“Personalisation is just a cover for cuts” – debunked

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:

1. Personalisation would have been introduced deliberately to achieve/deliver cuts to social care services
2. Further, personalisation would have to have been introduced at the time the need for cuts was identified
3. 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 [1], 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”) [2].

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.

Timing

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.

Conclusion

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.

[1] – Gross social care expenditure, excluding Supporting People. Since SP couldn’t be personalised (see [2] below), these figures possibly favour non-personalised services

[2] – These are categorised according to what, in theory, can or can’t be personalised through a Personal Budget or Direct Payment.

Advertisement

Persuasion for institutional change

It requires a great deal of hard work to persuade people that institutional change is needed in the first place, build a coalition in favour of change that can overcome the resistance of existing stakeholders in the old system, and then condition people to accept the new set of behaviours as routine and expected.

I just happened across this line, right at the end of Francis Fukuyama’s The Origins of Political Order. It somehow felt appropriate to post it at the end of this week.

See also this line, which is the best I have seen at dealing with the conflation of personalisation and funding cuts (which is, in my view, an inaccurate conflation.)

Personalisation and funding cuts

This is a really neat way of putting things when it comes to personalisation and funding cuts:

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.

From IRISS’s insight on Self-Directed Support: preparing for delivery.

It’s an important observation, and we should always be careful not to conflate personalisation and funding cuts – either as commissioners or as campaigners.

On Labour’s recent disability discussion paper

There is much to be welcomed in Labour’s discussion paper, “Making Rights a Reality for Disabled People” (pdf), including:

• Using the period leading up to the General Election to develop ideas and to generate debate about disabled people’s priorities
• Undertaking this process with disabled people
• Challenging what is thought to be wrong with current policies regarding disabled people. For example, the paper feels to me to be spot on when it says the changes to DLA stem from saving money and not much else, or when it says that unsustainable risk falls on small third sector providers in the Work Programme, or when it says that the changes to Legal Aid will leave the most vulnerable without any legal support when things go wrong
• Highlighting that disabled people are bearing a greater brunt of cuts in government expenditure than, for example, bankers
• Reasserting that (a) rights should be fundamental to a society where disabled people are valued as participating members of the community, and (b) universal provision should be just that, “universal”
• Similarly, talking of Social Security rather than Welfare (a point Jenny Morris has made many times, and with which I was previously unsure but have now seen Jenny’s point on).

There are also, and you can probably see where I’m going with this, a few things that worry me a little about the discussion paper, including:

• The conflation of “universal provision for those who need extra help because they are unable to work” (my italics). First of all, extra help isn’t limited to only those people who can’t work (think Access to Work); and second, as JRF has regularly pointed out, help is also needed for people who are in work
• Noting that RNIB told Labour “currently someone who is totally blind can be found fit for work”. Erm, yeah – blind people can work!
• The precarious line that’s being drawn between welfare rhetoric and disability hate crime (on which, read Neil Crowther’s excellent post)
• The headings of each section are excellent. The body of each section, though, takes one or some of the government’s welfare changes and has a (justified) dig at them. That’s fine, but there’s a big leap to be made between people’s benefits and people’s rights (see point at the end of this post). This is quite aside from how narrow it makes the focus: the right to a home is much more than Housing Benefit
• Putting the issue of the cumulative impact assessment of changes to policies affecting disabled people so much to the forefront (Demos, amongst others, have already done a great job on highlighting the cumulative impact). This begins to mistake process for policy – something also done in the paragraph on improving assessment, and which makes no reference to the two significant recent attempts to do just that (Right to Control and the Individual Budget pilots)
• Claiming mismanagement of Remploy (something Labour itself did)
• Not recognising some of the more positive things that have happened in the last couple of years, including the Access to Elected Office Fund and the Paralympics
• No meaningful mention of education, civic participation, culture or transport. Why not?

It’s a slightly longer list than what’s good in the document, but I think it’s salvageable if the Labour party is willing to do what it says it will do: listen to and act on, meaningfully, what disabled people want.

There are two wider points to make.

The first is a lingering feeling I have from the document that Labour’s focus is more on impairments you can see than those you can’t. I didn’t get much sense that people with learning disabilities or mental health problems, for example, were prominent in their thinking and I hope there is more focus on these groups in ongoing discussions.

The second picks up on Neil’s blogpost about frames. The whole document has a very heavy basis in welfare, particularly benefits. This is paternalistic at best and, to my mind, doesn’t provide the right platform on which the rights of disabled people should be built.

