Unsettling Future: The Implications of Personalisation of Services for the Ageing Population

Personal social service has a long history however; it has gradually developed in different forms and approaches for example, the Monasteries, the Friendly Societies, the Poor Law and the National Assistance Act (1947), who provided safety net for universal standard of care. Despite the legislative frameworks for care standards, family care system has been unique and the longest approach known to human race to support the disabled and sick people in society. Thus, the legislation in 1947 only unified, strengthened and shifted emphasis towards the state’s interventions through health and social services. However, the sectors have witnessed a number of changes and developments though; the focus has been to support older people, people with learning or physical disabilities, those with mental health problems and recently those with HIV/Aids. In hindsight, the advent of “care management process (DH 1990), personalisation of services (DH 2005) and recently the Eligibility Criteria Matrix (DH 2010)” has revealed the declining of universal standards for care. Yet, the proponents of the “Care Quality Commission” may argue that the commission is in a position to address the issues relating to poor quality of care and Safe Guarding of Vulnerable Adult but; practice observations have shown otherwise.

In this age of civilisation, quality of care is paramount in the lives of the vulnerable in society. We have to admit that some of the concepts or service frameworks such as care management approach have contributed to falling standards of care. This is because social workers are no long able to practice social work but gate keepers for budgets. They barely apply their knowledge-based practice, experience and professionalisms to monitor services delivery. On reflection, the system faces increasing pressures from people living longer and some have more complex needs as they approach the end of life. Given the current economic climate within health and social care the government needs setting out the support and services that service users, patients, carers and families can expect to receive from the establishments. Equally, there should be a declaration from the government to rein-fence social care budgets now and the future as this would help to uphold standards of care. The redesigned services and budgets would enhance the safety-net of the vulnerable in society. This would indicate new systems of support to achieve high-quality care. In addition, families’ involvements and supports would promote lasting support services for the growing vulnerable users in our society.

We must not lose sight that development in medical sciences and bio-technological advancements mean that people are living longer even with disabilities and chronic conditions. These reflect the complexity of service users’ and patients' needs and the type of care required. However, enhanced community care with adequate budgetary commitments would allow social workers and allied professionals (community nurses, occupational therapists and physiotherapists) to practice their profession. This would tentatively modernise community-based services whilst enabling more people to remain in their own home for as long as possible. Experience has shown that collaboration between health professionals and social workers have the propensity to deliver quality care standards within best value principles. By contrast, collaborations have been slowed down because of both internal and external factors such as, organisational cultures and traditions, politics, power and technical know how while budget constraints have been put at the forefront. To avoid these mishaps, there should be a change in the system to allow merger of the two agencies and this would enable them work together towards a common goal.

Operationally, service users get better clinical or personal social services and economic outcomes when they receive services in their own home. This means social workers should be given the freedom to practice social work as directed by their professional ethical standards. Lack of this opportunity meant there is no adequate tariff to monitor quality in the community and is not surprising that good outcomes are not achieved. The tariff would cover all patients' or service users’ clinically assessed needs, regardless of setting, age and disabilities. Each patient or service users would have an appointed health/social care worker to help guide them through the different services. They would also have their social care needs covered at the end of life. However, the modernisation agenda/personalisation of services such as “Cash for Care, Direct Payments or Individual Budgets” have not made significant contributions to improve quality standards hence there is little interventions by social care workers in the community.

On the other hand, family units are declining yet, in most cases families are the first point of call for service users before they could approach the state for support. To facilitate universal standards of care, families have to be involved working in parallel with either personalisation or care management service frameworks. However, it could be argued that quality is in the eyes of the beholder but practice evidence has demonstrated that families have the abilities to provide psychosocial wellbeing than strangers and that enhances quality and standards of care. Family care giving is linked with cultures and traditions as well as sharing past and present family history between generations. Interactions of any kind provide learning opportunities for the younger members of the family who disseminate such practices, experiences and knowledge to their own offspring. Families’ involvements are not a question of parochial views but significant observations because they know the standards their relatives are used to as a result they would endeavour to maintain that better than strangers. Nonetheless, to achieve universal care standards it requires political will that is unconditional, this is directed to promote family values and norms while social workers are encouraged to practice social work to later.

Rethinking Community Care in the 21st Century: The Perspective for Marketisation of Social Care

The agenda for marketisation of social care revisited familiar themes around the enhanced involvement of users in service delivery, upholding choice and control, increasing accountability and developing these by integrating a role for self-organisation and independent living within services. The modernisation of the social care market, drawing on the principle of provider/purchaser split (NHS and Community care Act (DoH 1990), managerialism in welfare services and best value cost effectiveness, provided a focus for delivering social care. Both the Conservative/Liberal Democrats government and New Labour administrations have pursued these ideologies. It also has included the privatisation of care for older people, raising the issue whether the for-profit sector in indeed likely to be the best option for good quality care, especially for frail older people.

A key feature of marketisation policy is about breaking down large-scale organisations providing social care and using competition to enable exit or choice by service users. The ideological position is to increase flexibility in the social care market as this would bring about equilibrium of demand and supply in the market. Individuals and groups at different positions on the political spectrum have promoted the idea of users’ rights to exercise choice in their use of public services. Progressive self-help movements have argued for choice as a means of promoting market-based solutions and curbing the power of the state (Clarke et al 2000; Leadbeater 2004; Cameron 2010; Ugwumadu 2011).

