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TX: 28.01.08 - Individual Budgets

PRESENTER: PETER WHITE

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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.


WHITE
Now we continue our season of features on social care by looking at what is really regarded as the big idea in this area, certainly by the government - individual or personalised budgets. In essence the idea is based on the principle that when it comes to knowing best about what kind of care an elderly or disabled client needs the answer is likely to be - try asking the client themselves. The idea has been piloted in about - in 13 local authorities and just before Christmas the government announced that from April this would be the system adopted across the board. So how will it work and can the claim be substantiated that this will be cheaper as well as more people friendly? Carolyn Atkinson is with me. How did we get to this point Carolyn?

ATKINSON
Well Peter in the beginning, as it were, care came through an agency, so if people needed care at home they'd be told you qualify for x number of hours, this is the name of the agency, a carer will come at 10.00 a.m. to get you up, they'll return at 9.00 p.m. to put you to bed. And some councils also had an in-house team of carers who did pretty much the same. Now the good thing was that these carers were trained and they were regulated but it was very inflexible and in fact I remember speaking to one woman who complained that the carers came so early to put her to bed she was ready before her nine-year-old son. So that system does still very much exist and some people have very good experiences with it but others don't. And in 1997 the government then came up with the idea of giving people more control and they came up with what are called direct payments. So instead of a person receiving the care in kind, they actually receive the money directly to buy their own care, hence the name a direct payment. So what people do is they employ people directly and they become an employer or they can still buy in some carers from an agency but it's all on their own terms when it comes to timings.

WHITE
Okay let's hear from - sorry you took a breath, have you got something else to say?

ATKINSON
I took a breath. I'll just quickly say that this was all the start of what's called the personalisation agenda - it was giving people control of what they want, what care they have, when they have it. And the next big thing is the personal budget - they're going to be rolled out and they'll take things to a whole new level, they'll go way beyond just care per se, if you like, they'll bring in all sorts of things like social life, respite, transport equipment and there's even been a hint from government that there may be some movement and some cross-over between social care and health, so all very radical.

WHITE

We'll hear more about what they're going to do in a moment. But let's hear from Julia Winters who's been on the pilot scheme for personal budgets and before that was receiving direct payments.

WINTERS
With a direct payment you had a social worker who came to see you and assessed you and they then gave you a prescription, if you like, of hours, so yes you need help with washing, dressing, going to the toilet, feeding, whatever it is, here's your prescription for 10 hours at £10.60 an hour, whatever it might be. With an individual budget you fill out a self-assessment questionnaire and then you're told an annual budget, so instead of being given so many hours you'll get told you're entitled to say £10,000 a year. And then you are then taken through the process of planning how to spend that money and that is done either with a social worker or you can choose anyone you like to help you - so it could be family member, friend - and you ask questions within this support plan - what's important to you, what's working in your life, what's not working, what would you like to change and how would you like your life to be. Now that is something that never really heavily featured in any reviews I'd had in the past, it was very much the professional telling me what I needed. And this was actually quite a liberating experience - to allow to be the expert on me. So actually the most important thing in my life was to keep out of hospital.

I have a lung condition and I need oxygen. Previous summers I've spent a lot of time in the car with the air conditioning on to help my breathing but I thought well if I could have one unit in my house, which was air conditioned, which would help my breathing and that has actually enabled me to stay at home on several occasions rather than be admitted to hospital, which I'm sure the NHS could give you figures about how much money that's saved. It was important to me because it meant that I wasn't in hospital and also as importantly my son and my husband weren't stressed by me being in hospital. I'm not getting a penny more money than I was on direct payments or on a direct service, what I'm doing is making the money I have got work in a more efficient way.

WHITE
Well listening to Julia with us is Melanie Henwood, Melanie is an independent healthcare consultant and advisor also to the Commons Health Select Committee and she was commissioned by the Department of Health to look in depth at personal budgets - the obstacles, the opportunities and the philosophy behind them. Melanie, I think we now know what they are basically but what kind of new things will they allow you to be to do, I mean Julia gave us a health example but there are some more, what you might call, life orientated things aren't there?

HENWOOD
Yes Peter, I think Julia's experience illustrates perfectly the transforming potential of individual budgets and the impact they can have on people's lives. And essentially - I mean the way I describe it very often is to say that people who qualify, who meet the conditions for an individual personal budget, can use it for anything that's legal. Now that opens up a whole set of new opportunities for people, instead of thinking in terms of services let's think in terms of people's lives, so this is about getting out of having social opportunities, it's about doing things differently - going to the gym perhaps instead of to the day centre; going down the pub; having help perhaps to go to see the football match; having a subscription to Sky television - these are all possible under individual budgets.