Others regularly put it better and more eloquently than I will here, but the state must be not only a safety net when people need it, but a mechanism by which the barriers disabled people face can be addressed and removed such that disabled people can use their strengths, capabilities and assets to contribute to their communities and society as a whole.

Report from Wiltshire CIL on ILF consultation

This is a good report on the work done by Wiltshire CIL – a DPULO in the South West – on the Independent Living Fund. This is a great example of the support a DPULO provides people, as well as how they can help represent people’s views on different issues.

Strengthening DPULOs Programme monthly bulletin, no. 10 (end of year edition) #dpulo

This is the tenth monthly update about the Strengthening DPULOs Programme. This is also the last update of 2012, so rather than the usual mix of links and stories (which will begin again in January) I thought it would be useful to reflect on where the DPULOs agenda has got to.

2012: a year for DPULOs?

At the start of the year I suggested 2012 could be the year for DPULOs. There were 3 reasons for this view:

1. There was a detectable shift towards leveling the playing field for different types of providers in public services
2. There was proof that DPULOs could be clear about the value they add in representing disabled people’s voices locally
3. The evidence for the difference DPULOs make was starting to come through, and stakeholders were starting to take note.

What we’ve seen over the last 12 months is further evidence for each of the points above. For example:

1. DPULOs, social enterprises and mutuals are starting to be treated differently – and for the better – in the way public services are commissioned. Liverpool is one good example and we’ll have more in the New Year
2. There is now significant evidence of the difference the voice of disabled people in their local communities, represented through DPULOs can make. This isn’t just in saving money (though that’s important), but also in the improvements in people’s quality of life. Just look at the evidence here.
3. There is also now much more evidence than there’s ever been of the unique value DPULOs add when they deliver local services. They increase choice and control. They’re trusted more. They deliver a return on investment. And they save money. The evidence is here.

As a result, there’s been a major shift in thinking: the question I used to be asked all the time was “What is a DPULO?” Now, the question I am asked is “Now I know the difference they can make, how can I get the most out of one in my local area?”

Government has taken note, too: where DPULOs used to be thought of mainly in terms of social care, now they are reflected in several areas of policy:

• In the ODI’s Fulfilling Potential documents and Right to Control Trailblazers
• In the Home Office’s Hate Crime Action Plan
• In the DWP’s drive to increase take up of Access to Work
• In the DfE’s new approach to SEN and disability
• In DCLG’s Community Budgets work
• In the Cabinet Office’s Open Public Services White Paper
• (A full list is here)

Not only this, but the Strengthening DPULOs Programme has provided over £1m of funding through the Facilitation Fund to enhance the sustainability of DPULOs (see here) .

And we’re thinking ahead to the future, too: whilst keeping on with the good stuff we’ve been doing, we’ll be getting new work going  in areas such as:

• Examples of DPULOs working well with commissioners
• DPULOs and Making It Real in social care
• DPULOs and local Healthwatch
• DPULOs and young disabled people
• DPULOs, social media and accessible engagement
• DPULOs and fundraising
• Mapping the DPULO sector
• Further evidence on the return on investment DPULOs deliver.

What about 2013?

Despite all of the positives of 2012, it has of course been an incredibly challenging year. DPULOs have not been immune from this, partly because of the significant challenges that disabled people themselves have faced and will continue to face.

And we know that circumstances facing DPULOs are likely to be just as hard, if not harder, into the future as local government and others also face a tough time.

But I am optimistic. As Baroness Campbell said:

Disabled people are the best problem solvers.

In a year that will see lots of problems for lots of different people and organisations, what better people and organisations to have working with you than disabled people and Disabled People’s User-Led Organisations?

Over the festive period, I shall reflect on the incredible work that all of you have done through your DPULOs in your local communities, and think forward to what you will continue to achieve in 2013 and beyond.

I hope you have a restful and relaxing holiday.

Rich Watts

(On behalf of all at the Strengthening DPULOs Programme team)

Find out more about the Programme

To find out more about the Strengthening DPULOs Programme, you can visit our website. We also regularly update our Facebook the page with lots of information you will hopefully find useful, plus news from other DPULOs: http://www.facebook.com/dpulos. If you are on Twitter, you can share information and find out more about DPULOs using the hashtag #dpulo. Please also remember to use the #dpulo hashtag if ever you’re tweeting about your work

You can find all 9 of the previous monthly updates here.

