Social Care - Health Committee Contents

Examination of Witnesses (Question Numbers 840-859)



  Q840  Stephen Hesford: You are not a Rochdale fan.

  Councillor Sir Jeremy Beecham: I do not know that there are many Rochdale fans—except for this chap. We are going to have that kind of debate, I think, about what people choose to spend their money on. Councils will have to help people, but will clearly not be deciding for them. There is a cost to that. It is too early, frankly, to say how much of a cost that is going to be. It will partly depend on our partners locally, and this will vary from place to place as well. Where you have a strong third sector, a strong Age Concern, for example—and I declare an interest as the honorary president of Newcastle Age Concern—organisations like that will be able to help people but to be providers as well. That will be important. That then raises a question about the relationship with the third sector. Again that will come under financial pressure from local government, and it may be that central government is going to have to look again at whether extra provision needs to be made to strengthen the role of the third sector in that respect.

  Q841  Stephen Hesford: Jenny, obviously you can add anything you want to what Jeremy has said, but in terms of levers to get this thing done, what are they and how are they working?

  Ms Owen: I do not recognise the parallel working question.

  Q842  Stephen Hesford: It is more that Jeff Jerome's organisation, as I understood what they told us, did not seem quite to fit. It seemed to be bolted on.

  Ms Owen: Perhaps I could address that part of it as well.

  Q843  Stephen Hesford: Yes.

  Ms Owen: Rather than seeing this as parallel activity, I see it as absolutely essential and the whole of the work that we do in local authorities at the moment in adult social care is a huge transformational programme. It is cultural change, it is process change, it is operational practices change. It is fundamental. When we brought in the community care changes in the early 1990s, that was fundamental change. This is bigger, in my view, and it will take just as long. I think that was underestimated when it started. I would say a very, very significant programme. It was set up by government as a three-year programme, funded for three years. We are halfway through, so we have some idea about progress which I will come on to. In terms of what we did in order to help the sector, one of the things that has been very, very good about the way this government policy has been implemented is that it has been done in co-production with local government. That means we have sector-led improvement, the sector driving the agenda. We set up a consortium to manage that. It consists of the Association of Directors, the LGA, and the IDEA. That group of people, with Jeff Jerome as National Director, provide leadership for us around the work. So not parallel but actually providing some leadership and driving forward. In terms of where we have got to, one of the problems we had to begin with is that one of the soundbites, one of the easy ways of describing personalisation, was "personal budgets," but of course the changes are much more significant, much bigger than just personal budgets. They range right through from looking at prevention, looking at information, looking at market development, looking at social capital in the way our communities are organised. It has fingers in each of those areas. We did a self-assessment back in April and May, and in May we were able to set a benchmark of the progress that had been made. We knew from that piece of work that there was progress being made in every authority. Most councils had dedicated teams to lead the transformation agenda and it was funded by the reform grant; most had active engagement with their providers and were planning for development in the markets; four out of five authorities were saying that provision had already become more flexible; 23 authorities felt that their local information services were going to provide good information, advice, potentially advocacy. When we did this survey—so the latest figure then we had was 31 March—93,000 were receiving personal budgets. We were asked to estimate how many we would have by March 2010 and that was estimated at 206,000. You can see, starting from a fairly low base, that the trajectory was fairly significant. There are big variations, everybody started from a different place, but everybody is working on an aspect of the transformation. In terms of levers, because this is co-production and we are driving the improvements ourselves, we have put our own levers in place. There was a letter that came out from the LGA and from me as President to say: "These are the milestones" and we set five milestones that we expect everybody to have achieved. I could go through those with you if you like, but they are around how you engage people, the people who use services, what you are doing around prevention, what you are doing about information and advice.

  Q844  Stephen Hesford: When did that letter go out?

  Ms Owen: It went out in September, so a couple of months ago. Everybody is now working to that. They have to do returns next March, and we are looking at how we do the collection. The work that is currently going on is on what bits of support local authorities want help with to reach each of those milestones. We had our national conference in Harrogate at the end of October and a very significant amount of guidance and helpful tools were published at that time.

  Councillor Sir Jeremy Beecham: It is interesting that quite a number of councils are now using people who have been through the system and benefited from it as advocates to spread the word. That is partly leading to this more than 100% increase in people on the personal budget side.

