The Health and Social Care Bill currently limping through Parliament is a mess. Even though I try to take an active interest in its progress, even as someone who is desperately concerned and involved (working, as I do, in an NHS team), I lose heart at trudging my way through some of the details which have been changed, adjusted and repackaged beyond the level of human (oh, ok, maybe it’s just me!) comprehension.
I was baffled though by this piece which turned up on the Guardian website yesterday.
Announcing that Lansley, having been stung and having lost credibility as his health reforms (hopefully) hit the buffers, is going to be delaying his announcement of reform in social care.
The article states that
The Observerhas been told that No 10 has “seized the reins” on social care from Lansley, the health secretary, and called in experts to ask their views on what should be in a much-delayed white paper. “No 10 know they have to ensure this is not another disaster like the health bill,” said one.
One of the concerns is that plans to give more elderly people their own “personal budgets” – sums of money with which they can buy in social care from private providers – might open up the government to more damaging accusations of the “marketisation” of health services.
This made me (proverbially of course!) hit my head against the desk. It is such wrong and muddled thinking. Plans to give more older people personal budgets have been ratcheting up over the past few years. What we actually NEED in the sector is better use of these systems, not more of the same.
Now, currently, today, we have in place systems for everyone who receives social care regardless of their age to receive personal budgets for social care. It is the way that these budgets are delivered that is wrong sighted and potentially discriminatory as the greater flexibility is afforded to those who are able to best engage in the process and advocate for themselves (or have families to do so).
What we in the sector, really really don’t need is for the government to stall with this where we are at the moment because, in a sense, we have the worse of all situations where older people suffer from institutional discrimination because the systems don’t exist to ensure that they best benefit from the extension of personal budgets as fully as younger adults have done.
The article goes on to explain
Lansley’s plan to give every eligible person a “personal budget” through a direct payment by April 2013 has also raised concerns. Under the plan, first introduced by Labour, people’s needs are assessed by local social services. They are then allocated a budget, paid as a direct cash payment, with which they can buy care. Currently, personal budgets cover 340,000 people.
Opponents of the system argue that personal budgets will be inappropriate for huge numbers of elderly people who will not be able, or want, to manage their own funds, particularly at times when they are in greatest need of care. Critics also say people’s needs will change and the system may not allow them to switch providers quickly enough if contracts have been signed.
Another head meet desk moment. I am not an ‘opponent of the system’ although I have real concerns about the current systems we have in place. ‘Personal Budgets’ exist now for older people and for everyone. It is the different means of delivery which is confusing as direct payments are not the same as personal budgets. As for the statement that they are inappropriate, that’s irrelevant because they are a current reality. This is not the proposed change. My hope is that any changes would include safeguards to ensure that those for whom access to direct payments has been more difficult – whether due to lack of capacity or desire to manage direct payments – and thus ensure that ability to choose and prefer particular providers, rather than be tied into the decisions of distant commissioners (sorry, guiltycommissioner, if you’re reading, this isn’t personal!) that make no allowances for personal preference.
Today, there’s a joint letter in the Guardianfrom the heads of various charities urging the government to act on reform of adult social care. The letter emphasises the need for more money. I was delighted to see advocacy organisations involved in this as I truly believe that it is a way of improving access and equity across the system.
But if Lansley delays the Social Care Reform, mark my words, it is not because of the mess he’s made of the Health and Social Care Bill – it’s because he wants to avoid making difficult and potentially more costly decisions related to long overdue reform of Adult Social Care.