Examination of Witnesses (Question Numbers
760-779)
PROFESSOR CAROLINE
GLENDINNING, PROFESSOR
PETER BERESFORD
AND MR
JOHN WATERS
3 DECEMBER 2009
Q760 Charlotte Atkins: That is helpful,
thank you very much. I will open up with some general questions
first, and this is addressed to all you. What do you make of the
funding options set out in the Green Paper? Which, if any, do
you favour—and why?
Professor Glendinning: From my
experience of being involved in the consultation exercises but
also looking at the experiences of other countries, I would say
that it is a shame that the taxation-based option has been dismissed.
In other countries taxation-based funding for long-term care is
common. Scandinavia, Australia and France all use a combination
of local and national taxation and user co-payments to fund social
care and, indeed, some elements of long-term healthcare as well.
I think it is also important to remember that older people are
taxpayers as well and that they contribute to the overall tax
base. In terms of the other options that are proposed, the partnership
model proposes that a proportion of your total needs will be met.
My concern about that is that I think it may be very difficult
to operationalise with people who have very significant fluctuations
in their conditions, or deteriorating conditions, where the amount
of money that would be contributed may well change from time to
time and, indeed, on a very frequent basis, and I think that conflicts
with the kind of commitments and concerns in the Green Paper that
people should know what their contributions will be. In the case
of fluctuating needs for care, I think that may be very difficult.
My concern about the optional and the compulsory insurance schemes,
the two options for insurance, are that it risks a two-tier system
in which some people can afford contributions but then there are
complex arrangements for people who cannot afford to make the
premiums that are required. I would just like to point, finally,
to the experience of Germany and the assumptions in the Green
Paper that we cannot ask for increased contributions from the
working age population towards the costs of care. In Germany there
is a long-term care insurance scheme. There have been recent increases
in contributions to that scheme from the working age population
as well as from employers and there has been relatively little
controversy over those increases, but I think that is because
it is based on an assumption of trust, an implicit assumption
that if people make contributions they will receive help when
they need it. I think that issue of trust and certainty about
future needs being met is absolutely essential in underpinning
any requests or expectations for greater contributions.
Professor Beresford: I was commissioned
by the Joseph Rowntree Foundation to carry out a consultation
on a national basis with a diverse range of adult service users
in different situations using different services late in October
this year. The key views of that wide, well networked group were,
first, that there were problems since the options were not costed,
and we still do not know what the costings are. It was felt that
the sums identified were unrealistically low, like the first estimates
for a new jet aircraft or aircraft carrier. People felt that none
of those three options would offer a reliable, sustainable, inclusive
equitable basis for social care for all groups. An underpinning
concern of the people we consulted with was that the Green Paper
was framed very much, going back to what Caroline has just said,
in terms of seeing service users as a burden and dependent rather
than recognising that by providing appropriate support they might
be able to be better contributors, so there is a real concern.
People were almost unanimous in the view (1) that general taxation
should definitely have been included as an option, and (2) in
thinking that it was the preferred, more viable option for the
future funding of social care.
Mr Waters: I would echo much of
what Peter and Caroline have said. I suppose there are two key
elements to this. One is the issue that has been touched on in
terms of where does any more money come from, but, secondly, how
should that money then be administered, and some thought in terms
of the fact there does not seem to be great logic to saying that
it is unfair to just draw on the working age population for support
to meet the social care needs, for the reasons that Caroline has
said. But the issue in terms of where the money is administered
in terms of the two main areas—either local authorities
or the benefits system—if there is movement between those,
that needs to be done with some thought in terms of the money
that currently is in the benefit system, once it reaches people,
is genuinely under their control and is in their hands and they
can do with that as they determine. Local authorities, because
of the historic pressures and rationing systems, tend to ration
through service types. Thus that issue would need to be deal with
very clearly if there was a move away from a national benefits
system into a more local system.
