U-turn on social care targets
by Claudia Wood
The Coalition Government says it is in favour of decentralised services and against top-down management. So why is it introducing heavily prescriptive targets in the field of social care?
Seven years ago, I wrote a report on public sector targets. I discussed what made a good and a poor target, how they needed to be realistic, but aspirational, and focus only on the most important issues for each department. This was at a time when there were 110 Public Service Agreements across all government departments, underpinned by 1300 smaller targets. Who would have thought that PSAs would be scrapped just two years later, with the government keeping just 30 central priorities?
These were then swiftly replaced by departmental business plans by the new Government, leaving just a handful of national targets in place – such as the target to end child poverty by 2020.
As the Coalition Government has ushered in a new era of locally devolved responsibility and professional discretion, only such big headline targets – about the wellbeing of the nation – seem appropriate. Old-style micro targets – telling each department exactly what teachers, doctors and probation officers had to achieve, how, and by when – seem a terribly outdated style of top-down governance.
It is incongruous, then, that within social care, the Government has introduced two new targets very much from the old PSA mould.
The first is the adoption target – more a target regime, to include a score card and a number of performance indicators to ensure local authorities place children with adoptive parents as quickly as possible. Whilst the ambition – to speed up adoption of children in care – is laudable, the target is vulnerable to the flaws of a poorly thought through PSA from the early 2000s.
Adoption is a highly complex and delicate process, with many different stakeholders playing a part. To boil this down to one objective – speed – and laying this at the feet of just one stakeholder – local authority social workers – may encourage corner cutting, and create perverse incentives, such as placing children in inappropriate placements to meet the target, or not trying to adopt difficult to place children, as social workers are unable to tackle delays in other parts of the system – such as family courts.
The second requires 100 per cent take up of personal budgets in adult social care by 2013. This has been the subject of much debate recently after ADASS questioned the target's value in achieving personalisation. Again, this is another classic PSA style mistake – setting a target for a process (take up of personal budgets) rather than an outcome (personalisation).
Personal budgets do not guarantee personalisation – the fact that two thirds of last year's increase in personal budgets were 'managed budgets' (where control stays with the local authority and a person is told they have a 'virtual' budget) could suggest that the meeting of the target has become a box ticking exercise rather than a sincere attempt to achieve personalisation for all care users. As many point out, personal budgets are just one (albeit effective) way of achieving personalisation, but the two are not the same thing.
So is the Government backtracking on its commitment to end top down direction in public services? The Adoption Action Plan explains:
"The Government does not believe in managing the performance of local authorities from the centre by reference to a large and comprehensive set of targets and indicators. However, where necessary, we continue to take action ourselves to ensure adequate services are provided to the vulnerable."
This sends a damaging message – 'we trust local and professional discretion, but only so far. If vulnerable people are involved, we'll keep an iron grip'. The concept of 'vulnerable' could expand to include all sorts of public service users, but it's clear that social work may well be first in line for any new targets the government introduces.
We must admit targets are an important way of achieving rapid progress (as with PB take up), or a way of focusing everyone's attention on critical issues (as with child poverty). But poorly designed targets can do more harm than good. The question is, will this Government be tempted back to further central direction wherever they become frustrated with progress in health and social care? And, if they do, will they learn from the mistakes of the micro-managing bureaucracy and perverse incentives created by the PSA regime?