Why we need to mutualise social care

By pooling their budgets, care users can have greater purchasing power to influence the market.

Britain is an ageing society, with healthier lifestyles and medical advances meaning that our older population will continue to grow. Many older people have lived their lives proud of their independence, and they value the control they have over their life choices. For these people it can be a frightening as well as a deeply disempowering experience to find themselves subject to decisions made by others. Some older and disabled people are told which day centre they will attend, who will come into their home to care for them, when and what they will eat, when they can socialise, sleep, bathe or even go to the toilet. In a time of austerity, with cuts to basic local services, it remains vital to meet the wider challenge of ensuring that people using care services preserve their power over what happens to them.

There are two changes already under way that start to address these problems: integration and personalisation. Integration seeks to remove the artificial barriers between services which are preventative or home-based (often commissioned using council funds) and acute services, such as hospital services provided by the NHS. By integrating the preventative with the acute, there is a clearer financial incentive to stop low-level health problems escalating.

Personalisation is an approach that gives the person using care services more control over what care they receive, who provides it, and what they want to achieve with the rest of their life. By giving the individual more control over what is done with the budget allocated for their care, with appropriate professional advice, they are in the driving seat.

Take-up of personal budgets, particularly of those taken as a cash Direct Payment, although growing, is still low, particularly for older people. There are barriers that need to be overcome to extend personalisation more widely, including better advice, guidance and facilitation for the service user and their carers, and a wider range of flexible services to meet new and changing needs.

Integration is a structural change; personalisation is based on empowerment. That principle of empowerment is key to improving a wide range of public services by making them more responsive to the real and self-defined needs of the people who use them. A logical next step for personalised care budgets is to expand its power to influence the market by encouraging the creation of clusters of budget holders. The cluster would be self-defined as far as possible, and would pool the budgets of a number of service users who have something in common that affects the service they want to receive. This might be as simple as living in the same neighbourhood, or it might be a shared ethnic or faith background, type of disability, or care objective.

By pooling their budgets, care users can have greater purchasing power to influence the market to provide appropriate services. If a group of Somali Muslim elders want to receive home care that is sensitive to their specific cultural needs, they may be able to commission such a service through pooling their individual allocations.

For optimum effectiveness, clusters need to be small enough for individual service users to know and care about each other; stable enough to deliver the outcomes required over a sustained period of time; and flexible enough to adapt as needs change or individuals need to move in and out. They require the full engagement of professionals at every stage so that individuals are supported in understanding their problems, agreeing a care plan that addresses their needs, and moving on when necessary.

This will inevitably lead to demands being identified that are not currently being met. As well as influencing existing service providers in the third, public or private sector, councils are well-placed to help develop new start-up enterprises to meet new needs and to provide the necessary oversight. Local authorities have access to office space; back-office systems including HR, IT and finance systems; and legal advice. They can facilitate mentoring from more established service providers, as well as holding budgets on behalf of users that could provide financing to new providers. By bringing these supply-side interventions together, councils can help develop new community-based services including social enterprises to meet changing demand. In some cases, this would also create new employment opportunities in communities experiencing high levels of social exclusion.

Pooling personalised care budgets is a model of mutualising care services so they become more responsive to the needs of the people they serve. If people don't like the services they are receiving, they can change them. If they want services that don't exist, they can help create them. This is not a panacea that can magic away the pain of funding cuts, but whatever level of resource is available, we will generate better value for money if public funds are used to deliver outcomes that service users want. 

Read RSA's new pamphlet The New Social Care: Strength based approaches

Steve Reed MP for was elected as member for Croydon North in November 2012, having previously been leader of Lambeth Council

Actor Tony Robinson joins campaigners protesting in support of social care opposite Parliament. Photograph: Getty Images.
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What's to be done about racial inequality?

David Cameron's words on equal opportunities are to be welcomed - now for some action, says Sunder Katwala.

David Cameron made the strongest, clearest and most high profile statement about ethnic inequalities and the need to tackle discrimination ever yet offered by a British Prime Minister in his leader’s speech to the Conservative Party conference in Manchester.
“Picture this. You’ve graduated with a good degree. You send out your CV far and wide. But you get rejection after rejection. What’s wrong? It’s not the qualifications or the previous experience. It’s just two words at the top: first name, surname. Do you know that in our country today: even if they have exactly the same qualifications, people with white-sounding names are nearly twice as likely to get call backs for jobs than people with ethnic-sounding names? … That, in 21st century Britain, is disgraceful. We can talk all we want about opportunity, but it’s meaningless unless people are really judged equally”, said Cameron.
While the proof of the pudding will be in the eating, this was a powerfully argued Prime Ministerial intervention – and a particularly well-timed one, for three reasons.

