For many years we have been told that the voice of service users should lie at the heart of any service and certainly the vast majority of care providers take this very seriously to do what they can to ensure the voices of the service user is both heard and responded to.
Of course, much of this focus on responding to the voices of service users has been hard-won and over many years the disability rights movement advocated, quite rightly, for people who use services to be at the centre of the agenda and for person directed support to be the norm, rather than the exception.
In many areas, this desire for the service user to lead the agenda has paid significant dividends and the way in which care is delivered now is unrecognisable compared to the paternalistic way in which things were done in the past.
Listening to the voices of people who use services is something that service providers have really focused on, but sadly in many local authorities, the commissioners have not followed suit and particularly in older people services, we see endless examples of commissioners who make decisions based on budgets rather than responding to people’s needs.
A recent report by the Labour Party showed the number of older people who are being placed in care services a long way from the communities in which they had spent most of their lives. I believe much of this is driven by local authorities who have completely failed in their market shaping role and now find themselves in a position, where there is either not enough provision in their locality or the funding that they are offering is not at a sufficient level to be able to purchase care in their local area.
Good quality care is extremely reasonably priced, yet, in many areas we see local authorities trying to use their power as a monopsony commissioner to force down the price of care to totally un-sustainable levels.
In recent months we have also seen the resurgence of authorities bringing in private companies to try and drive down the cost of individual care packages. This is usually done as an attack on learning disability services and we have all seen the impact and concern this causes, for both people who use services and their families. The start point of these so-called reassessments is not the needs of the person, rather it is a target which has been set on how much the local authority wants to save from the care package. This sort of approach has no place in a system which is supposed to be listening to the voice of the user and responding to their needs.
As a taxpayer, I would be very concerned if any local authority brought in external organisations to negotiate care packages, unless they sacked commissioners and social workers who are paid by the local area to do this job. Complex person-centred care must be funded properly and local authorities must understand that they cannot simply cut costs at the expense of vulnerable people.
If the Government and local authorities did what they tell the rest of us to do, which is listen to the voices of service users, they would give people real choices and fund care at realistic levels.