Q761 Charlotte Atkins: Could you
tell us a bit more about your organisation's ten-step plan for
reforming social care funding and how that relates to the Green
Paper options?
Mr Waters: There is a lot of overlap
and there is a lot in the Green Paper that, hopefully, draws on
some of these ideas. What we have tried to do with the ten-step
plan is to identify some of the key issues that face local authorities
as they move forward, to inform the debate with some of the progress
that has been made and to try and give a practical model to say
it is possible to get money into the hands of older and disabled
people in a way that defines clearly the conditionality. Why is
it that certain people should have a certain level of money and
what are the restraints around the use of that money and to focus
the restraints, not, as is currently the case, on paying for services,
as maybe with direct payment, but in terms of greater clarity
in terms of outcome. What is it that is being achieved here? It
is a helpful shift to be able to say to people, "Here is
a framework of a level of needs. These are your circumstances,
the support you can draw from the family, and here are the outcomes
that this money is going to help you achieve." That is quite
a powerful thing to be able to do, and our ten-step plan really
flows from that idea; that it is helpful to give people a clear
entitlement to resources based on both their level of disability
but also their social circumstances and, then, what you would
need to do to make that a reality, and it begins to explore more
fully, and with greater ambition than the Green Paper, some of
the integration of funding streams that might need to be taken
forward. For example, currently the focus of the rationing of
use of the Independent Living Fund is around task and activity—I
can spend particular money, but only in certain ways—and
it kind of undermines the attempt to get control close to people
when really the focus needs to be on the outcome here, and the
outcome in that instance is that I get to live in my own home.
Q762 Charlotte Atkins: Caroline,
you told us something about the conclusions of your studies into
social care funding, but is there a particular system which you
think we should copy?
Professor Glendinning: No. I think
it is very difficult to make recommendations about a particular
country, a particular approach, because other countries have got
their own institutions, their own structures, their own cultures
and traditions, but I do think it is possible, from looking at
a range of other countries, to draw some general conclusions about
the principles that seem to underpin care arrangements and funding
arrangements in other countries, and I just want to highlight
four of them. The first is the principle of universal access based
on levels of need regardless of income or assets. Having said
that, that universal access dependent on level of need can be
linked with and combined with progressive means-tested co-payments;
so you have a principle of universality that people, nevertheless,
can and do contribute where they are able to. The second principle
is equity. Across Europe, across federal systems, where regional
governments and provincial governments have very considerable
autonomy, nevertheless there are very clear moves to ensure equity
across the country to reduce the geographic variations between
provinces, between regions. There are also attempts and pressures
to create equity for people with different types of disabilities
as well, and particularly equity between, say, older people with
cognitive impairments, who often get less than people with physical
impairments. The third area of equity is around age groups as
well. Many other countries have the same arrangements for a disabled
child of the age of five up to an older person of the age of 95.
That equity principle is important. The third issue is around
cash or services: do we give people cash payments or do we give
them help in the form of services? Many countries are experimenting
with cash payments, and they have different underpinning rationales,
but I think one of the conclusions from the experiences of other
countries is that giving people cash on its own does not necessarily
stimulate the growth of a provider market. It does not mean that
providers respond with a wide range of flexible responsive services.
The fourth issue, which is linked to that, is the role of family
carers. All countries recognise that carers are absolutely crucial
to the long-term sustainability of social care systems, and arrangements
and support for carers are often built into the wider social care
arrangements. Many countries, nevertheless, offer what we might
term a "carer blind" assessment, so that the help that
you get is entirely dependent on your needs for help and it does
not take account of whether or not there is a carer there, a family
member, who can provide some of it. The other thing (and this
is where it comes back to the cash payment issue) is that reliance
on cash payments, care allowances, as the main form of support
can very often trap families and trap carers, because there are
no services as an alternative to their labour. I think the cash
payment issue and the impact on carers is a very big one that
needs to be thought about very carefully. Indeed, in some countries,
like Italy and Austria, some families have opted out of providing
very heavy amounts of care and are using care allowances to employ
"grey" migrant care workers who live in the home of
the older person. Cash versus care is an important debate, but
my view is that where cash options are available they need to
be underpinned by services as well.
