A big debate about devolution is brewing. For some, this is about more than empowering town halls or creating new layers of government in our regions. Instead of more politicians, they want to go one step further and devolve power directly to users of public services – in line with Ed Miliband’s agenda of people-powered public services. This is the argument that Liz Kendall, shadow minister for care and older people, has been making, including at the recent Labour party conference where she spoke at an IPPR-Institute for Government fringe devoted to devolving power and delivering reform in government. Creating health and care services that work best for patients – particularly at a time of increased pressure and squeezed budgets – means ensuring genuine patient input into solutions.
Too often we are working under two false assumptions: that politicians know best, and that one service can fit all.
It is difficult for politicians to admit – although Kendall certainly does not shy away from it – but they do not always know best. The chances are that those using public services have a better idea of how they work (and do not work) than most politicians. By encountering the problems first-hand, they can identify what is wrong and what needs to change – where services should be more joined-up and bureaucracy cut. They can also identify where early intervention is needed to prevent problems occurring further down the line, saving themselves trouble and time, and saving the government money. These should be the people directing the change.
When it comes to health and social care, there is no one size fits all. We need a system that adapts to the individual and gives them what they need. No one should feel like they have to battle their way through a disjointed system in order to receive the care they are entitled to – as if they do not already have enough problems to cope with while they are unwell and in need of care. The last thing anyone needs is to hit bureaucratic walls and be repeatedly passed from one service to another.
Giving people the power to change their services means putting people in charge of the money, says Kendall. A good example of how effective this can be is personal care budgets. Giving people control over budgets can help to increase their independence, ensure individualised needs are met and make them less reliant on expensive hospital services. Kendall tells the story of Alex, who, following a minor stroke, received excellent hospital care but struggled to get around the community. He used his personal care budget to buy a satnav, which allowed him to travel around again and attend a stroke survivors’ support group. Different people have different needs, and achieving individualised care often means trusting people to make the right decisions for them with the money available.
Kendall believes that the next step for personal budgets is to look not only at how they can be joined up in terms of social care, health care and mental health care, but also at how people with personal budgets can come together to drive changes in the services that they are using. This means pooling budgets to prevent duplication and maximise people’s power. This has been done in Lambeth, where the council has worked with those on personal budgets to see what services are needed, then acted as a broker, either changing existing services or bringing in new providers.
In government and in our local councils, there is a job to do to join up services to reduce bureaucracy, save money and, most importantly, help those that are currently struggling. Let’s do it by putting more trust in the people that know best: the public.