WHITE
It sounds very nice but people will say how can that be cheaper because alongside these whizzy things all your ordinary care needs still have to be met, and we were told community care was going to be cheaper on the same sort of basis but it wasn't?

HENWOOD
I think we have to be realistic here and we need to recognise that the money that goes into social care is not well spent, there's not a good relationship or association between the investment that goes in and people's needs so as soon as you start to turn that around, to free up the money that's locked into services and to use it differently, you can do a lot more with the same money. The point that Julia made very effectively.

WHITE
What are the potential problems though, because presumably - I mean one thing this might mean is less jobs mightn't it?

HENWOOD
I think there are a number of problems with implementation Peter and moving this from an experiment, if you like, from pilots, to the whole system and I think some of those problems are about what people think and feel about it - hearts and minds that have got to be won over. People who work in social care are understandably anxious about this - what does it mean for the future, what does it mean for their job? Let's look at social workers - have they got a role in this brave new world? I think they do have and I think that's less about assessment and gate keeping and more about helping people to live their lives and envisage what the future looks like.

WHITE
So the problems, of course, that we've been talking about throughout this series about paying for care is the belief that the system is a lottery and that means testing is unfair. Mike Smith, from the National Council of Independent Living, is also with us, a service user and a wheelchair user. So is the current system fair?

SMITH
Well not at all Peter. You find that different people in different situations have to pay different amounts or in some cases none at all, depending on where they live. You find that local authorities have very different charging policies despite central government guidance and that's applied differently and also not in a particularly transparent way. And, for example, Kent County Council last year increased their charges by 35%, so very different treatment for different people. You also find that people who are getting support to live in their own homes, domiciliary care, are treated very differently depending on their life circumstances. So, for example, everyone gets assessed, the people who are on earned income have earned income that's discounted, the reason for that is because of successful lobbying a number of years ago saying you shouldn't be doubled taxed for being employed but it means that there are inequalities for those who are on income support benefits as well.

WHITE
Well there's a further anomaly to the ones that Mike's given us when it comes to people who find themselves in residential care. Carolyn has been speaking to Doug Pawley, he's 29, has a rare neurological condition which means he passes out randomly and so it's not possible to provide a cost effective care package in the community so he lives in a residential home. He's got a first class honours degree and would love to work but if he did all but £20.45 a week would be taken off him to pay for his care home fees.

PAWLEY
At the moment I'm on income support and some of my income support gets taken off me to pay for the home and then social services tops that up to the home's fees, which is £945 a week. Which leaves me with £20.45 personal expenses allowance a week. And then anything that I earn over £20, first of all gets taken off my benefit pound for pound whilst the contribution to the home remains the same. It makes me feel very frustrated that this is the situation, it's a sad reflection on assumptions that are made about people in residential care.

WHITE
Doug Pawley. Well Melanie Henwood is still with us listening to that. You've heard those anomalies that both Doug and Mike have talked about, will the new personal budget scheme be able to operate within this current means testing system that we've got?

HENWOOD
Not within this system. I think what's very clear is that this system belongs to another world, it belongs to the past and you can't simply impose that on top of this new world. The IB pilots have been struggling with different ways of doing it and they've looked at what they now call a contribution to the budget rather than a charge, the impact is the same - it's still about co-payment or people contributing to the overall budget. But look Peter I think we're on the cusp here of the most fundamental change in social care since the welfare state came into being 60 years ago and it's essential that we get this right. So my view is that there should be a national system both to allocating the resource for the individual budgets, but also for having a basis for charging which is transparent, equitable and that people can see what's going on, we mustn't replace one postcode lottery with another.

WHITE
And Mike Smith what about you, I've heard you amidst all this euphoria express some doubts, I mean what would you like - what will it take to make the individual budget change your circumstances?

SMITH
Individual budgets have to be a great way forward and I agree with everything Melanie's just said but changing the system at the fundamental level is crucial to this, we have to give adequate support so that people can make informed choices around how they want to do it. There needs to be fair and transparent and open systems for charging and assessing. At the beginning of your series you had people saying they were prepared to make a contribution but as your own message boards on the programme say when it comes to the reality of being assessed and charged people find themselves in a very difficult position and they don't really want to pay for each of these services, they feel they're forced to, otherwise any life support systems they have may be taken away.

WHITE
Right well we will be watching this way beyond the month of programmes that we have been doing. Mike Smith and Melanie Henwood thank you both very much.

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