Contact us

For information, biographies, contact details and details of the areas covered by each of the DPULO Ambassadors covers, please visit the Ambassadors page.

If you have any questions about the Facilitation Fund or any part Strengthening DPULOs Programme, please contact odi.businessperformance@dwp.gsi.gov.uk

Please feel free to forward this information on to any DPULOs, networks or stakeholders you think might find it interesting.

Beyond Barriers – Improving Library Services for all in Solihull

As part of the Strengthening Disabled People’s User-Led Organisations programme, I’m always keen to hear about how DPULOs are doing interesting work in their local communities. Enable-Solihull is doing some fascinating work with their local council on the topic of libraries as community hubs – read below for more details. If you’d like to share a similar story/success, freel free to leave a comment and I’ll follow up.

Enable-Solihull is a User-Led Disability Organisation based in Solihull, West Midlands. In close partnership with Solihull Council’s Libraries and Action for Blind People, we are currently organising two Beyond Barriers events.

Solihull Borough’s libraries are vital community hubs; not only the gateway to a vast range of information and entertainment, but also valued community meeting places. Our libraries should be readily available and fully accessible to all members of our community.

Although Solihull libraries provide a range of support services for disabled people, people are not necessarily aware of these. In addition, there may be other physical and social barriers that prevent disabled people from using these services. It is vital to engage with the local community to understand what their needs are and to be able to respond to them.

These events aim to raise awareness of these specialised services and to explore with disabled people any barriers they face in accessing these services.

Following the two sessions, Enable-Solihull and Action for Blind People will work with Solihull Council to put together an action plan to make improvements and address any concerns that are raised by this engagement.

The first of the two open mornings takes place at Chelmsley Wood Library on Thursday 6^th December, with the second event at Solihull Central Library on Tuesday 22^nd January 2013. Both events run from 11:00am – 1:00pm, with an optional tour of our library facilities beginning at 11:00am. Please see flyer for full details.

Independent Living Information Points

In January, a brand-new disability and social care signposting and information service Independent Living Information Points will be launched. This will be available to the public on a drop-in basis and based in community libraries.

This will initially be a pilot scheme, with the service initially available in the two main libraries in the Borough: Chelmsley Wood Library and Solihull Central Library.

This new service will be delivered by trained volunteers and is seen as being the first step to developing a Centre of Independent Living (CIL) for disabled people and carers in Solihull.

This new service is being provided by Solihull Independent Living Consortium (SILC). SILC is led by Enable-Solihull and is a partnership of local charities involved in providing health and social care services to Solihull people.

Services offered by SILC members include home care, advice and information services, day services, leisure activities and care homes. The members of SILC are Enable-Solihull, SoLO, Family Care Trust, DIAL Solihull, Solihull Carers Centre, Age UK Solihull, Solihull Care Ltd and SWICDA (Solihull Workforce in Care Development Association).

For more information on Enable-Solihull visit: www.enable-solihull.org.uk

For more information on SILC Visit: www.solihull-silc.org.uk

3 reasons for coproduction (dedicated to #localgov making tough decisions)

In a recent report (Demos, 2010), the ways in which different local authorities were dealing with the difficult decisions they need to make – the need to do “more with less” and have “new ways of working” – were highlighted and discussed.

Though there was no magic formula for undertaking this, there were some common elements to the ways in which some local councils had successfully done this.

The first of these was through coproduction, which is

active input by the people who use services, as well as — or instead of — those who have traditionally provided them. So it contrasts with approaches that treat people as passive recipients of services designed and delivered by someone else. It emphasizes that the people who use services have assets which can help to improve those services, rather than simply needs which must be met. These assets are not usually financial, but rather are the skills, expertise and mutual support that service users can contribute to effective public services.

That is, coproduction is using a service user’s expertise and capabilities in designing, planning and (in some cases) delivering the services they use.

The report gave 3 reasons why coproduction is important in supporting local government to make decisions, as follows:

First, local people using disability and care services are likely to be a valuable source of expertise — coming up with effective and innovative cost saving solutions, and new ways of working based on their experience of using services and drawing from a range of community-based sources. Codesigning services with disabled people themselves can in fact lead to improved outcomes at lower cost.

Second, coproduction is key to more cost-effective solutions that tap into peer support networks and community support. !ere are many excellent examples of disabled people providing their own peer and mutual support services through social enterprises and user-led organisations — capturing the true essence of coproduction. Examples include the Southwark Circle, KeyRing (a mutual living support network for groups of nine people with LD) and Never Watch Alone (which enables football and rugby supporters with a learning disability in Wigan to attend matches alongside their fellow supporters).

