Examination of Witnesses (Question Numbers
940-956)
RT HON
ANDY BURNHAM
MP, MR DAVID
BEHAN AND
MS HAZEL
HOBBS
7 JANUARY 2010
Q940 Dr Naysmith: It has also been
suggested to us that Disability Living Allowance and Attendance
Allowance can be described as "the original personal budget".
If you really want to put individuals in control should you not
just leave these benefits alone?
Andy Burnham: We come back to
your original question. The reason why we should not pass responsibility
to DWP is that there will always be a role for the local authority.
There is a role in commissioning, assessing need and ensuring
there is a range of providers building the provider base to cater
for all needs. There will be some people who choose different
kinds of provisions and do not want to take as much individual
control, so there will remain a role for the local authority in
overseeing the development of the local market and commissioning
services from it. It does not mean that we say to somebody we
will take away his or her benefit and give a few afternoons in
a day centre in return. We say that all of the empowerment of
cash benefits needs to be replicated in the system for those who
want it. There is a really important role for local authority
social workers in helping more vulnerable people make a reality
of direct payments and the empowerment that comes with it. It
is not possible to say to everybody that they should now get on
with it. With help some people could really unlock the freedom
and independence that they might not otherwise get from council-provided
services.
Q941 Dr Naysmith: Disability benefits
come from the social security budget which is entitlement-led.
On the other hand, the social care budget is cash-limited. Do
you aim to keep the lid on future spending by transferring resources
from one budget to the other? Is that a possibility?
Andy Burnham: That is a very good
question. This where one encounters conflicts between annually
managed expenditure that DWP largely deals with and DEL expenditure,
but in this system there will be a merger of both. It is a question
of where you set the entitlement. In any national care service
the point at which you set universal entitlement would become
your AME spending. That would automatically be given out to those
people who present those needs. What you then provide on top of
and around that is a matter for departmentally-controlled spending,
but you make a very good point. My old Treasury days come back
to me now and that was stuff I had to know in detail.
Q942 Dr Taylor: Why have you given
up on individual budgets which combined local authority social
care money and other funding streams?
Andy Burnham: We certainly have
not. Ms Hobbs may be able to say more about the right to control
work that is going on for which DWP has legislated.
Q943 Dr Taylor: So, you have not
given up on the idea?
Ms Hobbs: Certainly not. The principles
running through and across government in this sense are about
giving people the right to control, bringing together different
funding streams, for which parliament legislated in the Welfare
Reform Bill last year. That will bring together a wide range of
funding streams for disabled people, including access to employment
and that kind of thing. Trailblazers will be up and running in
October of this year. We shall be working closely with the Department
of Health to align that with personal care funding. When one goes
out and about one is struck by how crazy the current system is
and how difficult it can be for people, whether they are of working
age or are pensioners, to find their way round this deeply confusing
system.
Q944 Dr Taylor: Are you just giving
up the words, because "individual budgets" as opposed
to "personal budgets" were very confusing without explanation?
Ms Hobbs: I certainly agree with
that.
Q945 Dr Taylor: So, you will have
personal budgets but with local authority social care funding
and other public funding streams coming into that?
Ms Hobbs: What we have said in
the Green Paper is that at the heart of a national care service
is the principle of personal budgets. Basically, we are saying
that people will be able to decide how they spend the money in
a way that meets their needs and keeps them independent. There
is a lot about words here.
Andy Burnham: When one talks of
personal budgets, individual budgets and direct payments people's
eyes start to glaze over. This is a very interesting side of public
service reform that will play out not necessarily immediately
but over the next 20 years. When you look at the effect of our
health personal budgets pilot the intention is to merge it with
direct payments in social care, employment and elsewhere, but
here you cannot run before you can walk. The implications of all
of this are pretty vast. This is the way public service reform
is going. I believe this degree of empowerment of the individual
who can call down the support he or she needs to deal with a range
of needs is very exciting and is now genuinely opening up. The
momentum is there in all public services to go this way.
Q946 Dr Taylor: So, somebody could
have his personal budget supplemented by money from the Independent
Living Fund, for example?
Andy Burnham: Yes.
Q947 Dr Taylor: So, it is just words?
Andy Burnham: Yes.
Q948 Charlotte Atkins: The implications
for council services are quite great. I believe that Oldham is
one of the first councils to start closing down the services and
simply telling people they should be using their individual budgets
and do the commissioning themselves. It has done that in respect
of dance classes for people with learning disabilities, but the
same could be extended to day centres, for example. If you want
to attend a day centre you can use your individual budget to buy
into it. Do you believe that is acceptable, or should those sorts
of services be ring-fenced given the difficulty of individuals
being able to get sufficient agreement across a wide range of
people who use those services, or will it just be used by councils
as a way to close down services and confine people 24/7 to their
own homes and get services delivered to their homes?
