If there was a pound for every time someone has said that personalisation is just a cover for cuts in adult social care, then we could pay off the national debt.
For a moment, though, let’s assume that personalisation is just a cover for cuts. What would this actually involve? I think there are three things:
- Personalisation would have been introduced deliberately to achieve/deliver cuts to social care services
- Further, personalisation would have to have been introduced at the time the need for cuts was identified
- We wouldn’t see cuts in services that aren’t personalised or have the option of Personal Budgets.
Let’s look at each of these in reverse order.
No cuts elsewhere
Is it true to say that there haven’t been cuts in services that aren’t personalised?
Below is a table that captures social care expenditure over the last 9 years , including for different types of services – “personalised” (incorporating Direct Payments and homecare services) and “non-personalised” (Nursing care, residential care, supported/other accommodation, equipment and adaptations, meals, “other”) .
Figure 1 below charts gross levels of adult social care expenditure for all personalised and non-personalised services.
Figure 2 charts year-on-year changes in levels of adult social care expenditure for the same.
What the table and figures 1 and 2 show that little distinguishes levels of spend or year-on-year changes for personalised and non-personalised services. Or, put another way, the data doesn’t show that personalised services are more likely to be cut that non-personalised services.
If personalisation was a cover for cuts, it would have to have been introduced at the time the need for cuts was identified.
It is agreed the financial crisis hit in 2007/08, though public sector spending increased from 2007/08 to 2009/10. Since the General Election in 2010 we know that public sector spending as a proportion of GDP has decreased, and that there have been real-terms cuts in local authority budgets.
Personalisation would therefore need to have been introduced in at least 2008, and certainly by 2010, were it a mechanism for delivering cuts.
However, Putting People First – the key policy document that heralded the formal introduction of Personalisation – was published at the end of 2007. Before this, there had been the Individual Budgets pilots which ran from 2005 to 2007, as well as the Personal Health Budgets pilot that ran after, from 2009.
More pertinently, personalisation has a long history. Quite aside from campaigning efforts, Direct Payments legislation was first introduced in 1996 through the Community Care and Direct Payments Act 1996 and 2001’s Health and Social Care Act made it mandatory rather than discretionary to offer direct payments to those with an assessed need. (See both the King’s Fund and SCIE’s excellent timelines of adult social care.)
What these timings therefore show is that personalisation, as enacted in legislation, pre-dates the financial crisis by at least 10 years, and that the introduction of the existing policy framework, Putting People First, pre-dates public sector spending cuts by 3 years.
A deliberate plan?
The final piece of ensuring personalisation is a cover for cuts would be for it to have been introduced deliberately to achieve/deliver cuts to social care services.
Anyone who has worked in government, in local government or in provider organisations – actually, anyone who has worked for any large-ish organisation at all – knows that the gap between what’s asked for and what’s delivered can be large. This is especially so if what’s asked for challenges existing behavior / culture.
In the case of personalisation we know the benefits of it haven’t flowed as far and as fast as people would like, mainly demonstrated by ongoing debates about how well it has been implemented and how true it is to any original vision.
Such a debate highlights to me there is simply not the level of command and control through the adult social care system – with its national policy from DH, distributed through 152 local authorities with their own local policies, decision makers and workforces, and 1000s of provider organisations supporting people on the ground – that can deliberately do anything very easily, quite aside from use personalisation as a means of achieving cuts.
I can understand why people think personalisation is just a cover for cuts in adult social care. This is especially the case for anyone who doesn’t have a more detailed, perhaps professional interest in the issue.
But, as demonstrated by this post, anything more than superficial thinking on the topic shows that saying personalisation is just a cover for cuts is wrong.
I close with the best observation I’ve seen on this topic:
Although the implementation of Self-Directed Support will be affected by funding cuts, personalisation brings challenges regardless of the financial context; cuts bring challenges regardless of the model of social care.
 – Gross social care expenditure, excluding Supporting People. Since SP couldn’t be personalised (see  below), these figures possibly favour non-personalised services
 – These are categorised according to what, in theory, can or can’t be personalised through a Personal Budget or Direct Payment.