Natalie Tarry, Researcher, NLGN
It is time to recognise that we can no longer avoid offering personalised and tailored services. ‘One-size-fits-all’ is widely recognised as a failure. Outcomes have certainly never been universal. Choice and personalisation are the new policy mantras and many hype these concepts as the panacea for all problems besetting public services. But to others it is as great an evil as privatisation was in the 1980s. Both views seem somewhat flawed.
User choice certainly is a tool to improve services and lever up standards, but it is not everything. However, where some degree of choice has been introduced it is delivering great improvements for users. Direct payments are one example where people are now offered a choice over who provides their social care tailored to their needs and preferences. The payments are primarily used to employ a personal assistant, but can be appropriate for anything that fosters the users’ wellbeing, including the sound proofing of a bedroom, massages and the like. They are also available for carers to use for short breaks, help in the garden and house; anything that allows them to carry on with their caring role for that little longer. Essex County Council has a particularly successful scheme, one of the biggest in the country with around 1200 users.
The kind of choices I am talking about are absolutely fundamental: who is allowed to enter your house, to touch your body, wash and dress you? We are not talking about the choice between different mobile phones, denim jeans or Heinz beans. Professor Barry Schwartz’ argument that greater choice will lead to anxiety just does not carry when looking at the experiences of disabled people. Instead of being reliant on a previously inflexible service, they are now able to live more independent lives, and even hold down a job.
Often direct payments are wrongly discounted as a limited success. Overall take up remains low with the most recent figures around 18,000 (even thought this is an 80% rise on the previous annual figure). Many adopt this as the main argument against direct payments. Yet the figures are misleading as they don’t include the many children that are now receiving direct payments. Nor do they tell us anything about lives that have been changed for the better. We need therefore to think about how we can ensure higher take up across all user groups.
Research evidence reveals that the main barrier to success is due to care staff’s reluctance to offer direct payments to the user in their care assessment. The main reason for this being that they are either making the judgement that the user will be overwhelmed with the task of being an employer or that staff will have difficulty understanding how the scheme works. Both reasons highlight the need for more and better training if we are determined to make direct payments a success.
Support and relevant information for the user are also vital. In many areas, people are benefiting from dedicated advocacy groups providing help on all elements of direct payments – from payroll to crisis management. Take up is highest were those groups work well.
Personalised and tailored services are definitely the future. No longer can we get away by offering a ‘one-size-fits-all’ service. If we want the unprecedented investment in public services to have an effect on the perceptions of users, we need to rethink and truly put them at the heart of the service. We need to pay more than just lip-service to “voice” and give people a real say over service provision. No longer can professionals assume that they know what is best for individual users. If we want our public services to evolve according to what users really want, we have to let them choose.
Making Choices is available from firstname.lastname@example.org, price £26.25 (inc p&p)