Third, by working with disabled groups to make budgetary decisions, [those] affected by [changes] can help decide where to make them. By giving the local population a frank account of budgetary realities, and allowing them to decide[,] people have a sense of buy-in and ownership of even the most difficult budgetary decisions, leading to more public support.

Man walks into a column, no.22: Cuts

As part of my day job, I have worked with a number of local councils to help them make the best decisions (or least worst, depending on your point of view) about how they use the substantially diminished resources at their disposal. In so doing one has to suspend any suspicion that the authority in question has a choice not to save lots of money, and also that in working with a smaller budget they could achieve required ends without – at least in part – cutting or cutting back on services.

I don’t personally find it difficult to take these leaps of faith: one skim of a council’s budget report shows that the reduction in government grants, when combined with loss of revenue due to the recession, leaves a yawning chasm in most council accounts. And for all the talk of ‘more for less’, there are few if any radical delivery/prevention models which have achieved proof of concept, yet alone moved into the mainstream. As for the idea that cutting ‘back office costs’ or swollen senior management salaries is a magic bullet, the figures speak for themselves (the LGA estimates that halving chief exec pay, for example, would save a whopping 0.35 per cent of the total needed). In short: cuts must be made. The only choice that councillors and managers in local authorities have is how and where.

It’s with all of the above in mind that I found myself feeling a bit sceptical – irritated, even – by the simplicity of the coverage of the news that a couple of councils have decided to charge for the use of play parks. I do not need convincing that access to high quality play facilities is vital for children’s health and happiness. But what about access to high quality social care?  A decent standard of home in which to live? What if a child has a learning disability: it’s important to provide good specialist services too, isn’t it? And then there’s the vexed question of libraries: free access to good books is pretty essential too, no? (I posted previously on whether or not access to libraries themselves is the only way to achieve this).

My point, obviously, is that children – as all of us – have many needs, most of which are jolly pressing. If you accept my argument that councils have no choice but to make cuts, and if you accept also that services for children must bear at least some of the burden (the second point doesn’t follow the first, of course) then is it really that surprising that one or two councils have swung the axe in the playground?

I’m not saying that Bexley and Wandsworth have necessarily made the right decision. It’s just that to assume prima facie that they’ve made the wrong decision is very narrow-minded. I can understand that any headline combining ‘Tory’, ‘children’, ‘cuts’ and ‘play park’ provokes a gut reaction and a suspicion that rotten old milk-snatching tactics are afoot.

But these are rotten old times, and there are a series of further questions we need to ask to assess the rightness or wrongness of any such decision. The most important include: are there measures in place to ensure poorer families are protected? Are the costs proportionate to the value of the service? Have alternatives (e.g. different models of service delivery) been properly explored?

But by far and away the most important question is: was this decision reached with local people, or without them? In my experience when conversations with service users about difficult decisions are well-handled, people respond in a mature and level-headed way. Crucially, when a final decision is reached, they’re much more likely to accept it (even if they don’t like it). The problem is that having these kind of conversations requires elected members and council managers to admit the unpalatable truth: that cuts to services will have to be made somewhere. And doing so requires real courage, which is why you see so many examples of councils trying to sneak news of spending decisions out under the radar. This almost never pays off, and much of the subsequent ire can be partly explained by perceived underhandedness. It may feel harder to be upfront, but it’s a classic example of ‘invest to save’: invest time and political capital in an honest dialogue early on, to save anger and negative coverage down the line.

Incapacity Benefit linking rules being stopped for disabled people

Benefits and Work are reporting that the “linking rules” for disabled people, which provides some security for those who take up employment but are unsure what the impact may be on their health/impairment, are being stopped:

Linking rules which allow incapacity benefit (IB) claimants to return to their previous rate of benefits if they try work and have to stop again on health grounds are to be scrapped from 31 January.

From that date onwards any former IB claimant who stops work will no longer be able to take advantage of the 104 week linking rules and will, instead, have to make a fresh claim for employment and support allowance. They will be eligible only for the assessment rate for the first 13 weeks of their claim, a lower amount than they would have been entitled to if they had been covered by the linking rules, as they were promised they would be at the time they started work.

This information came via this blog post from Social Worker To-Be (itself via a tweet from @monstertalk).

More on this when I have it.