Are personal budgets really the way ahead for social care?

Two key figures in social care have expressed doubt about the government’s reliance on personal budgets as the way forward

Social care ofen feels uncomfortably like the film Groundhog Day. Nearly 16 years ago, with Stephen Dorrell as health secretary, David Brindle, now the Guardian’s public services editor, was writing about the “Battle to rescue care from chaos” (Society, 20 September, 1995). Now, with Dorrell heading a health committee inquiry into the state of adult social care, Brindle could readily reuse the same headline.

Social care is making headlines again, with prime ministerial statements about the desperate need for health and social care integration, amid widespread concerns that underpinning funding issues are yet again going to be ducked, despite the Dilnot report’s urgent recommendations for radical reform.

Meanwhile, two different but key figures in social care, Simon Duffy, pioneer of personal budgets and former director of In Control, and Mike Oliver, founding member of the UK disabled people’s movement, have rejected personal budgets and personalisation as the right policy for the future.

Given that the central government target for social care is for everyone to receive a personal budget by Spring 2013, we may ask where this leaves social care reform. Moreover, while there have been major divides between Labour, the Liberal Democrats and the Conservatives over social care funding, there is a strong political consensus of support for personal budgets. All three major political parties continue to be strongly committed to them as the way ahead for social care policy and practice.

The reasons and the context for Duffy and Oliver’s change of heart are very different. Duffy now runs the Centre for Welfare Reform, a thinktank and consultancy, which “works to reform the welfare state by developing and sharing positive innovations”. Giving the 2011 Tizard Centre Annual Lecture he said:

    “Either to your relief or disappointment … I am not here today to praise personalisation. Instead – in a way – I am here to bury it … The limits of personalisation on its own are now very apparent and it is time to move our thinking forward. It is time to think much more deeply about the welfare state as a whole.”

Clearly, though, such aspiration is not reflected in the arbitrary cuts in disability, sickness and housing benefits now being made by the coalition government in the name of plugging the public deficit.

Mike Oliver, on the other hand, giving the eulogy in December at the funeral of Vic Finkelstein, one of the most influential and innovative voices in the disabled people’s movement, seemed to be castigating just those recent developments in which Duffy has played such an influential role:

    “I was delighted when our efforts gave rise to direct payments legislation. Not so Vic however – it’s a capitalist dream, he told those of us who would listen. Today as we hurtle headlong into personalised budgets, personal independence payments and a diminishing market in social care, I can’t help thinking he was right.”

Of course, every social policy can be ambiguous in a mixed economy. There are always risks with cash benefits. They can be cut, restricted and withdrawn. But while there may always be tensions, these inevitably become problematic when, as now, there seems to be an ideological, political and economic commitment to stigmatising disabled people and to making them subject to the most severe cuts in public spending.

There can be no question that the direct payments invented and pioneered by disabled people were a route to empowerment, independence and liberation for many. However, the current reality in many cases seems to be that personal budgets have come to represent the degrading of direct payments as a means of emancipation. While the number of personal budgets continues to rise, the numbers of people on direct payments, the development most directly associated with improved life chances and increased independence for disabled people, appears to have plateaued. Instead, a new term has emerged, “managed personal budgets”. All this means is rebadging the narrow range of traditional services people have received in nominal cash terms to up the numbers.

Personalisation and personal budgets are beginning to look like just the latest in a long line of good ideas in social care, from patch and community social work, to genericism, care management and community care, which through underfunding and poor implementation have withered on the vine. The trouble this time round though, where the policy goal has been to increase choice and control through person-centred support, is that it is difficult to see where’s left to go.

• Peter Beresford is professor of social policy at Brunel University