Funds For Public To Buy Own Care And Teaching
The government’s new programme of personalised public services could see NHS patients being given a budget to buy their own care and parents the money to hire their own teachers.
Ministers have approved an expansion of individual budgets after successful pilots in social services. Now officials and Labour figures are thinking radically as they prepare for the biggest shake-up of public services since the welfare state was formed.
Budgets for patients with long-term conditions, such as cancer, may be announced as part of the celebrations of the 60th anniversary of the NHS this year.
The education reforms may come later as part of a big government drive to give users control of public services.
The idea has already been piloted – and judged a success – in social services. There, for example, people with disabilities have been able to hire their own ‘personal assistants’ to help them out of bed, prepare meals, or even to take them to the theatre.
“Debate on whether we should have more personalised services is over. The question is how do we do it and how do we get it right,” Hazel Blears, the communities and local government secretary, told the Guardian-sponsored Managing New Realities (MNR) conference this week.
“This is not just about a few pilot schemes to give people control of their own budgets, it is about long-term change in the way of providing services.
“Participatory budgeting is taking place in lots of areas. Jacquie Smith at the Home Office is keen to do some, as is Ed Balls at the Department for Children, Schools and Families.”
Individual budgets for social care users – under which service users are given a budget as cash or in the form of services – have been piloted by 13 councils from Gateshead to West Sussex. The evaluation report is due this spring but Blears signaled clearly they to be rolled out across the country.
That now seems likely to be the just the first stage of a fundamental shake-up in the way public services are delivered.
“As part of the sixtieth anniversary of the NHS we are looking at some form of individual budgets for people with long-term conditions. All I’m prepared to say is that we are looking at it,” Mark Britnell, the director-general for commissioning and system management in the NHS, told the MNR conference.
Leading New Labour thinker and head of the RSA, Matthew Taylor, had earlier said he made himself unpopular by floating the idea of parents hiring their own teachers.
“I make myself unpopular by saying to headteachers social care is in the vanguard and if parents go to parents’ evening and the teacher does not recognise their child’s name and parents are worried [their child] is not being treated as an individual they could learn their child is worth £6,000 a year so if they can find six people they can employ a teacher who will know their child and employ them to teach in their own home,” he said.
“That is the challenge education and other services are going to have to face in the next 10-20 years. It’s already happening in social care.”
The implications for unpopular hospitals or schools are enormous but the government has already said it wants to make it easier for parents to set up their own schools.
Anyone, including parents, may already publish proposals to set up new schools. This September the first parent-promoted school opened in Lambeth, London. But proposals are assessed on their merits and against other priorities for local and national expenditure.
“Proposals would be decided by the local authority, with a right of appeal to the schools adjudicator. Proposers would need to demonstrate parental demand for the school, and that it would deliver education of an acceptable standard.” the DCSF said.
The ideas floated by Taylor go further, by suggesting parents could be given control of the budget the local authority had allocated for their child, with the freedom to spend it as they wish.
Despite the radical ideas being considered, there are likely to be limits on how far individual budgets could be extended. While patients with long-term conditions might find it helpful to plan their own care, rapid response to an emergency cannot be budgeted for.
However, Blears said the days of deferential people being passive recipients of services are over.
A Department of Health spokesperson said: “As part of the Darzi review we are investigating the scope for individual budgets in health care and learning from the individual budget pilots in social care and experience in the US. These investigations are at a very early stage and no final decisions have been made.”