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.

I 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.

Within 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.

In short, the goal was total transformation - an organisational process - providing total transformation - a personal outcome.

So, 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?

Some recently-experienced rules from local authorities might elucidate the situation:

“We won’t cover the cost of volunteers through Personal Budgets”

“We don’t recognise the input of volunteers”

“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”

So, 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.

When 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.

There 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.

In 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.

We 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.

Karyn 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.