Q
2The
Chairman: Thank you very much indeed for that full and
concise explanation. May we now hear from Oldham
council? Paul
Davies: I agree with everything that has been said
and will give a little more detail from our perspective. It is worth
saying that Oldham council has taken something of a lead on personal
budgets in adult social care, and that is important because there is a
bit of a worrying point, if I am honest. About 1.75 million people
across the country use adult social care or social care services in one
form or another, but only 10,000 of them have a personal budget, which
is a tiny part of the overall figure—really just a drop in the
ocean.
That reflects
the history of choice and control in adult social care. We have had
direct payments since the 1990s, but progress under the direct payments
legislation has been very slow and disappointing. I make that point
because I think that it contains the seed of a warning for the Bill,
and from my perspective there is no question but that the figure of
10,000 for people with personal budgets, over 2,000 of whom are in
Oldham, is insufficient and represents an insufficient pace. There are
several reasons for that, some of which relate to the difficulty that
organisations—whether central bureaucracies or local
authorities—have in reorganising their services to meet a new
agenda. My
concern is similar to that expressed by my colleague: the provisions in
the Bill could be more ambitious. Our experience in Oldham—and
it is a strong experience on the numbers alone—is that division
in funding streams is a sovereign recipe for ensuring that people who
use services, or try to negotiate their way through them, do not manage
to make any progress. It is extremely difficult, even when you have
partially integrated funding streams, to deliver success for people,
because the organisations that retain responsibility for that element
of their funding keep their own mechanisms of control, their own routes
and their own way of doing things. For people using the service and
trying to take control of their lives and services, it is frankly a bit
of a nightmare.
If people do
not have that element of choice and control, we cannot see any other
way by which to empower them to take control of their own lives, to
become co-producers in the delivery of their own services and to
contribute all the good things they have to offer as full citizens.
Within the current adult social care
system, none of that takes away from a local authority’s duty of
care—that is not reduced in any sense by any of this. I think that
that is important, because it seems to me that there are two elements
that need to be picked up: duty of care and affordability. Our
experience in Oldham is that things are unaffordable if you do not
reform your existing systems—that is what causes a problem.
There is a remorseless logic to giving people choice, control and money
but, in doing so, you have to unpick some of your existing
arrangements. That is very difficult and perhaps explains why there are
only 10,000 people with a personal budget.
There are
some hard questions to be asked once you go down that route. When you
do so, however, you get something of an explosion of creativity among
the people who are using, choosing and controlling their own services.
I will give you a generalised anecdote. If I tell somebody that I spend
£40,000 a year on their care they say, “You must be
joking. I could do considerably better than that for half the
money.” To be honest, they are very often
right. There
are some key lessons that we need to learn about the integration of
funding streams. We need to ensure that there is a system
lead—for want of a better description—for all aspects of
a person’s life, whether it is employment, where they live or
the care services that they receive, if they receive them. We will not
be able to deliver this absolutely fantastic agenda of personalisation
if we do not make things workable for people. You cannot expect people
who have been out of employment for a very long time and may have lost
their skills, or may never have been in employment or had any form of
meaningful day time activity, to exercise choice and control in their
own lives if you do not make the system simple and put in place
guidance and support. If that is not delivered by the Bill, the system
will fail and not deliver what is required.
The
Chairman: Thank you very much for that very helpful
evidence.
Q
3Mr.
Mark Harper (Forest of Dean) (Con): Both of you had a
consistent theme of making sure that different funding streams were
integrated and available to individuals. The Bill currently provides
for funding streams from only the Department for Work and Pensions to
be included, and as Liz Sayce said, that does not include the adult
social care funding. The Department has said, in written answers, that
it is going to consult on how its own funding stream should be included
in their pilot programmes and whether the disabled facilities grant and
adult social care should be included. I got the sense, from your
evidence, that you very much think that it should and I want to get a
sense from you of how critical that you both think that is.
