Fifty shades of white?

Read Martin Routledge's blog post on the White Paper.

Many shades of opinion were expressed about the social care White Paper yesterday. On the up side I did feel able to read it on public transport without any risk of embarrassment! So what should we make of it?

In Control receives many requests for help and advice and these are generally about two things. Increasingly they are from people desperately worried that their support packages are under threat or have been reduced - often dramatically. Secondly they come from people wanting to self-direct but very frustrated by bureaucracy and inflexible local rules. Regarding funding we are deeply disappointed, like most others, that more immediate progress has not been made in achieving the shift to a sustainable long term system. Given the news this week about a £1.7b NHS underspend we feel that even if long term decisions don't get made until the spending review, more immediate relief could be  offered to the creaking social care system. The targeted sums provided including for extra care, information systems for the public etc. are certainly welcome but more surely could be done? Pressure will now have to be maintained through to next year's spending review to ensure that social care doesn't remain the poor relation of the NHS and the many admirable elements of the White Paper aren't thwarted by lack of the necessary funds. Another half a billion or so over the next year would powerfully demonstrate government intent and undermine scepticism.

Having made this point, all responsible people who want to maintain the drive towards personalisation and self-direction must then look at what is rather than what isn't in the White Paper and what possibilities this offers. We need to consider what opportunities this offers in our long journey away from a dependency model. In this blog I will offer a few specific thoughts rather than review the whole White Paper. Over the coming months we and partners will explore closely how we can positively influence particular elements, including in the period of pre-legislative scrutiny of the draft bill.

What strikes me strongly about the White Paper and draft bill is that there is a great deal of real possibility and also much to be played for. In many sections a positive direction of travel is set out and some next steps about how detail will be developed. The positive influence of Think Local, Act Personal (TLAP) is very evident from the "I" statements setting out what people should expect through to the requests from Government for TLAP to help develop key areas of work including those on quality, market development and social capital. This is very welcome and In Control will continue to play a positive part in the partnership. Making it Real offers a tangible way for us all to demonstrate our practical commitment and make real progress. I am sure that this will be at the heart of the quality initiatives that TLAP lead on for the Department of Health.

You would expect me to talk about personal budgets. I am very pleased that the issue of whether these will continue to be a core part of social care is effectively put to bed. The White Paper and draft bill make clear that people eligible for social care will get a personal budget - end of. Hopefully now we can shift from endless argument about whether they can benefit certain groups etc. to making sure they do. Within the crafting of the legislation and associated regulations and guidance, however, there are critical issues about how to ensure that personal budgets maximise self-direction and we will closely involve ourselves with this. There is a big opportunity here but it is not yet taken.  It's no use someone being told they have a personal budget for them not to have real control and options in their support. The focus needs to be on people defining and achieving outcomes. Research from our National Personal Budget Survey shows that the best outcomes are still being achieved through direct payments and we are encouraged that the White Paper and draft bill sends strong signals that the drive to help more people get these will be maintained. For some, a council managed personal budget is the preferred option but when this is the case we still need to ensure that the individual can exercise choice and control. We need to keep working to develop managed options that can deliver this such as Individual Service Funds (ISF). The strong words about outlawing by the minute commissioning in homecare need to be matched by practical ways of achieving this. We are pleased to be exploring an ISF model in homecare with Helen Sanderson Associates and partners in the North West.

It is critical that local authorities continually measure the outcomes that are being achieved with people's personal budgets alongside people and families. We are about to embark on a second phase of our personal outcomes and evaluation tool - POET - in 30 local authorities across the country which will enable us to publish with TLAP a clear national picture of what's working and what's not and how localities can achieve improvements. We know that for many personalisation is working, despite the system rather than because of it, so we must remove the obstacles that still exist such as unhelpful bureaucracy and process, lack of co-production with people using social care and continuing cultural barriers. In Control is currently working across a number of regions to look at ways these challenges can be addressed.

There are strong indications in the White Paper of a push towards integration at the level of the individual via personal health and care personal budgets. This is very much to be welcomed and In Control's strategic partnership with the personal health budget pilots and practical work with health and social care organisations tell us that where there is a local will there are real possibilities here.

Looking more widely at opportunities presented by the White Paper - in a paper recently published by In Control in partnership with Community Catalysts, Shared Lives Plus and Inclusive Neighbourhoods, we urged the government to use the White Paper as an opportunity to redesign the social care system at the point of need so that we have a system based on a partnership with people, rather than a battle. This paper 'Redesigning the front end of social care' focuses on what happens when people first encounter social care and looks at people's assessments, eligibility and access to services. Here we recommend a very different "front door" into the system which includes replacing current community care assessment processes with an assessment or impact model which more robustly assesses risk and triggers access to support planning at an early stage. We are encouraged by some nods in this direction in the paper and our partnership will aim to engage with government further on this.

Equally the strong push towards a health and wellbeing purpose for key public services offers real possibility if turned into tangible action. In control has long taken the view that maximising people's real wealth in their communities is the key to citizenship. We will be keen to add tangible practical ways of achieving such as our Community Fund Holding approach into promised developments

So - one day on my thoughts are turning strongly towards optimising the possibilities presented by the White Paper and Bill. We will all have to keep working hard on two fronts - making the case to public and politicians for a sustainable settlement and positively influencing what happens next with White Paper implementation. And finally dare I say - and not getting too tied up in knots?

Martin Routledge

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Last Updated : 12 July 2012. Page Author: Laura Bimpson.