Q763 Charlotte Atkins: Scotland has
had free personal care since 2002. What is known about how well
that is working? Is it affordable? Has it proved to be affordable?
Professor Glendinning: It has
been politically very popular, and it remains politically very
popular. It is not clear that demand for services or demand for
personal care has increased; there have been wider policy changes
and demographic changes that have affected costs anyway. The research
that has been done, particularly from the University of Stirling,
has shown very marked variations between local authorities in
the level of additional costs that they have had to bear but,
also, there are some big weaknesses and shortcomings in the data
that is available both at local authority and at national level
that would enable the future costs of free personal care to be
properly estimated. Indeed, the Scottish Executive has been criticised
for introducing the policy without a clear understanding of the
long-term costs. There is still a shortfall in the data that is
available to help understand the current and longer-term costs.
Q764 Charlotte Atkins: You were suggesting
that some local authorities had greater costs than others. What
was that based on: the nature of their populations?
Professor Glendinning: It is partly
based on demography, partly based on the number of people who
were previously funding their own care who came into scope for
free personal care. Of course, free personal care is offered to
people in residential care as well as in their own homes. To the
extent that local authorities are able to shift the balance of
care into the community and away from residential care, there
is the potential to contain some of the costs of free personal
care.
Q765 Mr Scott: Perhaps I will start
with John. What are your views on the policy set out in the Queen's
Speech about providing free personal care for those with the greatest
need? Could you see any unintended consequences of this policy?
Professor Glendinning: Shall I
go first? You go first.
Q766 Mr Scott: Do not fight over
it!
Professor Beresford: No, no, I
think we are of similar minds on many issues here. The real concern
that I have personally is if we have ruled out as an option considering
general taxation in a Green Paper to which there have been 24,500
responses, a significant number of which have supported the idea
of general taxation at least to be included, then it feels like
it is policy being made on the hoof to introduce a new idea which
contradicts that. We carried out our national consultation after
the announcements had been made, both about the Government's proposals
and the Opposition's proposals, and I think what people said is
really the way I would feel about this. For example, what is "critical"?
Who decides and how, and what if your needs fluctuate? I think
it is difficult to answer. One of the things that concerns me
is when you make an intervention in one part of the system, you
can have unintended consequences in other parts of the system.
I think if you say we are going to provide free domiciliary care,
my question would be: what happens to the rest of the system?
I think what people are saying is: does that mean that to offset
costs fewer and fewer people will be seen as having appropriate
qualifying needs, and would that mean that there will be perverse
incentives, for example, for people either not to receive support
that could prevent things getting worse or, alternatively, for
people to be seen only as candidates for residential care? I think,
unfortunately, if you do touch one piece you need to look at the
whole, and that is the worry about this proposal.
Professor Glendinning: I think
there are some interesting lessons from Scotland here, because
it is very similar to the proposal in Scotland, apart from the
fact that in Scotland free personal care is also funded for people
in residential care. Scotland has got some interesting new boundary
disputes about what is personal care and what is domestic help.
20 years ago we were arguing: is it a health bath or a social
care bath? In Scotland there are now debates, for example, around
eating and feeding, so you get into situations where helping people
to eat is personal care, food preparation in some local authorities
is regarded as domestic help and, therefore, is a charged-for
service, so you are creating new boundaries in the system. I think,
also, that means the potential for some really complex financial
assessments and to the extent that non-personal care will still
be charged for we will have local authorities trying to assess
what proportion of a care package is non-personal care and, therefore,
subject to means-tested user charges. I think that kind of division
is incompatible with other policy objectives, particularly the
policies of personalisation which are based on assumptions about
flexibility and user control. You are looking at a package of
support that somebody gets and beginning to put up boundaries
round, "You can use this for this and that for that",
and I think that is incompatible with the broader policy of personalisation.