  Q845  Stephen Hesford: Personalisation, it is suggested in some quarters, is an excuse for budget cutting. Is that fair comment?

  Councillor Sir Jeremy Beecham: It should not be. When we talk about personalisation we should not be thinking of it purely in terms of adult services either; we should be thinking of it in terms of health generally. Of course that is part of the Government's approach. Obviously efficiency is important. I suspect personalisation may be more costly rather than less, given the need, as I say, to help people through the system, but it is undoubtedly the right approach, and we have to offer people more choice and tailor the service to their needs and aspirations

  Ms Owen: I think it will be better value for money. My experience locally in Essex of having 5,000 people going through the personal budget system, of having a resource allocation, is that some people are less on the resource allocation than they would be under the old system and some people are slightly more. Overall it just about balances out. But if you are giving people first time what they believe will make a difference and meet their care and support needs, you stop throwing away meals on wheels as soon as the meals on wheels van has gone away, you stop using services that you did not really want and which were quite expensive but there was not anything else, and so you are getting a better value product. You should be saving money through that alone.

  Q846  Stephen Hesford: The 5,000 of your total responsibility, the number of people accessing adult social services, what percentage does that represent?

  Ms Owen: At the moment, any new referral, referred in since last October, is being offered a personal budget. Some people are taking the money. Some people are saying that they want a managed service, but it is very transparent how much that service is costing. About half the people are taking a bit of both. Overall in Essex at the moment we are supporting 24,000 people. We are going to be moving to a programme of offering up the personal budgets for existing service users but we are doing that in a managed way, because otherwise we will get all sorts of destabilisations that are quite difficult to manage.

  Q847  Stephen Hesford: Is the 5,000 a good sample to give you a good idea of where this thing is going?

  Ms Owen: It is giving us a very good idea of what people are choosing in their support plans, of ways in which their care and support needs can be met. Some of the most interesting things that are coming out of that are the different ways in which people's support plans look from their old traditional care plans.

  Q848  Charlotte Atkins: Jenny, could we have a copy of the letter you mentioned.

  Ms Owen: The milestone letter.

  Q849  Charlotte Atkins: Yes, please.

  Ms Owen: Certainly.

  Q850  Charlotte Atkins: I would be grateful if we could have a copy of that. I am going to move on to talk a bit about direct payments. Direct payments have been available since 1996 but the take-up has not really been very high. We are now moving very much towards individual budgets, personal budgets. Is this an attempt to repackage direct payments which in some people's view would be seen to have failed?

  Ms Owen: I think it is a bit different. Direct payments historically were aimed at younger physically disabled adults. They did not have very big take-up with older people, and so they were very much more focused I think. They were used and allocated to help people organise their own care. The personalisation agenda is much more wide-ranging. One of the differences with personal budgets should be on what you can use it for. Direct payments were quite strictly ruled around that. There were rules about what you could use your direct payment for.

  Q851  Charlotte Atkins: Yes, you were not able to use it for local authority services, for instance.

  Ms Owen: No, and it was very difficult to use people who were in your close family circle and so on. This is opening all of that out. Because it is about whole system change, it is not just about repackaging direct payments. You can see from the take-up of 93,000 straightaway that it has much wider appeal. I think we now know that something like 40% of the personal budgets are going to older people. That was not the way in which direct payments were used in the past. I do not think it is just a repackaging; I think it is a transformational change.

  Q852  Charlotte Atkins: Older people are claiming it more and younger people are continuing to do so.

  Ms Owen: Yes.

  Q853  Charlotte Atkins: One other thing that seems to be changing is that rather than having individual budgets which combine several funding streams, we are now moving to personal budgets involving just social care funds. Why is this happening? Why is the reason for this? Does it matter or is it just part of the transformation process?

  Ms Owen: That is a difficult question. In Essex, I was one of the 13 pilot sites for individual budgets. The aspiration behind that was that these funding streams would come together in a much more flexible way and therefore people could bring all of those funding streams around them to look at what their terms were. It did not work. We could not get agreement for how the independent living fund would come into that, for example. It was very complicated around Supporting People money. We just did not manage to do it and it ended up, by default, being the care budget from local authorities. We hope we will be selected for a trailblazer site for the Right to Control, the Welfare Reform Agenda around welfare benefits. This is an attempt to bring different funding streams together under the control of the person for whom this funding is allocated. It requires government support for these funding streams to be used and it requires flexibility for those agencies locally to think about using it. We need to make sure that there are no blockages to this working and I very much hope that the trailblazers for Right to Control will take us further than the individual budgets did.

