If childcare was Blair’s ‘new frontier’ of the welfare state, could social care be Brown’s vision of a new welfare state? The introduction of individual budgets for social care announced on Monday is an attempt to both renew the vision and reaffirm commitment to reform in public services.
Health Secretary Alan Johnson called the expansion of individual budgets in social care ‘potentially one of the most radical public service reforms for a generation’. Individual budgets allow a mix of cash with services – and social care with other services – widening the choice and control currently offered through direct payments (cash payments made to individuals who have been assessed as needing services, in lieu of social service provisions).
The policy has potential, but there risks attached. There are two major questions that need to be answered. What services should individual budgets be spent on? And who should get them?
To answer the first question, a lot rests on local authorities being ‘joined up’. The whole point of individual budgets is that they allow people to define for themselves what they need to live independently. In order to live independently people may need housing, employment advice, education or primary health care, as much as social care itself. This is why the single health and wellbeing service put forward in the concordat is the right ambition. Individual budgets are a big step in that direction, because the ‘demand’ for services comes from one person, who rarely has a different ‘health’ or ‘social’ part to their needs.
Going further also means we have to break boundaries in the ‘supply’ of health, care and other services. That means a better linking-up of local budgets and accountability, as well as joining up assessments of needs and service performance.
Much also depends on practitioners being clued up. Adult social care workers in all sectors will need to be supported to play a different role from providing care, to becoming of ‘brokers’ and ‘advocates’ to help users choose their own care. Professional anxiety about the risks of reform is understandable, and it needs to be managed through development and support for the workforce. Carers too are absolutely crucial to making user choice and empowerment a reality. The strategy of support for carers, currently under review, should therefore be integral to this strategy for users.
The quality of services bought with individual budgets remains important. Choice can certainly drive quality, but a range of high quality services is required for meaningful choices. And user choice can only drive improvement where there is good user-led information, advice and scrutiny on service quality.
The second major question is about who gets individual budgets. Extending individual budgets to those who ‘lack capacity’ is an important stride in widening the pool of beneficiaries. But it is the funding model for social care that remains the major obstacle to extending choice and independent living to older and disabled people. Most people won’t qualify for individual budgets not because of the degree of their capacity to make choices, but because if they have assets of £22,000 and over they won’t qualify for state support at all.
‘Investment and reform’ has been New Labour’s public service mantra. Brown appears to have taken on social care as the area for some of the most innovative reform. But social care is the public service yet to see the necessary investment. The radical potential of individual budgets will depend upon whether the forthcoming green paper includes some radical reforms to the funding of social care.
Brown’s vision of the user at the centre of public services needs to be matched by a fresh vision of the state. To be truly transformative, user choice will require state support, and bigger public budget for individual budgets.