The People as Partners project is primarily concerned with ensuring that the independent sector and those who use older people’s services are properly aware of and prepared for the implementation of Self-directed Support.
There is a presumption in that paragraph that everyone will accept that Self-directed Support is a positive step forward and that it will be beneficial to older people and their families. Alas not everyone would seem to share that viewpoint. Already since this project has begun I have heard and come across people who whilst enthusiastic about personalisation for those who have physical and learning disabilities or for those who have mental health conditions – are lukewarm or at least reticent about the value of personalisation and Self-directed Support for people who are older – and often for those who are younger too.
Often the range of sentiments which are raised include remarks that many older people just want to have things sorted out for them; they don’t want or need the hassle of being in control of their own budgets. The opinion is expressed that residential care, in particular, lacks the range of choice and options for it properly to be a theatre for Self-directed Support. Concerns are raised about the degree to which someone with, e.g. episodic dementia can fully understand the range of choices and options that might be theirs. Such well-intentioned sentiments, I would suggest, miss the point entirely.
To deny any group the right of the fullest choice possible, and the greatest degree of control achievable is to marginalise one sector of the community and to act in a profoundly discriminatory manner. It also views older people in a homogenous manner which is the very attitude that Self-directed Support in its principles seeks to contest and challenge. That is is not to deny the challenges or to minimise the difficulties.
The threats to the principle of older people having greater autonomy has most recently been raised south of the border – what is interesting is that the challenge to the Government’s policy aim of personal budgets for all receiving social care – has chosen older people as the first target. Interesting but perhaps not surprising.
ADASS (The Association of Directors of Adult Social Services) in its paper ‘The Case for Tomorrow: Facing the Beyond’ has called for a joint review with the Government of how to make personal budgets work for older people in England and Wales and has asked for a longer time period to make this happen.
Martin Routledge from InControl raises the questions:
‘So what might this intervention by ADASS mean for the future of personal budgets, and in particular for older people? Some might see this as a simple suggestion that personal budgets can’t work for many older people and other approaches to personalisation should be pursued instead. However this would potentially be a discriminatory denial of the potential benefits of personal budgets to older people’
It is clear from lessons south of the border that there are very real and particular challenges for Self-directed Support and older people.
People and Partners over the next few months and years is eager to work with all organisations and individuals wishing to address these challenges, not least in residential and care at home environments. However, to enable that challenge to be met, the first step is surely an acceptance of the critical importance of older people playing a full part in controlling their lives, making meaningful choice, ensuring positive outcomes – and that includes their budgets.
As Routledge reminds us in relation to recent research:
‘In terms of social care need groups, older adults tend to report less positive outcomes than other social care need groups in six out of the 14 outcome domains. However, these differences are ones of degree (older adults are more likely to record personal budgets as making no difference; they are not more likely to record personal budgets as making things worse).’
Donald Macaskill
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