Q767 Dr Taylor: This is really addressed
specifically to Peter. You have picked out some splendid words
that service users want to be cared for by workers with vital
human qualities, and you have listed them: warmth, empathy, honesty,
respect and competence, which I think is a brilliant summary.
You go on to say that too often they are not treated by these
sorts of people. Why is that? What can be done about it?
Professor Beresford: This article
in The Guardian was based on a report commissioned by the
then Minister for Care, where we spoke to 110 or 112 service users,
a very wide range, and over a quarter of them came from black
and minority ethnic communities, across people with learning difficulties,
older people, people who use mental health services, physically
and sensory impaired people, and I think what you will notice,
if you read the article, is the concern and support that people
register for the workforce as well as their concerns about bad
practice, and I think this is a complex issue. We carried out
another consultation which was published earlier this year, again
relating to the more recent agenda, again talking to about 100
people, and there are remarkably similar findings. The two things
that people emphasise when they are trying to get to grips with
why it is not working are (1) the issue of funding, which is seen
as problematic, and (2) the issue of culture, which is seen as
problematic. It is the wrong culture in place still. However,
if we are talking about the quality of the workforce, there do
seem to be negatives at work. We are expecting of a workforce
(and amazingly we often get it) amazing levels of human skill
and understanding, a workforce that is treated, in terms of their
reliability and quality and rewards for the employment, very meagrely,
at the level of check-out staff, as that article said, working
in supermarkets. This is a very difficult occupation and it has
been reflected, of course, in high rates of turnover, low retention
and difficulties in recruitment in the social care work force
which are expected to get far worse as the population needing
social care support is expected to grow bigger. I think that is
part of the problem, but there are other problems too. For example,
the way in which commissioning is undertaken, the purchase of
services. We know the Government understands that because the
whole shift to personalisation expresses a concern to move away
from that, but people so often talk about the fallibility and
unhelpfulness of domiciliary care—repeated mantras from
people that we talk to that you get a troop of people you do not
know, one after another, always different, coming into your home
who may not treat you with understanding, may not know you, may
not treat you with respect, who will undertake very personal intimate
tasks with you not necessarily in the best way possible—and
we also know, of course, that there are real problems with that
workforce. Apart from the poor conditions in terms of income,
people may be expected to do a task within 15 minutes, no allowance
may be made for the transport time that there is between one person
and another, and people may be expected to pay for that time and
the cost of travel themselves. We know from some further work
that we have undertaken, again commissioned by the Joseph Rowntree
Foundation, about person-centred support, a big national project
which is reporting next year, that people may not receive training
or supervision except in their own free time, and they will not
be paid to undertake that, and so there are real essential problems
in the work force which, I have to say, it feels to me that policy-makers
are reluctant to recognise and face up to.
Q768 Dr Taylor: Thank you; that is
very helpful. Bad commissioning: what should commissioners be
doing about the quality of staff that they include and these problems
with the staff?
Professor Beresford: I think there
are micro issues and what you might call macro issues in relation
to commissioning. You can see, as we have seen in the big project
I have just referred to, the standards we expect where locally
people make supreme efforts to make the very best of the resources
that are available but, if there is only so much money allowable
to pay, whether it is domiciliary care or residential care, and
that does not match what it actually costs to provide good care
and support, if there are cultural problems in terms of the kinds
of people you are recruiting—and domiciliary and residential
care is not an area which is constructed and envisaged in career
terms as a positive role, although many people, nonetheless, carry
it out in that way—then we have problems. There are essentially
built-in problems at a macro level is what I would argue.
Q769 Dr Taylor: What can the regulator
do? How can the Care Quality Commission going into a home pick
up the quality of the workforce, whether they do have the empathy
and the warmth that you describe?
