Giving the old the dignity of choice

Cllr Chris Taylor, Chairman Adults Services Overview and Scrutiny Committee of Bexley Council, on pushing forward with the personalisation agenda to pay for wardens in sheltered housing

The personalisation of social care is a very Conservative concept. At its core it promotes two ideas that have been the cornerstone of Conservative policy in local government for some time. It usually means value for money where block contracts do not, and it puts choice and control in the hands of the resident.

The London Borough of Bexley have for sometime been a strong advocate of the personalisation agenda, and it forms the heart of our policy in regard to Adult Services. We have two acute pressures facing us as an authority, a low grant settlement and an aging population. These issues come on top of the news that we will receive just £19 per head for Public Health spending, the lowest in London, thanks to historic spending decisions by our colleagues in the NHS.

When you are working in such an environment, there can be no justification for wasting precious resources on inefficient block contracts, especially when you cannot control unit cost and ensuring help is targeted on the basis of need. However, operating within tight budgets does not have to translate into cuts or poor quality provision. In Bexley we are pioneering a new pilot programme that aims to grow the local market of providers, and combine the principals of the “Big Society”.

We have recently commissioned a Care Company to facilitate the direct employment by residents of those who deliver their care. The user is the boss, who decides how they want their care delivered, and by whom. The Care Company takes care of the HR and other technical issues around employing someone who is working with vulnerable adults. A particular innovation we are proud of is our solution to protecting the wardens who work within sheltered schemes. The private company that provided wardens in our schemes recently decided to withdraw offering the service, as they were unable to take advantage of the personal budget model of funding. Our new umbrella care company are in the process of facilitating the pooling of personal budgets to collectively pay for their wardens.

The wardens will effectively be self employed with a contract with each resident. As a result, the residents will set the terms of the package they want, and the warden’s pay and conditions will be improved. Another added advantage is that those who self fund will pay the same as those who hold a budget, instead of paying a higher rate, which is often the case. Where residents decide not to pool budgets, or for those who remain in independent living, self employed floating support is also an option. This innovation is the next step in maturing the market in relation to care providers locally. Without a mature market, residents will not have real choice, and Councils will not realise substantial savings.

As we move closer to joint commissioning with the NHS, I hope that our health partners will benefit from the expertise and knowledge that many Conservative controlled authorities have in making a limited budget go far, with value for money commissioning that meets the needs and expectations of our residents. Some complain about the pressures that recent budget reductions have placed on local government, but in Bexley we see an opportunity. The challenge of working in this environment is exciting, and is fostering new ways of thinking. In Bexley we are embarking on the next stage of the personalisation agenda, growing our markets, delivering choice, and saving money, without compromising quality.