Personal budgets and paternalism
by Claudia Wood
Personal budgets are one of the most revolutionary developments in the reform of social care. They have turned passive recipients into active ‘care consumers’, wielding the power of the purse over shoddy providers and picking and choosing what they want to fit their needs. In the process, thousands of people have seen their lives improved immeasurably, including many working age adults leaving care home settings and living independently in their communities.
More recently, however, various criticisms have been levelled at their implementation, with some suggesting the target for personal budget take up should be scrapped in order to concentrate on the wider concept of personalisation. However, the only aspect of personal budgets which comes in for mainstream public criticism is the freedom with which they can be spent.
Stories of people spending their personal budget on football tickets, or worse, a trip to Amsterdam’s brothels, has generated a tabloid splash every few months – so much so that the Telegraph’s story on the recent care White Paper chose to focus on the (wholly expected) roll out of personal budgets as the big issue – ‘despite concerns that they can lead to money being spent on the wrong things’.
In reality, personal budget spending is highly regulated – it has to be agreed in advance, based on a care plan, and then is audited (with people having to provide bank statements and receipts) to ensure it is being spent according to that plan. The media stories mentioned above weren’t cases of an individual’s unauthorised misspending – they were cases of social workers believing personal budgets could be spent in a way which journalists didn’t agree with.
The fundamentally subjective judgement being made in the tabloid press, regarding spending on ‘the wrong things’, will, I believe, become an increasingly political issue by the end of this Parliament which could threaten the foundations of the current government.
First of all, personal budgets are now being introduced in health, children’s services and housing support. Questions regarding the level of oversight and control appropriate for each of these have yet to be fully explored, and one can foresee the inevitable discussion: should we allow personal health budgets to be used to buy aromatherapy or holistic medicine? If the person awarding the health budget thinks such practices are hokum, but the person with a terminal illness is convinced it alleviates their symptoms, who has the final say? Do we value the health outcome, or the process of being able to make one’s own choices (even if we think them wrong)?
Second, more controversially, is the direction of this government’s welfare reform agenda. We have already seen caps on the total amount of benefits a family can receive, and time limitations and increased conditionality on particular benefits. With the advent of Universal Credit, the temptation to discuss what people should spend their single payment on becomes greater – it is another form of conditionality.
With this begins the slippery slope of paternalism – and it is very slippery. We might start out with the liberal intention of preventing spending on alcohol or betting, but the temptation to incentivise healthy behaviours and prevent unhealthy ones can lead to a highly prescriptive list of the ‘right things’. Public health concerns can quickly become moral and behavioural judgements that we have already witnessed with ‘troubled families’.
Just last week, I was able to get a room full of disabled people using personal budgets to agree that feckless parents should be given their child benefit in £10 daily sums, to stop them from spending it on inappropriate things. Would they want the same level of control applied to their personal budgets, even though the case for guarding against financial abuse by carers and safeguarding was much greater? Of course not.
In the US, state assistance is provided in the form of food stamps – which, depending on the State, restricts certain ‘non-nutritional’ purchases. They also use pre-paid cards for unemployment benefits – downloaded with funds and set to work in some shops but not others.
These cards are already being used in some local authorities in the UK for personal budgets, for the very valid safeguarding and monitoring reasons outlined above. They have massively cut down on the auditing paperwork required. But what if they were used for benefits, and other personal budget payments? An integrated pot of money would be the upside, but the option to monitor, incentivise, or control it, even – becomes a real prospect.
Currently, Child Benefit doesn’t have to be spent on one’s children. Should we make sure it is? Should we stop the funds from buying junk food, and give discounts for fruit and veg? This may sound sensible at first, but where do we draw the line?
This is dangerous and fundamentally ideological territory. It gets to the root of liberal and conservative differences regarding individual responsibility and the use of state resources. If the government is to tackle these issues – as it must in the wake of universal credits and the advances in payment technology – it cannot simply take the temperature of the public. It must look hard within its own ranks and find a position that will not split it in two. And this may be easier said than done.
For more information please email email@example.com