Professor Beresford: I think there
is a problem in seeing regulation as an appropriate means of dealing
with a problem whose origins may lie elsewhere, may lie in problems
of supervision, training and particularly of funding and resources,
and, of course, regulation can sometimes be a blunt and crude
instrument. I think it is very difficult to expect a regulator,
especially a regulator like the new Care Quality Commission, which
in a sense is required to have a less hands-on role than was previously
the case, to compensate for other more substantial difficulties.
If, for example, I say to you, checking out a residential service
where one knows that the report from the predecessor of the Care
Quality Commission was very positive but that when you speak to
a resident there they do not even realise that they are permitted
to go into the garden, you realise, of course, that there is a
big gap, many a slip `twixt cup and lip, between what it is possible
to do by a regulatory system (and that too much is expected as
such) and what needs to be achieved in terms of other change.
One of the things that service users feel very strongly is that
to rely on regulation and registration as a cure-all is not going
to work. They recognise that there are problems of a more face-to-face
fundamental issue than a regulator should be expected to resolve.
Q770 Dr Taylor: So low pay, poor
training and time for doing tasks are really the vital things?
Professor Beresford: I think that
they are, and I think also that there is a low value placed on
such work in our society. I think it is interesting that very
recently we have been able to read in The Guardian—and
we know this is the case—the way that immigrants are being
exploited to undertake such work. It is because it is not a job
that, unfortunately, people can see as offering an adequate career
for the future, it is an entry job, and I think for that to be
true is an appalling indictment of our society; the value it places
on the human and personal needs of people who are having difficult
times or who are at difficult ages.
Q771 Dr Taylor: Certainly in my area
at home, care workers in residential homes are Filipinos, and
they do a splendid job.
Professor Beresford: Absolutely.
Dr Taylor: Thank you.
Q772 Stephen Hesford: Mr Waters,
your organisation In Control claims to have conceived and developed
the concepts of personal budgets and self-directed support. Can
you tell us how you came up with these ideas and what shape they
take?
Mr Waters: I suppose they have
evolved over a number of years and they came from a recognition
of some of the problems that we have been talking about this morning.
The intention really has been to say how is it possible to fairly
share resources that are available to local people and to place
the decisions about how resources should be spent as close to
people as possible, whether that is the person themselves or,
if they do not have capacity, their family member or, in some
circumstances potentially, a social worker or somebody advocating
on the person's behalf. It was the intention to say how do we
get control close to people when previous systems had struggled
to do that. We have heard Peter talk about some of the difficulties
with the way services and the workforce operate at the minute.
We worked initially with six local authorities for a couple of
years and we said here are some core ideas about what a personal
budget might be and some ideas building on the work that then
happened around person-centred planning to say, "Is it possible
to get control close to people? What are the tensions in there?
How do you solve some of the debates around what is good use of
public money?" and we have done that by working together
with families, people themselves and particularly with local authorities
and challenging them really to change their systems within the
parameters to which they operate. That work has moved forward
over six or seven years now and we have produced a couple of significant
reports that have said: this is the emerging model, this is the
effect that we think this approach can have in terms of getting
control close to people. The key issue, I think, is this idea
of partnership—getting control of resources close to people
but sharing out resources fairly to people using a transparent
framework that allows people to identify their own level of need
and what for them is a fair allocation of resources—and
to tie into that a clearer idea of what is the outcome here. For
example, one of the outcomes might be to maintain family relationships.
Quite clearly, the Green Paper says one of the things that services
should do is support maintenance of family relationships. We have
taken a step back from that idea of services and said overall
the system should be doing this and that the financial resources
should be under the control of the person and, so long as they
are used in a way that can be agreed to achieve those outcomes,
then it should be the person who decides and not the commissioner
or the local authority who decides.
Q773 Stephen Hesford: There is a
term that we have got from you called "total transformation".
Can you tell us a bit more about that?
