Examination of Witnesses (Question Numbers
840-859)
MS JENNY
OWEN AND
COUNCILLOR SIR
JEREMY BEECHAM
3 DECEMBER 2009
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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