We are very
supportive of what the Government are doing across Government about
individual budgets, but there is a danger that different Departments
are setting up their own. We already have adult social care: this one
from the Department for Work and Pensions; the Department of Health is
looking at personal budgets for health care; and the Department for
Children, Schools and Families is looking at piloting individual
budgets for disabled children. It seems to me that there is a
danger that we are just going to replicate different Departments and
different funding streams. Individuals will not actually have control
and will have to battle with a number of Departments and a number of
funding streams with different rules, and will not be able to bring
them together. I would like a sense for the Committee, before we debate
the Bill, about how critical it is to grapple all those funding streams
together. Liz
Sayce: It is very important for two reasons. First,
individuals talk to us about the fragmentation of the system and how
difficult it is to navigate through it. People want to have control
through a simple route to access either the pot of money or the right
for that money to be used on their behalf across the different funding
streams. Quite often the Departmental boundaries do not make intuitive
sense to the individuals. There is a lot of overlap in what we call
social care or health care and support for employment. Some of the
things you need for social care might very well help you in your
journey into employment because it might be about having a PA to
support you. That PA helps you to get up and get out of the house but
can also help you to travel to work. These things are all interlinked.
Having to navigate through multiple gateways is a complexity that
people would prefer to do without, to put it mildly.
The other
thing is that there is a risk of a poor use of resources if you have
multiple assessments and multiple funding schemes. Our sense is that
the right to control with integrated funding streams, where possible,
will lead to a better use of resources because the individual in their
self-assessment will be able to say what they most need such as, as
Paul was saying, “I could do better if I knew how much money
there was across the piece.” It is critical. Obviously there are
real complexities in delivering it. We certainly intend at RADAR to
seek expert advice on potential amendments to this part of the Bill to
see whether some kind of requirement to pool budgets might work better
than simply having an exemption, and what is obviously a very genuine
intention to align the piloting where possible and to consult. There is
a lot of agreement that people want to move towards better alignment.
It is a question of how and at what pace to do it. We do not want that
pace to be too
slow.
Q
4Meg
Munn (Sheffield, Heeley) (Lab/Co-op): I share the
frustration about how slow the process is. I worked in social services
in the ’90s and remember some early attempts to do precisely the
kind of things that Ms Sayce was talking about, and people’s
fear about what that would mean. It seems to me that, however many
years on, we should be well past that, but we are not. How much do you
feel that what is holding people back is about what is in the
legislation, and that this is an opportunity to do something about
that? How much is about the structural problems which are out there and
will continue to exist, regardless of whether or not we change the
legislation? Paul
Davies: Speaking from our experience at Oldham, which
probably holds good for many other places, too, we tried to integrate
as many funding streams as possible into our individualised budget
allocation to include just everything we could. Some of it worked
extremely well. For example—and this is not a plea for control
by local authorities—the parts of the funding streams that were
controlled within the local authority were relatively
easy to integrate. There was not a significant problem with that because
there was a single source of authority for integrating those streams.
We had some success in integrating Supporting People funding with
support from the Department, because it was within the gift of the
local authority for us to do that through negotiation with the
Department. That works very well. We have had very good success with
integrating continuing health care funding in Oldham, although I know
this is not the universal experience. That is simply through a
co-operative effort with our local primary care trust. It is a bit of
an exemplar for how one can make life easier for people.
Where we
struggled was in integrating Access to Work funding. Colleagues in the
DWP worked their socks off to make it work. They really tried very
hard. They were fantastic, but they just could not make it work around
the rules and regulations. Nor could we. That was a real problem for us
and it remains something of a separate stream that we have to work to.
We had a similar frustration with the independent living fund. I know
that that has been much discussed. There are basically two completely
different funding schemes with mutually exclusive assessment systems.
None the less, we managed to get some success in integrating those. In
terms of economy of effort, which is what we are looking for here, a
lot of hard work was required to integrate those funding streams that
were not naturally within the control of one
organisation.
Q
5Meg
Munn: So the issue is about the detail, the requirements,
the criteria and so on that will be in place, because inevitably you
have to limit who is entitled to things and how it is done, as opposed
to, in your case, the unwillingness of one of the organisations to take
part.
Paul
Davies: I would not say that it was
unwillingness; it was simply inability.
Q
6Meg
Munn: If you look at child care legislation on meeting the
needs of a child, other organisations, beyond the local authority, are
required to assist in doing that. I wondered whether, along with
changing criteria around spending, one mechanism might be permissive
criteria within the legislation.