Mr Waters: That is just the name
that we gave to a piece of work that we took forward. This started
off before the Green Paper had set out any of these ideas, before
Putting People First had said that personal budgets were
a helpful way to organise social care, but we had a lot of interest
from local people and from local authorities, who were saying,
"We recognise the value in this approach and we recognise
that we cannot just operate in small-scale pilots. We cannot make
it available to somebody with a learning disability but not to
an older person, or somebody in this area and not in this area."
So we responded to that and we said, "We will work with you
and figure how do you begin to change your whole system"
and we called that total transformation. We worked with about
20 local authorities to support them to begin to think through
the bigger systemic changes they need to take through.
Q774 Stephen Hesford: One former
government minister, in simple terms, described your organisation
as being fantastic.
Mr Waters: That is very kind.
Q775 Stephen Hesford: What exactly
is your relationship with government and to whom are you accountable?
Mr Waters: We are a charity, so
we are accountable to a board of trustees. Our main funding comes
from a subscription from local authorities and we provide a support
service to local authorities, figuring out how to meet the demands
that are being placed upon them. So we are accountable to a board
of trustees but, also, we would not exist if local authorities
did not think it was worth supporting our work.
Q776 Mr Scott: Direct payments have
been made since 1996, but the take-up has been very low. Why do
you think that is?
Professor Beresford: I think it
would be helpful for us to contextualise the terms "individual
budget" and "personal budget" with "direct
payments". Direct payments were an idea that came from the
disabled people's movement, and what they were crucially about
was making it possible for people to have more control over the
support that they had and more control over their life, and, sadly,
this is still a problem for many service users, many people have
not experienced. I can remember one of the first things that my
organisation did was a project concerned with measuring outcomes
and trying to develop user-defined outcomes. Not just what professionals
thought outcomes should be, but service users. When we put that
together in a video, we discovered that the only people who could
talk about outcomes and for them to have any meaning for them
were people who were accessing direct payments. Only they were
seeing appreciable change in their lives from the support that
they were receiving. There is so much evidence to show how well
direct payment can work, but we know that there have been obstacles,
in the sense that their take-up has always been different in different
parts of the country, different local authorities have been more
or less enthusiastic, that many social workers have not had the
support to understand them or have been able to implement them
well, and, of course, what was the case with direct payments was
that few promises were made that this would be a cheaper way of
offering support. It was made very clear that this should be,
and could be, a better way of offering support. One of the things
that we have seen with the more recent discussions, which is why
they have gained so much political support, has been claims made
that they can be much cheaper, and I think that those claims need
to be subjected to far more careful scrutiny. What was said about
direct payments was that they could make it possible for people
to live a fuller more contributory life, and that was in accordance
with values of a philosophy that the disabled people's movement
developed called "independent living", not meaning standing
on your own two feet, but having the support to be a contributor—to
be able to go to work if that is what you wanted, to get an education,
to sustain relationships, to be a parent, rather than have someone
coming in and getting you up at the time of their choice, putting
you to bed at six o'clock, and so on and so forth. I think there
were problems in the way the process was implemented, and I think
disabled people have often felt that local authorities were not
the ideal implementer, and I think many of the gains that we have
seen come with individual budgets have been because there has
been the opportunity to get back to the true spirit of direct
payments, which was: you should know what resources are available
and truly have control over them and, of course, have the support
to run the system. That is what was seen as the most important:
there should be an infrastructure of support—advice, guidance,
management, knowledge—from local service user organisations,
something which the Prime Minister's Strategy Unit said we need
to go ahead and have a network of nationally in this country,
but that has not always, unfortunately, been in place. I think
we are seeing an extension of continuity and to some extent a
rebranding and, I think because there is now more political will
there is much more chance of this working.
Q777 Mr Scott: Caroline and John,
would you like to say anything?
Mr Waters: My thoughts are that
I agree entirely with Peter's comments. I think there is a significant
issue in terms of direct payments have operated almost as a bolt-on
to the main way that local authorities conduct their systems.
