The latest ‘great and good’ theory is called ‘Personalisation’ and as the name suggests it is intended to place more power and specifically choice in the hands of the person. Personalisation is lauded and actively promoted by this government as a good thing and it even accuses local government of hindering the increased choice it says it gives to vulnerable service users. It also has its own quango called ‘In-Control’ to advocate this great and good theory and again we see its name being synonymous with (the purported) increased choice.
The easiest way to explain the theory is that instead of social services finding and arranging suitable accommodation and care for those with assessed care needs, social services give money to the individual in the form of a personal budget or PB. The individual then chooses what to spend this PB on and purchases the services he or she chooses and hence the ‘Personalisation’ and ‘In-Control’ tags of its advocates.
At this stage I should mention the discussion site on CommunityCare had an in-depth discussion on whether it was acceptable for a disabled service user to spend his PB on twice yearly visits to a prostitute in Amsterdam. They concluded it was acceptable.
However, while the theory of personal budgets and personal choice is hard to argue against, the reality of personal budgets in practice in supported housing reveals it will and must reduce the provision of supported accommodation and therefore reduce choice – the exact opposite of its aims as the scenario below explains:
A 10 bedded house for residents with disabilities (Sometimes called the Supported Living Model);
- Landlord is a social landlord who also provides support
- Service User chooses his care provider
- Entire service is thus funded (a) Rent through HB; (b) support through SP funding; and (c) PBs for each user with assessed care needs
1. The social landlords funding model is dependent on 10 lots of (a) rent and 10 lots of (b) SP funding. The care element is of no financial consequence as the landlord doesnt deliver care. This is the typical model across the UK since the advent of the Supported Living Model of care (SLM) became de rigeur after the Community Care Act.
Landlord charges £100 pppw in rent and £100 in support and so the entire service generates 10 lots of £200 each week which is £2000pw and £104,000 per annum. This £104k per year equates to the housing management cost, the intensive housing management cost (higher costs of supported accommodation such as staffing for security, furnishings, communal facilities etc) and support services and is a break even figure.
Under Personalisation residents could choose to stay in the accommodation but choose another external provider to deliver support services – after all Personalisation advocates state why should a vulnerable person only get the support if he or shes goes into specific accommodation. Another good argument that works well in theory but not in practice.
Two of the 10 residents decide they want another support provider. The existing provider still has the same staffing cost as it still provides housing management and intensive housing management to all 10 and support to remaining 8. Yet the income has reduced by £200 pw and £10,400 per annum, a 10% reduction on the ‘break-even’ income it needs. The service is thus non-financially viable and may need to close.
In that scenario 20% of residents get choice which negatively impacts on the other 80% and in fact on all whne the service closes. That is not real choice at all and it is reduced choice for all.
The point the advocates of Personalisation conveniently lose is that the provision of an accommodation-based supported housing service is sustainable at the whim of every service user. That is a risk too far.