Reasons to be Sceptical 1,2,3…..
Phil Saunders looks at some of the downsides to Individual Budgets<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
(First published in the September 2007 Sitra Bulletin)
Over the last few month’s, we’ve had several articles singing the praises of Individual Budgets. And quite right too – they represent an important tool in helping to achieve user empowerment and personalisation of services. But, in this article, I’m going to play devil’s advocate. I’m going to look at some reasons to be sceptical of the Individual Budget approach.
My elderly relatives won’t mind me citing them as an example. They hate the home care service they are provided with and feel they have no control over it. They would much rather be given money in their hands to buy whatever they want with. Even ten or twenty quid a week would go down well!
But the truth is, they would get nothing like the same level of service for that kind of money. So, instead of making sure the service improves, the Local Authority would effectively be buying them off on the cheap. And that is one of the drawbacks of Individual Budgets. If we are not careful, a seriously insufficient sum of money will simply be divvied up and doled out, with services users left to fend for themselves in the market place.
But at least they can do what they want with the cash, the pro-lobby will argue. Well, maybe. For all the instances of recipients purchasing, say, a football season ticket there are examples of professionals saying that there should be more policing of what people spend the money on. And so choice starts to get undermined from the outset, with a “visits to day centres- good, visits to the pub – bad” morality being imposed from above. There are real tensions between genuine choice and the fact that council budgets are intended for a particular purpose.
Nevertheless, surely scrutiny of how individuals use their budgets will be nothing like as major an industry of the whole “commissioning” framework that exists currently. I for one would not bet on it. Officials appear to carving out a future niche for themselves in “brokerage” and “capacity building” of services. I can see market management under Individual Budgets being just as cumbersome as current commissioning frameworks.
And of course quality control will be a real issue. We should be concerned that services users should still be able to get properly managed and qualified professionals to care for them, if they prefer that to <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />informal arrangements. But there is a danger that Individual Budgets could actually lower service quality, especially if the sums made available to recipients are too small.
Lastly, there are the challenges associated with the chaotic and socially excluded groups who benefit from Supporting People. Whilst the Individual Budgets model has many attractions for the purchasing of home care, how would it work in (say) a hostel for young offenders? The whole service model would be undermined if support was to be provided by a plethora of individuals and agencies – or not even purchased at all should the service user so choose. OK, so that is an extreme example - but even with ant accommodation based service you run into the same arguments. Projects that are set up with complex packages of capital and revenue funding need a degree of certainty about purchasing patterns if they are to remain viable.
Don’t get me wrong – I am all in favour of service users being in control. But we have to be realistic about Individual Budgets. In our enthusiasm to provide choice and flexibility, we must be careful that we do not impose a one size fits all solution. More traditional commissioning and funding arrangements will be continue to be suitable for some service models.
