one managed by the local authority. Which would be alright, except that this usually means little effective choice or control. Some people don’t even know they’re on a personal budget. In many places they’re restricted to having services from a very short list of ‘preferred providers’. Selected by a process that’s almost entirely focussed on keeping the price down, there’s little or no difference between the preferred providers. ‘Choice’ becomes a mockery.
The solution isn’t to force older people to accept direct payments they don’t want. The solution is to ensure that managed budgets offer the same level of choice and control as direct payments. That’s the theme of the new publication from Age UK. It requires action from local authorities – managers, commissioners and front-line practitioners. It requires action from providers – putting the principles of person-centred practice into action. And it requires all parties to work together.
We know what older people want – the research evidence is there. We’ve got examples of systems that really work. We know how to do person-centred planning. We understand that the market needs to be actively managed to deliver the diversity that people want. We can see the value of peer support. All we need to do now is make it happen. For older people on managed personal budgets. But also for those who take a direct payment – and for people who have to fund their own care and support – but struggle to find what they’re looking for.