Andy Burnham: You have just put
your finger on why we should not do what Dr Naysmith invited me
to do and hand it all over to DWP. There will be a role for local
government to make sure there is still a mixed economy in any
locality to cater for the range of needs. Some of that can quite
properly be in-house, direct provision by the council. For that
reason we need to proceed in this area with caution. We have all
agreed in principle that it is the right thing to do but there
could be a destabilising effect on collective services. Some people
are considered valuable to them and if you disturb the critical
mass of people who use that it may disappear. For me the council
has to hold the ring; it must manage the process and respond to
what people are saying they want. The end result is that people
will speak and get the services they look for. You quoted the
example of Oldham where there are examples of good practice. You
might say that traditional collective services have declined but
they very much encourage the development of new collective services.
Oldham works with faith groups to develop services that are more
sensitive to the needs of the community. That is an interesting
thing. That is the kind of change you will probably see in all
local authority areas. The best councils will encourage those
new forms of collective provision that people in those area want.
That is why the role of local government is still important. As
Sir Jeremy Beecham told you, there will be local circumstances
and needs that councils will be well placed to detect and then
help provide.
Q949 Charlotte Atkins: In one case
with which I am familiar a young girl with learning disabilities
received direct payments. She was being taken out to shop every
day. Some 18 year-olds would love that but she did not. She wanted
to access the local day centre but was told that because she had
direct payments she could not do so. I managed to get that overturned
but it was a big battle. It seems crazy to rush headlong down
the direct payments route which can work brilliantly for lots
of people, but if those people are then confined 24/7 to their
homes because the community out there does not meet that need
and it does not feel adequately equipped to access community services
in terms of social interaction you can end up losing valuable
day centres. Some are good and some are bad but they can be made
much more focused and inclusive. We may have a situation where
the individual rules and we lose that collective provision which
can be so important to keep people out of acute care.
Andy Burnham: I think you make
a very important and genuinely difficult point. It will be for
councils to manage that tension. You say "rush headlong".
In some ways I believe that progress towards direct payments is
not as strong as it might be in some places. Arguably, they tend
not to face the new world and should perhaps be cracking on with
it to a greater extent. Some authorities, for example Harrow,
are making great strides on this agenda and help to build that
new market. There is the emergence of new market places. I do
not know whether the Committee is aware of a service called Shop
for Support. It is a place where people can go and see the whole
range of accredited services available to them. User-friendly
and easy-to-use services are now beginning to be built and are
out there. Some councils are very proactive in using those services.
I hear what you say, but not everybody in the end will want to
have direct payments. On present figures of those for whom a personal
budget has been assessed 20% take the whole thing as a direct
payment; 50% will take their personal budget through traditionally
provided services and 30% will mix and match, so some element
of their care may come by way of a direct payment and the remaining
value will take the form of traditionally provided support. It
is managing that transition that is going to be, let me be honest,
a difficult job for councils.
Q950 Charlotte Atkins: It has been
suggested to us that councils should ring-fence some of these
collective services like day centres. What is your position on
that?
Andy Burnham: I think they should
pay great attention to the views of users. They need to understand
which of the services that are provided are liked, used and well
loved and which ones people are not as keen on because they vote
with their feet. Like the NHS, we must get better at measuring
patient satisfaction. The same applies in this field. If very
important services are jeopardised by people who remove themselves
from them the council needs to be on top of those issues, but
we should not do their job for them. Understandably, the very
strong argument that I hear from the LGA is that there needs to
be a council role in the national care service. This is part of
what it would be. I cannot take over that role. If they want to
keep that role in commissioning and market-making it is absolutely
right that they should do so; it is fine by me.
Q951 Sandra Gidley: Mr Behan, Can
you clarify exactly those things on which direct payments can
be spent? How should we monitor the spending to make sure taxpayers'
money is spent appropriately?
Mr Behan: Probably this question
comes from the more controversial aspects of direct payment spending.
When people use direct payment very often they do so to procure
quite traditional forms of service. There is very little evidence
that these are being misused by people for reasons other than
those things that help them to be supported. We have had direct
payments since 1996 and they were in large part born out of the
disability movement. In relation to Charlotte Atkins' questions,
interestingly enough they rejected the notion that group living
was good for them and said they could do a better job of looking
after themselves if we gave them the money. Out of that the direct
payment legislation was born. The evidence is that since 1996
people in receipt of direct payment have used it to arrange practical
help, very often to assist people to go to work and to continue
in employment. Some will arrange for personal care assistants
to help them get ready in the morning to go to work. Often that
practical assistance is combined with money from the Independent
Living Fund so they can continue to live independent and fulfilling
lives. One interesting issue is how one breaks away from traditional
services and begins to innovate. I spoke to a woman in Norfolk
who was a mental health service user. She had been assessed to
go back to a day care centre. She had earned her living earlier
as an actress. She said she wanted to take this as a direct payment.