  Q854  Charlotte Atkins: We are already seeing personal budgets in the NHS. Would you like to see personal budges integrated right across health and social care?

  Ms Owen: Yes.

  Q855  Charlotte Atkins: I can understand you, coming from the Director of Social Services, wanting to get your hands on that big pot of money at the NHS. Inevitably, I know that at local level many local authorities think that, for instance, primary care trusts should be contributing much more towards social care budgets. Do you think you will get resistance from the NHS locally, or do you think now that local authorities are working in a much more partnership-led way with commissioning services together?

  Ms Owen: The issue about health personal budgets we still have to play out and see how they are going to work. The pilots will help us to see that. The pilots are going to focus on people who have long-term conditions. In my authority we were going to look at one around mental health needs. We are spending money on the same people. This will not be about local authorities getting their hands on the NHS money; this will be about the NHS community services, who are currently supporting somebody, the same people we are supporting, putting that money together, so that packages can then be flexible and controlled by that individual. That will start to make a big difference. The money is already going into that person but not in a co-ordinated way.

  Councillor Sir Jeremy Beecham: Benefit sharing is really the name of the game, is it not, as opposed to cost shunting which is a traditional feature of the relationship between local government and the NHS. It has to change and in many places it is doing so. There are doctors who are now using part of their budgets to send people on what would be regarded as leisure type activities, dancing or swimming or whatever, because it is conducive to their health. That is a more sensible view because, ultimately, that becomes a preventative measure, either preventing illness developing or certainly making it more bearable. I think there is a willingness. We are speaking largely of PCTs and what I am not sure about is the extent to which the acute sector is engaging with this agenda.

  Q856  Charlotte Atkins: I think PCTs might agree with you.

  Ms Owen: Interestingly, when you think about the acute sector, one of the things we know is that too many people end their lives in a hospital. They do not want to be there but the alternatives are not there to support. End of life care would be a really good example, where if you put the personal health budget and the personal budget from the local authority together, people could make choices about how to end their lives with the right care and support where they want it.

  Q857  Dr Naysmith: Jenny, one of the risks of personalisation that we have heard about from previous witnesses is that some collective services, such as art classes or music classes or dance classes, normally held in day centres, have closed down as a result of personalisation. You must still be running them in Essex—quite a number of them, I suspect, with the size of Essex.

  Ms Owen: Yes.

  Q858  Dr Naysmith: Does it matter if that happens?

  Ms Owen: It is very difficult to say that that cannot happen. If you are giving people choice about where they want their services and they are choosing not to use the services we currently run, then I think it says something about the services that we currently run and whether they are fit for purpose. For those collective services I think there is a risk, and it is one that we are considering as we are thinking about developing the range of services.

  Q859  Dr Naysmith: What can local authorities do about it?

  Ms Owen: There are two things we can do about it. One is that we must be very flexible and make sure our money is not just tied up in services so that people cannot get a choice because they cannot access the money more flexibly. The second is that, by looking at what people are choosing to do with personal budgets and listening to what people want from those services, you can re-orientate them and make sure they are exactly what people want. We have not seen, at the moment, huge numbers of people leaving our day services, but we do have some very interesting conversations going on with our services, where people are saying, "Let's think about this. If people wanted to buy this what we would give them that is different?"

  Councillor Sir Jeremy Beecham: There could be a bit of an analogy here between this area of policy and, say, parental choice in schools. The exercise of some people's choice, which will suit them, may restrict the choice and availability of services for others. It is a difficult line to tread, I think. We have to be able to protect those who do not necessarily want to do a different thing, who may still want the day centre or luncheon club or whatever even though others may not. All we can really do then, as Jenny says, is to listen to people, listen to the organisations that represent them too, which are very often helping to make the provision, but we must protect those who are not willing or capable of making the choices that some will find easier to do. There will be a cost to that. It is part of the total costs that one has to meet.

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