A social worker supporting one of their clients to take up direct
payments would have to be following a completely different set
of processes and procedures. They would have to find the time
in their work to sit down and develop a good person-centred plan
with somebody, and that takes time; it takes energy. It is often
what folk want to do and is the right thing to do but they are
faced with the choice of saying there is a pre-commissioned, ready-made
solution here where I can pick up the phone and I can move on
to my next piece of work. So it is partly because it has been
a bolt-on.
Professor Beresford: Could I add
to that because I think that is a helpful comment and I would
not disagree. I do not think that is a statement actually about
good social work. If one looks, for example, at specialist palliative
care social work—and there are cases of individual budgets
and direct payments in specialist palliative care, where there
is a much more informal, thought through partnership approach
to assessment—you can see exactly what John has described
taking place. I think what the problem has been is that the care
management introduced in the 1990s has not sat comfortably with
these ideas of self-directed support.
Mr Waters: The other difficulty,
in terms of uptake, was clarity around the level of resources
that any one person should have available to them, and that often
was decided at the end of an assessment process once a service
had been costed and, in order to control and manage and ration
local resources, local authorities would place quite clear restrictions
on the things that direct payments could and could not be spent
on, starting perhaps down to a list of preferred providers, but
then, even more tightly, down to certain tasks and activities,
because there was a lacking of any sense of how much of a fair
allocation should be made available.
Professor Beresford: Could I pick
up on that one because again that is a very valid point. One of
the troubles we are seeing now is exactly the same happening with
local authorities interpreting personal individual budgets in
just the same way. I could point to an inner London borough which
has made it clear to people that if they want to spend some of
their personal budget on cleaning, it will deduct that amount
from their personal budget, and it has only been in the case of
some people who have taken that to all forms of complaint and
appeal that they have managed to reverse that decision. There
has been a cultural problem, which continues, of local authorities'
understanding of an open menu, I think, here.
Professor Glendinning: I would
add one point, and it is drawing on evidence from the Netherlands,
where there is a similar personal budget scheme in operation.
Again, take-up tends to be higher amongst younger disabled people
but, nevertheless, older people do use personal budgets. The crucial
difference is that the Netherlands allows personal budget holders
to employ close family members, including spouses, and I would
not want to say that employing close relatives is always easy—it
can bring its own problems—but for older people being able
to pay a close family member to provide care is sometimes more
acceptable than employing a personal assistant in a much more
formal employer relationship.
Mr Scott: I think employing family members
is something that Members of Parliament can relate to!
Q778 Stephen Hesford: Professor Glendinning,
can you summarise briefly for us the findings of the individual
budget pilot?
Professor Glendinning: Yes. To
some extent this supports the points that have already been made
about the difficulties and the challenges of transforming a system.
I think all the pilot sites extended the scope of their pilots
during the two-year pilot project and, indeed, some of them had
decided to introduce individual budgets across the whole of adult
social care during the course of the pilot. They found it was
very difficult to run the two systems in parallel so the pilot
sites were beginning to move towards this kind of total transformation.
The outcomes for older people were not as positive as for other
groups of people. The outcomes for people with mental health problems
were very positive and there was actually some suggestion there
that people with mental health problems were opting for personal
budgets, or individual budgets, where they had previously refused
to use or not been willing to use conventional day care services,
day centre services, and so on. There was some evidence of increased
demand there and people with mental health problems tended to
use their personal budgets, individual budgets, for leisure activities—adult
education classes and those kinds of things. Part of the reason,
I think, for the less than positive outcomes around older people
was that—
Q779 Stephen Hesford: I think we
have got a question on that, so if we can just park (a rather
inelegant phrase) older people for a second, we will come back
to that.
Professor Glendinning: Okay. I
think one of the important points and one of the important findings
of the evaluation that I do want to highlight was the failure
to really tackle the issue of integrating funding streams, and
this is where individual budgets differ from the personal budgets
that are now being implemented by local authorities. Individual
budgets were intended to bring together the resources.
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