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.
Photo: Getty
Show Hide image

There are sinister goings-on in the race to become the UN's next Secretary-General

The United Nations can and must do better than this, says David Clark. 

2016 was meant to be a year of firsts for the United Nations as it prepares to choose a new Secretary-General. Optimism was growing that the top job would go to a woman for the first time in the world body’s seventy-year history. There was an emerging consensus that it should be someone from Eastern Europe, the only region never to have held the post, provided a candidate of the right calibre was put forward. Above all, the selection was supposed to break new ground in openness and transparency after decades in which decisions were stitched up in private by a handful of the most powerful countries. Innovations like open nominations, public campaigning and candidates hustings were introduced in a bid to improve public scrutiny.
 
All of that now threatens to be turned on its head as the battle to succeed Ban Ki-moon becomes embroiled in intrigues and plots, according to stories that have surfaced in the Belgian and Portuguese media in the last week. Allegations centre on the activities of former European Commission President, Jose Manuel Barroso, and ex-Portuguese MEP turned lobbyist, Mario David. Both are said to be promoting the undeclared candidacy of Kristalina Georgieva, the serving European Commission Vice-President from Bulgaria. Barroso reportedly arranged for Georgieva to participate in a recent meeting of the Bilderberg group in order to boost her profile with world leaders. David is said to be touring the capitals of Eastern Europe to canvas support.
 
While there is nothing necessarily unusual about senior European politicians supporting a colleague in her bid for a major international job, there are two things that make this case very different. The first is that Bulgaria already has an official candidate in the person of Irina Bokova, a career diplomat currently serving her second elected term as Director-General of UNESCO. Reports suggest that Barroso is among those pressing the Bulgarian government to switch its nomination to Georgieva, while David’s role has been to find another country in the region willing to nominate her in the event that Bulgaria refuses to budge. The second piece of the puzzle is that Portugal also has an official candidate – its former Prime Minister, Antonio Guterres – who Barroso still publicly insists he is supporting.
 
It is in the nature of the way these matters are often decided that there is no necessary contradiction between these facts. Georgieva’s candidacy would appear to stand no real chance of success. She lacks diplomatic experience and news reports suggest that the Bulgarian Prime Minister’s decision not to support her was based on information linking her to the communist-era intelligence services. And while there is nothing to stop another country nominating her, precedent suggests that a lack of domestic support will be fatal to her chances. Georgieva is highly unlikely to end up as UN Secretary-General, yet she could still have a significant role to play as a spoiler. Bulgaria’s official candidate, Irina Bokova, is frequently described as the frontrunner. As a woman from Eastern Europe with heavyweight UN experience, she certainly has an edge. A rival Bulgarian woman candidate would create doubt about the strength of her support and potentially open the way for other candidates. The aspirants who stand to benefit most are men from outside Eastern Europe. Step forward Antonio Guterres.
 
Those with the best chance of preventing these manoeuvres from succeeding are the governments of Eastern Europe. Although the principle of rotation does not confer on them the automatic right to have one of their own chosen to run the UN, a degree of unity and professionalism in the way they approach the contest would make their claim much harder to resist. Unfortunately there has so far been little evidence of the kind of collective solidarity and diplomatic co-ordination that helped to deliver the top UN job to Africa and Asia in the past. The strongest advocate for Eastern Europe is currently Russia, although it has stopped short of threatening to use its veto in the way that China was prepared to do for Asia when Ban Ki-moon was appointed in 2006.
 
In addition to casting doubt on Eastern Europe’s chances, the descent into private plotting is an ominous warning to those campaigning for the UN to become more open and representative – the appointment of a new Secretary-General may not prove to be the turning point they had hoped for. What is the point of public hustings for candidates when the real discussions are taking place at a closed meeting of Bilderberg group? Why bother to encourage women candidates to put forward their names when the power brokers of international diplomacy already have their man? Seventy years after it was established, the UN should have found a better way to do this. It still can.

David Clark was Robin Cook’s special adviser at the Foreign Office 1997-2001.