Significant Changes in the Adult Social Care

Personalisation is the promotion of individualism which first originated from neoliberalism, it consists of autonomy and choice that is driven by one’s own preferences. (May, Cloke &Johnsen, 2005). Due to lack of funding for social care services, there has been a lot of pressure for politicians to deal with this funding problem that has been growing for a long time. Governments and politicians faced a big challenge, particularly because of the growing population of older people. 

This meant more hospital admissions and more activities being carried out. Older people are living longer with various demanding health conditions (Davies, Campbell & McNuty, 2018). In the late 1990’s, Labour’s new changes in the British welfare policy, also encouraged independence for service users and the importance to provide services that meet the needs of the service user and try to reduce reliance on service provisions. It is also a way for labour to seek a way out and manage austerity (May, Cloke &Johnsen, 2005).

Since the mid 1990’s, in England there has been an increased need for development in adult social care (Lymbery, 2010). Significant changes have been made in the adult social care. One of the concept has been the promotion of ‘personalisation’. This label promotes choice and independence in adult social care which is given through Direct Payment, this has been enshrined in the Care Act 2014. The Act lays down important changes in legislation in the UK. The Care Act provides different aspects of adult social care from previous acts and policy into one statues, giving importance to the lives of carers and service users (Barnes et al, 2017). 

In 2008 The Department of Health pledged to legislate Direct Payment in adult social care across the four countries in UK (Dickinson & Glasby, 2010). Direct Payment has been available since 1997 by the disable people organization. The idea originally came from the United States, which later was introduced to the UK in the 1980’s to early 1990’s. Disabled people living in UK who are eligible for adult social care are also eligible for direct payment (Dickinson & Glasby, 2010).

The current government policy is that anyone with social care needs is eligible for Direct Payment, which is offered by the local authority, they also provide everyone with information about the support and care available to them (Woolham et al, 2016). There have been positive reports for Direct Payment, not only is it efficient and cost effective, it also enables governments to shift responsibility and reduce staff costs, as it moved from institutional to home base care, this also encouraged families to take care of each other (Woolham et al, 2016). Personalisation allows self directed support where the person is directing their own support with the help of a family member or a friend who they feel is the best person to make the right decisions for them. Personalisation involves services which service users receive, are custom fitted to the requirements of each service user, instead of conveyed in a one type of service fits all style (Dickinson and Glasby, 2010). 

The Department of Health (2007) state in England two thousand service users and carers have had a positive outcome from personal budget. They have seen a significant improvement in some areas. However, according to Woolham et al (2016) researches show personal budget made no difference to older people and that personal budget had a negative impact on a person’s mental well-being. He goes on to state personalisation is to help people become an active citizen for example younger people will benefit more from Direct Payment as it will help them with education, driving lessons, training, employment and bringing up children (Woolham et al, 2016). However, for older people such as Gladys, who’s health has started to decline, personalisation will not be so helpful as she will lack capacity to make choices or live independently.

A care assessment will determine whether a person is eligible for Direct Payment. A person with a saving of to £23,250 or above will not be eligible for Direct Payment (Age UK, 2019). As Gladys already has a saving of £25,000 and receives £600 pension every month, she will not be eligible for personal budget and will need to pay for care from her income/savings. However, when Gladys’s saving is less than between £23,250 and £14,250 then Gladys may be eligible for personal budget and her house will not be included in the means test, therefore, Gladys does not need to worry about selling her house (Age UK, 2019). However, if Gladys was to move to residential care, which Gladys does not want, this will be very upsetting for her, particularly because she may not get the same treatment and care as she may get from family and friends and may not be able to get the carer she wants.

Furthermore, for Gladys, Direct Payment may not be so helpful as she is very old and has some dementia, this may put her at risk of not receiving the care that she needs. Gladys’s age and illness, may make it difficult for her to make decisions and take control of her care, which is central to the personalisation concept. Although individuals are supported to make their own decisions, sometimes they may not be able to make that decision due to lack of mental capacity, any decisions made by service provider’s, might not be in the service users interests (Age UK, 2013). Managing one’s own care can be very stressful for the older person. 

Personalised care involves having to make a lot of effort and spend a lot of time thinking about their care needs (Alzeimer’s Society, 2011). For Gladys, this may put a lot of stress on her mental wellbeing. Research suggests, older people experienced anxiety, physical health and psychological problem because of personal budgeting (Woolham et al, 2016). Studies show individuals with dementia, and those with other psychological well-being issues and the individuals who lack mental capacity, are not yet profiting by this Direct Payment (Community Care 2017).

Additionally, as older people require more personal care, Gladys will be spending most of her Direct Payment on personal care. This will not leave much money for any social outing or activities that she may want to do (Woolham et al, 2016). Also, Gladys may not have enough money to pay her neighbour who provides her with meals through Direct Payments, she can, however, pay from her own money but this will only reduce her savings. If Gladys’s grand daughter who has been made the power of attorney of her finances when she cannot make decisions herself, can provide Gladys with support in making decisions which are in the best interests of Gladys, for example, Gladys does not want to move to a care home, so when Gladys’s condition worsens and she needs full time care then Gladys’s grand daughter can use Gladys’s pension money or savings if needed to provide her with full time care at her home rather than move her to a care home. Gladys can stay in the comfort of her own home near her family and friends and still be part of the community.

However, there are many implications of individuals having control over their own care. For some it may enhance their independence but for other’s, it may put them at risk of being harmed because of their vulnerability and may need protection often in their lives (Assessing and Supporting Your Needs Policy, 2015). When Gladys’s condition deteriorates and does not have the ability to make decisions The Mental Capacity Act 2005 (MCA) can provide the protection needed (Mental health foundation, 2011) for example, When Gladys lacks the capacity to consent to particular types of treatment or care that others have assessed as being in her best interest, council need to follow the safeguarding policy and recognise that decisions made for the service user does not put them at risk of having their freedom taking away, it is important that the council take action before or when it occurs (Assessing and Supporting Your Needs Policy, 2015). 

Eventually, as Gladys’s dementia progresses she will not be able to live on her own and may need to move to a care home. Sometimes a vulnerable person like Gladys can be at risk of abuse or neglect, if this is detected during an assessment, then the council should carry out a safeguarding enquiry and decide which action is necessary and by whom (Assessing and Supporting Your Needs Policy, 2015). Direct Payment will not be helpful for older people like Gladys. 

Although it promotes choice, independence and control over one’s care needs, it also can leave a person stressed, confused and vulnerable to abuse. The political consensus must be to use all available resources, to allow Gladys grow old with her condition. It is essential that the care and support given to Gladys by her neighbour, friends and family is built upon rather than removed by an individual package of care that may create unhappiness because it may not be in Gladys’s best interests. Although studies have not yet found a good outcome for older people, however, Direct Payment for personalisation will still remain a very important concept for social care.