The twin challenges of quality and funding loom large over the adult social care sector. Age UK has argued that the future sustainability of long term care will require a rise in public spending from 0.5 percent to 0.9% percent of GDP: an extra £2–3 billion a year from 2015.* Andrew Dilnot, chair of a recent commission into the future funding of social care, called the system ‘confusing, unfair and unsustainable’. There is consensus about the need for change in the way we fund, manage and deliver social care. But we do not yet agree about what kind of change is needed, nor what should be the balance of responsibility between individu¬als, families, communities, providers and the state. The agenda is being led by events, and reform agendas in the NHS, local government and beyond are ensuring that the social care policy horizon keeps shifting.
Amidst this shifting set of policies and realities, there has been remarkable consistency around the need for greater personalisation of public services and a bottom-up, integrated approach. Today’s focus on direct payments and personal budgets is part of a long-term transition from institutional to community-based care, and towards the co-design and co-production of services. Now is the right time to ask where this transition takes us next and whether it stops with social care and health.
As Alex Fox shows in this thoughtful paper authored for 2020 Public Services Hub, the personalisation agenda encourages innovation, offering the potential to create new markets around localised and individual needs, to focus fiscal resources directly and discretely, and to enable small groups of individuals to ‘positively disrupt’ a complex and opaque system. These are all developments to be welcomed.
The success of the personalisation agenda in future will depend upon answering some even more fundamental questions about the nature of future supply and demand for public services.
Most crucially, these questions go beyond the capabilities of the individual, and beyond the mechanics of how health and care services are funded. As this paper suggests, this means exploring what the role of families, communities and collaborative groups could be in designing and providing support and creating inclusive communities. It means defining what is needed to catalyse and sustain a much broader market of services that would take personalisation to the next level. It means asking what government, citizens and the market can do to scale pilots and piece-meal change into long term transformational change for the sector.