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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The SNP thinks it knows how to kill hard Brexit

The Supreme Court ruled MPs must have a say in triggering Article 50. But the opposition must unite to succeed. 

For a few minutes on Tuesday morning, the crowd in the Supreme Court listened as the verdict was read out. Parliament must have the right to authorise the triggering of Article 50. The devolved nations would not get a veto. 

There was a moment of silence. And then the opponents of hard Brexit hit the phones. 

For the Scottish government, the pro-Remain members of the Welsh Assembly and Sinn Féin in Northern Ireland, the victory was bittersweet. 

The ruling prompted Scotland’s First Minister, Nicola Sturgeon, to ask: “Is it better that we take our future into our own hands?”

Ever the pragmatist, though, Sturgeon has simultaneously released her Westminster attack dogs. 

Within minutes of the ruling, the SNP had vowed to put forward 50 amendments (see what they did there) to UK government legislation before Article 50 is enacted. 

This includes the demand for a Brexit white paper – shared by MPs from all parties – to a clause designed to prevent the UK reverting to World Trade Organisation rules if a deal is not agreed. 

But with Labour planning to approve the triggering of Article 50, can the SNP cause havoc with the government’s plans, or will it simply be a chorus of disapproval in the rest of Parliament’s ear?

The SNP can expect some support. Individual SNP MPs have already successfully worked with Labour MPs on issues such as benefit cuts. Pro-Remain Labour backbenchers opposed to Article 50 will not rule out “holding hands with the devil to cross the bridge”, as one insider put it. The sole Green MP, Caroline Lucas, will consider backing SNP amendments she agrees with as well as tabling her own. 

But meanwhile, other opposition parties are seeking their own amendments. Jeremy Corbyn said Labour will seek amendments to stop the Conservatives turning the UK “into a bargain basement tax haven” and is demanding tariff-free access to the EU. 

Separately, the Liberal Democrats are seeking three main amendments – single market membership, rights for EU nationals and a referendum on the deal, which is a “red line”.

Meanwhile, pro-Remain Tory backbenchers are watching their leadership closely to decide how far to stray from the party line. 

But if the Article 50 ruling has woken Parliament up, the initial reaction has been chaotic rather than collaborative. Despite the Lib Dems’ position as the most UK-wide anti-Brexit voice, neither the SNP nor Labour managed to co-ordinate with them. 

Indeed, the Lib Dems look set to vote against Labour’s tariff-free amendment on the grounds it is not good enough, while expecting Labour to vote against their demand of membership of the single market. 

The question for all opposition parties is whether they can find enough amendments to agree on to force the government onto the defensive. Otherwise, this defeat for the government is hardly a defeat at all. 

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.