Firstly, the Prime Minister was able to root his case in an all-but-universally accepted appeal for equal opportunities. It will always prove more difficult in practice to put political energy and resources behind efforts to remedy discrimination against a minority of the population unless a convincing fairness case is made that values cherished across our whole society are at stake. Cameron’s argument, that any party which tells itself that it is the party of the ‘fair chance’ and ‘the equal shot’ must have a response when there is such clear evidence of discrimination, should prove persuasive to a Conservative Party that has not seen race inequalities as its natural territory. Cameron argued that the same principles should animate responses to discrimination when it comes to race, gender and social class. Put like that, wanting job interviews to be fair – by eradicating conscious and unconscious patterns of bias wherever possible – would strike most Britons as offering as clear a case of the values of fair play as wanting the best baker to win the Great British Bake-Off on television.
Secondly, Cameron’s intervention comes at a potential "tipping point" moment for fair opportunities across ethnic groups. Traditionally, ethnic discrimination has been discussed primarily through the lens of its impact on the most marginalised. Certainly, persistent gaps in the criminal justice system, mental health provision and unemployment rates remain stark for some minority groups. What has been less noticed is the emergence of a much more complex pattern of opportunity and disadvantage – not least as a consequence of significant ethnic minority progress.

Most strikingly of all, in educational outcomes, historic attainment gaps between ethnic minorities and their white British peers have disappeared over the last decade. In the aggregate, ethnic minorities get better GCSE results on average. Ethnic minority Britons are more likely, not less likely, to be university graduates than their fellow citizens. 

As a result of that progress, Cameron’s intervention comes at a moment of significant potential – but significant risk too. Britain’s ethnic minorities are the youngest and fastest-growing sections of British society. If that educational progress translates into economic success, it will make a significant contribution to the "Great British Take-Off" that the Prime Minister envisions. But if that does not happen, with educational convergence combined with current ‘ethnic penalties’ in employment and income persisting, then that potential could well curdle into frustration that the British promise of equal opportunities is not being kept.  Cameron also mirrored his own language in committing himself to both a ‘fight against extremism’ and a ‘fight against discrimination’: while those are distinct challenges and causes, actively pursuing both tracks simultaneously has the potential, at least, depolarise some debates about responses to extremism  - and so to help deepen the broad social coalitions we need for a more cohesive society too.

Thirdly, Cameron’s challenge could mark an important deepening in the political competition between the major parties on race issues. Many have been struck by the increase in political attention on the centre-right to race issues over the last five to ten years. The focus has been on the politics of representation. By increasing the number of non-white Conservative MPs from two to seventeen since 2005, Cameron has sent a powerful signal that Labour’s traditional claim to be ‘the party of ethnic minorities’ would now be contested. Cameron was again able to celebrate in Manchester several ways in which his Cabinet and Parliamentary benches demonstrate many successful journeys of migrant and minority integration in British society. That might perhaps help to ease the fears, about integration being impossible in an era of higher immigration, which the Home Secretary had articulated the previous day.

So symbolism can matter. But facial diversity is not enough. The politics of ethnic minority opportunity needs to be about more than visits to gurdwaras, diversity nights at the party conference fringes and unveiling statues of Mahatma Gandhi in Parliament Square. Jeremy Corbyn’s first speech as Labour leader did include one brief celebratory reference to Britain’s ethnic diversity – “as I travelled the country during the leadership campaign it was wonderful to see the diversity of all the people in our country” – and to Labour bringing in more black, Asian and ethnic minority members - but it did not include any substantial content on discrimination. Tim Farron acknowledged during his leadership campaign that the Liberal Democrats have struggled to get to the starting-line on race and diversity at all. The opposition parties too will no doubt now be challenged to match not just the Prime Minister’s rhetorical commitment to challenging inequalities but also to propose how it could be done in practice.

Non-white Britons expect substance, not just symbolism from all of the parties on race inequalites.  Survation’s large survey of ethnic minority voters for British Future showed the Conservatives winning more ethnic minority support than ever before – but just 29 per cent of non-white respondents were confident that the Conservatives are committed to treating people of every ethnic background equally, while 54 per cent said this of Labour. Respondents were twice as likely to say that the Conservatives needto do more to reach out – and the Prime Minister would seem to be committed to showing that he has got that message.  Moreover, there is evidence that ethnic inclusion could be important in broadening a party’s appeal to other younger, urban and more liberal white voters too – which is why it made sense for this issue to form part of a broader attempt by David Cameron to colonise the broad centre of British politics in his Manchester speech.

But the case for caution is that there has been limited policy attention to ethnic inequalities under the last two governments. Restaurateur Iqbal Wahhab decided to give up his role chairing an ethnic minority taskforce for successive governments, unconvinced there was a political commitment to do much more than convene a talking shop. Lib Dem equalities minister Lynne Featherstone did push the CV discrimination issue – but many Conservatives were sceptical. Cameron’s new commitment may face similar challenges from those whose instinct is to worry that more attention to discrimination or bias in the jobs market will mean more red tape for business.

Labour had a separate race inequalities manifesto in 2015, outside of its main election manifesto, while the Conservative manifesto did not contain significant commitments to racial inequality. The mid-campaign launch in Croydon of a series of race equality pledges showed an increasing awareness of the growing importance of ethnic minority votes - though the fact that they all involved aiming for increases of 20 per cent by 2020 gave them a slightly back-of-the-envelope feel. 

Prime Ministerial commitments have an important agenda-setting function. A generation ago the Stephen Lawrence case opened the eyes of middle England to racist violence and police failures, particularly through the Daily Mail’s persistent challenging of those injustices. A Conservative Prime Minister’s words could similarly make a big difference in the mainstreaming of the issue of inequalities of opportunity. What action should follow words? Between now and next year’s party conference season, that must will now be the test for this Conservative government – and for their political opponents too. 

Sunder Katwala is director of British Future and former general secretary of the Fabian Society.