Paul
Davies: My gut feeing is that permissive does not do
it. It requires something more direct. For that reason, I am also
concerned about the unreasonable financial burden, because, I suspect,
we are potentially building into this a system of gateways that does
not need to be there, through which those organisations that are
willing and able will pass, and those that are either unwilling or
unable will not. I think that it needs to be something more than
permissive. To deliver something that works, my feeing is that to bring
the full fire—for want of a better description—of all
these different organisations wrapped around the individual, it needs
to be more
directive. There
is good work outside of Government; organisations such as In Control
are looking at how different funding streams can be integrated through
a simple resource allocation system. That is the key; it is about the
individual knowing how much money they have to meet their needs, having
a set of defined outcomes that they have to work towards and having a
vehicle for delivering them. In our experience, where one is able to
integrate
those funding streams into that single delivery vehicle, wrapped around
the individual, with that individual having choice and control, it
works. What does not work is a load of bureaucratic jiggery-pokery at
the back as organisations try to sort things out, and not always
seamlessly. That is a not the way to ensure that we get people into
employment, meaningful daytime activity or a system of care that suits
them. Q
7John
Howell (Henley) (Con): May I pick up on a couple of points
relating to the level of support? One thing that concerns me is that in
rural constituencies, which many of us represent, the choice will not
be there and the cost will be greater, so budgets will not go as far as
they ought to. Have you picked up on that
concern?
Paul
Davies: Oldham sees itself as a country town really.
A large part of our borough is in a rural area in the national park,
but we also have a densely inhabited section close to Manchester, so we
are a mix. Your concerns are entirely justified, but in the case of
adult social care it is the responsibility of the director of adult
social services to ensure security and sufficiency of supply. None of
that takes away some of the things that we have to do. It is not simply
about giving people the money unconditionally and saying, “There
you are, get on with it. That’s absolutely fine,” and
people discovering that there is nothing to use the money on or that it
does not work for
them. There
is work behind all this that, in my case, a local government agency is
paid to do, which is ensure that supply is available and that there is
a sufficient market, if that is required, or sufficient support, if
that is required, to ensure that people’s needs can be met. That
is part of the needs assessment that needs to take place between
organisations. At
present, needs assessment, certainly in adult social care, has centred
on the relationship between health and social care, but it needs to be
broader than that because nobody’s biology is their biography.
It is not just about health or anything else; it is, exactly as my
colleague has said, about where they live, what employment is available
and even, in the case of a very large local authority, what transport
is available, as well as what role the whole council—in my
case—is playing in concert with, for example, voluntary sector
partners to ensure that there is sufficient supply. None of this takes
away that responsibility to make sure that those things are in place to
support the
individual.
Q
8John
Howell: I understand the point you are making about the
duty and how you intend to develop that. Nevertheless, it still prompts
the practical question of how it is possible in a rural area to
encourage new providers to come in and deliver the choice that people
in more urban areas would
expect. Paul
Davies: In my experience, there is a market. We were
told very early on in Oldham that we would lose. It was a great concern
among our providers, such as those offering domiciliary care, that the
atomisation of the market, due to personal budgets coming in, would
mean no work for anybody and people going out of business—it was
all going to be terrible. In the first year, we more than doubled the
number of providers coming to do business with us. The reason for that
is simple.
I
talked before about something of an explosion of creativity. If the
scope of one’s imagination is the existing traditional system of
support, you are quite right that there are limitations within that,
because it is the way that organisations do business and have done in
the adult social care base since the early 1990s, when community care
came in. But actually, the support that people require is often
non-traditional, things that I could not possibly imagine. I could
never had made up the things that people come back to us to say that
they need support with. Often to my great surprise, though less so now,
the solutions that people reach to meet their own needs are so far away
from the traditional but so effective that the issue of traditional
sources of supply is
minimised. I
guess that the point I am trying to make is that until you begin to
give people the ability to do this and to control and deploy their own
resources in a way that they feel comfortable with and that meets their
needs, you cannot begin to guess what solutions they will come up with.
Some of those solutions are within their neighbourhoods or often within
their own families—ones that previously would not have been
thought of. They are very unconventional
solutions. It
might help if I give you some facts and figures. Our experience in
Oldham is that about 50 per cent. of the people to whom we give a
personal budget say, “Thank you. I do not want the money. I am
happy either for you to control that or for me to have some element of
control over how that money is spent. You crack on and deliver my
services.” Another 25 per cent. say, “Thank you. I will
take all the money. I will plan, organise and commission my own care
and services, and deliver those. No problem.” The remaining 25
per cent. would say, “Thank you. We will take part of our
mission critical services as a delivered service, but some element of
it as services we will control
ourselves.”
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