The latest 'Green Paper' from ResPublica, Putting People into Personalisation: Relational approaches to social care and housing, argues that social care needs a radical shake up to ensure genuine choice and empowerment for older people.
The governing philosophy of modern public service provision is that of individual empowerment: it is believed that if people have the power to choose, their needs will be met by the services that they select. A whole industry has grown up around this philosophy, but it unfortunately cannot deliver on what people really want and need – other people.
The needs of older people in particular, which this paper primarily concerns, cannot wholly be met by enabling them to become more powerful consumers of public services. Their needs are rather far more social and relational, and it is this aspect – not greater choice and individual empowerment – that is in need of greater supply. Older people can be active producers of social capital, rather than simply consumers of public services.
This paper argues that ‘demand-side’ reforms such as Direct Payments do not on their own result in a change of provision in the care and support market. It asks what ‘supply-side’ reforms might be needed in order to bring real choice – the choice about the shape of their lives – to those newly ‘empowered’ ‘consumers’.
The goals of the care and support sector and its industry of providers might well be radically misaligned with the wishes of older people. Helping individual older people to choose between established offers cannot bridge the gap between what people want and what they are supplied. Furthermore, the goals and wishes of many older people cannot be delivered by services at all. For them, the focus on more empowered consumption of services has entirely missed the point.
If public service provision is currently based on such a model, what can be done to bring older people’s real needs back into alignment with what we supply? This paper attempts to put people back into personalisation and explores the various ways in which human needs can be met and their skills harnessed by existing and new models of support.
The Green Paper recommends that providers of care and support should develop new approaches that are better aligned with people’s relationships. Public services must help foster a wider sense of shared responsibility and reciprocity in all that they do. Individual choice and control are vital, but paradoxically, being able to act collectively brings people more real power than acting alone.
Working at a scale above that of the individual – at a family-sized or micro-scale, of a small group of people – helps to deliver this transformation. This paper gives examples of how even large organisations and systems can think ‘micro’ (working with small groups) and that a ‘micro’ ethos can also be spread through creating new kinds of soft infrastructure which resemble franchise arrangements and social networking structures.
The Care and Support White Paper and Care Bill attempt to reframe care and support for older people as preventative, community-based and empowering. But the paper concludes by warning that in their commissioning practice and their approach to regulations, public services and councils remain a long way from being to realise this vision.
The Green Paper is kindly supported by Hanover Housing and is part of the Hanover@50 Debate. Join the discussions online through Hanover's micro-site here