Instead of going to a day centre she resumed acting classes. She
used her direct payment for an acting class. Her feeling of wellbeing
and her degree of satisfaction was massive. About three years
ago she was about to return to employment. That is an example
of an innovative and quite different case which will often provoke
a question about whether going to acting classes is a good use
of public funds. For that individual it was a better use. It restored
her confidence and gave her the energy to seek employment in a
way that perhaps a more traditional form of day care service might
not have done. This is not to run down traditional services but
to say that the whole ethos of personalisation is to fit the package
towards personal needs and empower the individual. Peter Beresford
and Caroline Glendinning gave evidence to you about this. When
we conducted research on the individual budget pilots we found
that the greatest level of satisfaction on individual budgets
came from those people who were mental health service users. In
a sense it is not surprising because they would be of the view
that the system strips them of control and an individual budget
gives them the control to run their own lives. We need to balance
anecdotes about where in some cases money may not have been used
wisely with some of the anecdotes and evidence that now emerges
from the research that this money is being used well.
Andy Burnham: One of your witnesses
mentioned that a direct payment had been used to enable someone
to go off to watch Rochdale Football Club play. Perhaps you can
give me the name and address. I will send the details to the Audit
Commission because the value for money test is obviously questionable
in that case.
Q952 Chairman: Not when they are
playing Rotherham!
Mr Behan: That is an interesting
story because the benefit from that related to his wife who provided
care seven days a week. She would argue that £380 for a season
ticket for Rochdale was cheaper than her husband going in for
a day's respite in that period. There was a trade-off here with
the respite care that would otherwise have been paid. The season
ticket was for the neighbour; the individual got in anyway because
he was disabled. The respite was for his wife who hated football
and wanted to go shopping. There was an interesting issue about
where the benefit arose in that case. I believe we take an oversimplified
view about some of this stuff. The other question is about monitoring
in relation to this. This takes us back to the answer given by
the Secretary of State about the ongoing responsibility of local
authorities as custodians of public money at local level to ensure
that it is properly spent. They continue to have care managers
who will be involved in cases like this. Their role is to ensure
that the needs of those individuals continue to be met and they
have the fiduciary duty and responsibility as councils to ensure
that that public money is spent in an appropriate way.
Q953 Sandra Gidley: The example of
football is an old favourite. People with direct payments can
choose to spend their money in that way, but if people receive
services directly and want something similar should they be allowed
to do so?
Mr Behan: The care plan in that
particular case talked about the need for respite. The creativity
and innovation arose when the individual was not sent to a residential
unit for respite and the question was: how could this be done
in a different way? The plan was to get respite, not to give somebody
£300 for a season ticket; it was related to the individual's
need. The innovation arose in meeting the need.
Q954 Sandra Gidley: I appreciate
that the carer got a much greater benefit; it is a win-win situation.
Up to now direct payments cannot be spent on in-house council
services. Can a personal budget paid in cash be spent in that
way?
Mr Behan: Very often it is a notional
personal budget. Thirty per cent of people take their services
somewhere between that innovative approach where they make a direct
payment and much more traditional forms of assistance. A personal
budget can be a notional sum; it is not people getting cash into
their pockets with which they then purchase services, which is
what a direct payment is; it is a notional budget and it can take
the form of a direct payment in part and then support in a much
more traditional way, so the answer is: yes, you can use a personal
budget to procure council services.
Q955 Dr Naysmith: The final question
is a policy question in a way. Regulation and safeguarding have
been increased in directly-provided and commissioned services,
yet they are totally absent where people use direct payments to
employ personal assistants. Should it not be consistent one way
or the other, and what are the general lessons from this for the
regulatory implications of personalising social care? What are
you doing to address them?
Andy Burnham: There certainly
are implications, but I do not believe people want to thank us
for the long reach of bureaucracy into their homes, friends and
family who are known and trusted. As in the Rochdale example,
they are people the individual knows. We want to get that balance
right and it is an area to be watched as the matter unfolds, but
I do not think one would immediately say there must be a vetting
and barring scheme and all the things that that entails.
Q956 Dr Naysmith: Do you think there
might be regulatory implications?
Andy Burnham: There could be.
It is an area where one wants to proceed with caution but again
it points to the oversight role of the local authority to make
sure that nobody's safety is compromised or put at risk by any
care package that they may decide for themselves.
Chairman: Thank you very much.
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