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Let’s Talk Money

November 1, 2012

Commissioning. Brokerage. Fairer Charging Policy Co-ordination. Resource Allocation Systems. Procurement. Indicative Budgets. This is the financial vocabulary of social care. And it is crucial that any user of social care services gets to grip with it because to be ignorant of the language leaves you languishing in the starting blocks when it comes to arranging care packages.

This isn’t meant to be a tutorial in social care economics. I do believe, though, that a course in this very specific modern language would be enormously helpful to all carers embarking on the murky waters and navigating the care system.

No, the message of this post is quite simple – just talk money. It all boils down to that at the end of the day. Every other human, moral, ideological matter comes secondary to the price tag. All the great initiatives either become diluted, or at worst, hijacked by the money agenda. Take personalization and personal budgets – the great liberator for the service user, offering them real choice and flexibility in how they arrange their care. So, you have your FACS assessment (Fairer access to care services) and your needs are identified. Those needs are then fed into a resource allocation system and each need is given a monetary value. These are totted up and out pops your indicative budget – the cash value of your care. Think of it like the Sainsburys’ checkout: support with morning bath – £22.50; two to one support in the community – £96.75; support in preparing a meal – £16.26. These figures are made up by the way, because I have no idea what the actual figures are. Apparently, they are called algorithms but very few LAs could answer if you asked them how their algorithms work. (There feels like an old Les Dawson joke in there somewhere).

So, you have your indicative budget, based on …….? and it is more than likely that this budget will bear no relation to the cost of services in your area:

“Excuse me transformation manager – my indicative budget is for £100 but all the care agencies round here charge £200 for the service that I’ve been identified as needing”.

“Ah, but that is the beauty of the personal budget. You have the choice and flexibility to negotiate with the agencies to secure the right service for you”.

“But they’ll laugh at me transformation manager. I’m offering them half of what they’ve valued the service at”.

“All is not lost. We can go to Panel”.

As the excellent Sara Ryan points out in her wonderful blog “My Daft Life”, Panel is always refered to mystically. It’s not, The Panel, or A Panel but Panel with a capital P. What or who is a Panel? What do they do? How do they do it? You’ve got more chance discovering some Masonic secrets. One thing we do know is that Panel has the discretion to increase your indicative budget if they determine it doesn’t cut the mustard in financially meeting your needs. And you will be excitedly informed that you have been “successful at Panel” as if meeting your basic needs carries a prize. Off to boot camp and then judges’ houses.

But as you can see, we are no longer talking about a person or their quality of life; we are talking pounds, shillings and pence. The service user is a financial commodity.

For much of the time, the talk of money is considered unseemly, so you will be directed into talking about more palatable subjects. Like independence. We are not closing down the day centre to save money; we are closing down the day centre to promote your daughter’s independence. Now, instead of her making her own lunch at the day centre, we can encourage her independence by wheeling her around the shopping mall where she can stop off for lunch at McDonalds (and by the way, she will have to buy the support worker’s filet of fish as well. That will enhance her independence even more). It took me 18 months after the need had been identified to secure a respite package. For much of that time, the discussion focused on Steven’s independence and how it would be improved by him taking his respite at the unit where he was illegally detained. I was a fool; I went along with these discussions which included; social stories, subliminal messaging etc etc etc. After a year, the LA agreed to pay a support agency to provide respite at home but they weren’t happy about this and insisted it was a temporary arrangement because Steven’s independence was being compromised. When that temporary arrangement ended, I did some independent sums. The support agency were charging the LA £168 for overnight support but paying the support worker £55 (gross). I asked him if he would do the work under direct payments for £65 and I submitted a proposal to that effect to the LA. It would lead to the council saving £105. Funnily enough, we stopped talking “independence” and Panel successfully agreed my proposal. You are probably talking about money, even when you think you are talking about something else.

One last thing, and I’ve mentioned the word twice in this blog, is it’s interesting how the word “fairer” has suddenly entered into the social care doublespeak. We have “fairer access to care services” and “fairer charging policies”. This is designed to put you on the back foot because the implication is that anything that came before the fairer charging policy was unfair or less fair. But fairer to whom? The service user? The provider? The general council tax payer? As we’ve seen, the FACS usually produces an indicative budget that won’t financially meet the person’s needs. is that fairer? If, under the fairer charging policy, I’m having to contribute to the support agency’s profits out of my Disability Living Allowance, who is that fairer to? It’s a meaningless word. And it’s a mean word. It’s like being “successful at Panel”; it adds an emotive element to the basic process to disguise the fact it is purely a financial manoeuvre. Nice.

Do your own needs assessment; construct your own care plan; work out your own costing of the package. And talk in those terms and try not to engage in any person centred nonsense.

And so endeth the sermon. As we’re talking money – I’ll just pass the collection plate around.

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