Newspapers have reported that the UK government is to publish a ‘Big Society’ bill, supposedly giving citizens more choice and control. In practice, this may involve offloading further responsibilities on to individuals, families and communities, forcing them to put in extra time and money or go without much-needed services.
In social care, many people already have considerable control. Those who wish to, and are able, can usually ask for direct payments to employ care assistants or engage an agency themselves.
Personal budgets have been rolled out to many others, so that they can (in theory) exercise choice while leaving the administration to the local authority. The ‘big society’ bill – or ‘open public services’ bill – will apparently extend this to all adult social care clients.
This can be very useful. Yet overstretched local authorities already tend only to contribute towards the funding of care for those with high needs, and even then to a limited extent. The Equality and Human Rights Commission has been gathering evidence on home care. It has so far found that “Older people’s basic human rights are being overlooked.”
One of the key problems is that “The very brief time allocated to homecare visits – just 15 minutes in a number of cases – does not allow even basic essential tasks to be done properly. As a result people sometimes have to choose between having a cooked meal or a wash. The short visits also mean that staff have to rush tasks like washing and dressing.” This is a type of choice, but less than ideal.
Personal budgets in healthcare will also apparently be offered to people with long-term health conditions. In the case of NHS continuing care, this makes sense, but in other cases it is problematic.
In the rights summed up in the NHS Constitution, patients already have considerable say over their care (though this does not always happen in practice), and can discuss the best treatment with doctors and other health professionals. These will however take responsibility for patient safety and quality of care, so that they should not give ineffective or harmful treatments or mixtures of drugs, and can be held to account if they do. They can also quickly prescribe more expensive treatments if the need arises.
NHS organisations also have considerable bargaining power, especially if they work together (though this does not yet happen enough), and can get good deals from manufacturers, achieving better value for money.
But offering personal health budgets opens up risks of financial exploitation (especially since many chronically ill patients have dementia or other mental health problems) and raises other questions. What happens if a private provider persuades a patient to spend money on ineffective treatments – for instance a fake ‘therapy’ that supposedly cures AIDS? When regulatory bodies and the police are already heavily overstretched, who will protect the sick and confused from those seeking to relieve them of their money?
In addition, if the cost of drugs goes up or a patient needs a higher dose or different medicine, will a panel’s approval be needed to increase funding? What kind of delays will this introduce, and what will be the administrative costs? And if permission for more funding is not granted, will the patient have to ‘top up’ payments or go without much-needed treatment?
Again, the bill will reportedly give parents of children with special needs more choice about schooling – but what if they would prefer their child to remain in mainstream schooling, mixing with non-disabled children, with adequate support? Yet funding cuts have made it harder for schools to be accessible to all. Without enough resources, freedom is much restricted.
Likewise parish councils will supposedly be able to take control over parks and playing fields – but with huge cuts in local government funding, how will they be able to afford to maintain them? Will this mean that people will be expected to volunteer or pay extra for public facilities that they previously enjoyed free of charge?
There may be useful aspects of the bill. But faith and community groups, humanists and others concerned about society, and especially the most vulnerable, may wish to examine the proposals carefully and challenge whatever might do more harm than good.
© Savitri Hensman works in community care and equalities. She is a long-standing and respected writer and commentator on Christian social action and theology, as well as an Ekklesia associate.