Total transformation is
a phrase which should leave little room for ambiguity. Total: concerning the
whole, the entirety and all aspects. Transformation: change in form,
appearance, nature or character.
asked a few people what they thought the phrase meant. Their answers included a
paradigm shift, a move from one level to another, a complete reorganisation
which resulted in different outcomes. The phrase was used by InControl to name
a project which ran between 2007 and 2009.
the context of InControl’s project, total transformation meant a whole-system
change which allowed self-directed support to be embedded across a local
authority’s care system. The whole
thrust of the project was to provide the change model and the tools to make a
personalised life possible through people having their own budget.
short, the goal was total transformation - an organisational process -
providing total transformation - a personal outcome.
how in 2012 are we in the position that Personal Budgets are sometimes merely a
different pot of money paying for the same old services? How is it that this
innovative and potentially life transforming idea has become reduced to a
different method of paying for the same support options? How is it that some
service users with the capacity to choose their support, don’t even understand
they have a personal budget?
recently-experienced rules from local authorities might elucidate the
“We won’t cover the cost of
volunteers through Personal Budgets”
“We don’t recognise the input of
“If someone’s Personal Budget is
being managed by the Local Authority, they can only have services from our
approved provider list”
“You can only be on our approved
provider list if you can get your costs below £13 per hour”
within the short examples given above, we can see a double whammy of exclusion:
Services which use volunteers to offer greater flexibility and choice or which
have higher costs because they refuse to provide a service where staff get the
minimum of supervision and training are effectively excluded from the approved
provider list. In addition, the service user is offered a range of basic
services from the approved provider list. These tend not to innovate because in
order to get to the desired price they are usually high volume providers.
systems governed by such rules are put in place, the outcome is rarely going to
make a transformational difference in someone’s life. We have the opportunity for Personal Budgets
to be a watershed moment for social care; however, what has often been
experienced has been a tinkering around the edges as new ways are shoe-horned
into old thinking, providing few new choices and little room for the
imagination. Put in this light, Personal
Budgets are not always an attractive proposition to a service user and may
understandably be met with apathy.
is also some fear that Personal Budgets are a way of cutting costs and reducing
support. This is getting in the way of a full and frank discussion about how we
can provide people with the opportunity to develop the skills to have a life
which requires less support. For example, time spent improving people’s
shopping skills may well mean that less support is subsequently required.
Developing people’s skills in this area involves more than just traipsing
around the local supermarket with them, it involves teaching people about
healthy eating, meal planning, budgeting and travelling. In the short term it is cheaper just to do
the shopping with them but ultimately the cost in both monetary and human terms
is much greater.
order for Personal Budgets and personalisation to really work we need to see a
willingness to think laterally and to allow people to select the right support
from the right provider. We need to embrace the local community and all that it
has to offer, to value volunteers and providers whose support is more expensive
because they offer greater quality and better opportunities for the development
of skills. And we need Local Authority systems which free people up to make the
right decisions. This doesn’t mean unbridled risk-taking: it means evolving
systems which fit the new landscape.
call on decision-makers to scrutinise personalisation within their area of
responsibility and ask to see evidence of transformational change in people’s
lives, to dig behind the one or two exceptional case studies which may be
offered, and to ensure they have an understanding of the system as it is
experienced by the majority.
This article has been published in
the ResPublica Fringe magazine, a collection of articles and essays from our
party conference partners.
Kirkpatrick will be speaking at ‘Choice in social care: Making care personal’,
a ResPublica public fringe event co-hosted with Keyring and Home Instead at
Liberal Democrat Party conference: Tuesday 25th September, 12.30pm –
1.45pm, Holiday Inn Brighton.