We welcome this post from Tony Pilkington, managing director, Younifi, the managed service that makes the care system simpler.
Personalisation has been a watchword of the UK’s adult social care system for some time now. The premise is sensible; give people more choice – both in the type of care they receive and how much control they have over it – and the ‘outcomes’ for those people should be greater. At the same time the premise means councils should be able to make care budgets – their second largest area of spending – go further to deliver more. It’s a win-win, or at least it should be, but many local authorities are struggling to make personalisation work, especially when they’re under so much pressure to stretch budgets and control spending; indeed my own council recently said that they will run out of money in three years, so how can these challenges be reconciled?
Of course this pressure is something local authorities will feel right across Europe if not globally. While welfare systems differ from country to country, they all face common challenges. For example, over the past ten years Governments have cut or frozen welfare spending as a result of the economic and financial crisis, while there is also universally increasing demand for care services owing to aging populations, more people living with long-term conditions, higher numbers of unemployed and more people at risk of poverty and social exclusion. Moreover, birth rates are falling limiting the future availability of adult children to pay into the public purse or care for their parents and others. Current carers are required to do more, for longer and often with less support – future ones more so.
Parallel to these global challenges the movement towards empowered, individual services has grown with greater user involvement, increased choice, flexibility, control and coproduction – essentially ‘personalisation’. In many European countries including England, Germany, France, Spain and Scandinavia, monetary transfers such as Direct Payments and vouchers underpin this personalisation movement by providing individuals with their own purchasing power to establish new social care markets.
So why is personalisation such a challenge? The problem is partly that austerity measures lead to procurement practices which flew in the face of offering freedom of choice. Take for example the simple notion of pooling your buying power with a handful of key suppliers that operate large networks of home-based care. These purchasing decisions have historically been at the centre of council care procurement strategy, and with pressure to deliver more adult care to more people with less budget, it would be easy for councils to consider ‘bulk buying’ the only option. However, this immediately limits choice, and choice is at the heart of care personalisation. Defaulting to limited numbers of providers may be getting a bulk deal but it’s on a ‘top price’ product that doesn’t necessarily meet demand, may not be the most cost effective and doesn’t support people to be active within their communities.
Another personalisation challenge is around giving people the choice to manage their own funds in different ways, from the council retaining control to individuals receiving a lump sum to spend freely. This can both dilute the measurement of outcomes or indeed the value derived from care spending, while also creating extra layers of bureaucracy and process for people and councils in the working out of how to pull all of these different methods together into one reconciled budget.
To the first point, choice shouldn’t necessarily just mean complete freedom of choice, as more freedom for people to spend their money how they want needs to be tempered by market stimulation. Investigation into what the wider care provider ecosystem could offer to people is needed, enabling councils to move from being providers of care to facilitators of care relationships between recipients, providers and local communities.
To the second point – that financial personalisation creates work for councils – it’s a question of trying to teach an old dog new tricks. Council financial processes were engineered around a system designed when all care money was controlled by its treasury and transferred directly to the care provider when they delivered services. Personal financial control adds a third dimension to that, with individuals spending their council money from their own bank account, creating a long trail of ‘shoebox accounts’ that someone within the council has to manually reconcile and match up with budgets. This sounds more like going back in time, not forward. Why is it the case that different models of care funding all result in different processes and different experiences?
A recent webinar highlighted again the myriad complexities, poor customer experience and lack of market insight that still exists. These all result from trying to deliver personalisation by building it on top of old ways of working. To meet the broad objectives of personalisation, cost reduction, sustainability of councils and good experiences for people needing care, the old way surely isn’t the answer.
I firmly believe that personalisation is the right future for adult social care services. However, as many council leaders, finance executives and procurement heads will agree, unless something changes, personalisation is going to be difficult to ever achieve, certainly not cost effectively through a single process that can deliver whatever ‘flavour’ of care provision a person wants.
In Part 2 I’ll examine exactly what needs to change to make personalisation work and also the types of cost saving that the right approach can achieve.