Marketisation significantly centred on issues of cost efficiency, consumerism, and responsibilities and cost savings, whereby the allocation of cash for care rather than services raised concerns as to the accountability of government monies.  Marketisation policy clearly presents significant opportunity for delivering personalisation of services through direct payments and individual budgets model and related support structure in the future social care market (Leadbeater 2004; Hasler 2006). According to Zarb and Nadash (1994) and Hasler (2000, 2006), they argued that direct payments is around 40% cheaper than direct provision. New Labour government assured in its positioning of direct payments and individual budgets as part of a wider marketisation of social care, established initially through the 1990 Community Care Act. This framed the market as an instrument for accessing choice and diversity in social care provision through the development of local care markets (Hasler 2006; DoH 2008).

The central doctrines for the Conservatives/Liberal Democrats government and  New Labour government’ agenda are: a focus on managerialism not policy and on performance appraisal and efficiency; the disaggregating of public bureaucracies into agencies which deal with each other on a user-pay basis; the use of quasi-markets and contracting out to foster competition; cost-cutting; and a style of management which emphasises, amongst other things, out-put targets, limited-term contract, monetary incentives and freedom to manage (Hood 1991; Osborne and Gaebler 1992; Leadbeater 2004; Cameron 2010). These ideological policy frameworks are fundamental principles behind the Big Society’s agenda to enhance the welfare systems. The Big Society project is claimed to offer the opportunity to deliver the personalisation agenda and to maintain cost effective social care.

However, many people would disagree with this position on the grounds illuminated below. For example, changes in delivering personal social services are accompanied by an increasing tendency to define home care intervention in terms of narrow tasks. This has resulted in complaints of unmet needs and lack of opportunities for more generalised social interaction between carers and service users (Sale and Leason 2004; Ugwumadu 2011). The continuous changes within social services’ policy and practice have influenced social work practice and social care delivery. According to Morris (1993a) and Glendinning et al (2002, 2009), changes in policy meant that social workers were no longer in a position to uphold social work ethical practice, but had to participate in a policy that deprived users of their rights and choices, as outlined in the National Health Services and Community Care Act (DoH 1990).

It is also possible to see the Community Care (Direct Payments) Act (DoH 1996 a & b), and the Carers and Disabled Children Act (DoH 20001 b) as an attempt by government to promote a distorted and flawed notion of empowerment by exit, shifting responsibilities to users. The aim was to control and reduce an escalation of public expenditure. In such a service, Leece (2000) claimed that it would be left to local authority social services departments to balance the books and reconcile the very real demand for direct payments with already stringent budget constraints. Pearson (2004a, b and 2006) noted the contradiction and tension between the legislation and practice.

The Conservatives/Liberal Democrats government has largely intensified the marketisation approach as the basis of their broader modernisation programme in social care with its increasing focus on personalisation services. The Big Society project and Personalisation of services are very potent but, highly contested and ambiguous idea that could be as influential as a privatisation was in the 1980s and 1990s in reshaping public provision.

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Reconstruction of Social Work Through Personalisation

  This book is aimed at bridging the gap in the existing literature in the field of social policy for older people; personalisation of services, family reciprocity and education regarding contemporary social care and the social care market in the UK.  While there are publications in social inclusion and personalisation, yet, they do not look at the inter-relationships between personalisation of services for older people, family reciprocity and payment to informal family caregivers. In essence, life long learning by service users and their informal carers are lacking and as a result they are not conversant with developments within the system, therefore do not know how to access services within the wider welfare systems. Publications on longevity of care giving to older people, care needs assessment and demographic change also do not focus on life long learning. Thus, this book aims to break new ground by linking these important issues.  However, it might be unusual within older people service and long-term care literature to have a focus on the learning needs of a particular population for example; those with long term health and social care problems.

  This book has revealed the views of the key stakeholders (service users, family caregivers, social workers, social work managers and councillors) about the potential of family care giving. The majority profess the need for a changed social work practice in order to offer personalisation of services to the growing older people population. In as much as transformation and personalisation are the “buzz words” in social services, yet, many older people would prefer their family members to help them with their social care needs. This view is supported by both practice experiences and empirical research carried out in Essex County Council area of the United Kingdom (Ugwumadu 2010). Thus, the aim of this book is to modernise social work practice in line with the aspirations of the baby boomers that are now entering the social care market. This would provide the opportunity for power balance from the professionals “do it all” to the family members who would carry out assessment of care needs and provide care for older relatives for payment if they wish to.

  This book has also highlighted the interrelationships between health and social care for which longevity of care is now prevalence in our society. Presently social policy for older people, in particular the NHS continuing  healthcare for older people, is undergoing a considerable paradigm shift in terms of re-thinking core services that have been taken for granted such as collective welfare systems, ability for social inclusion, informal care, education, training, empowerment, and the meaning of recovery from physical disabilities. The re-thinking is accompanied by a slower pace of changes in social care and clinical practices, albeit no less significant, and at times with projects reflecting a leap into the new world of personalisation services.  

The book can be bought from major bookstores and Amazon: (www. Amazon.com)