Is now the right time for Individual Service Funds?
It was a pleasure to help draft the Individual Service Fund (ISF) guidance for TLAP, and a welcome source of income at a time when most of my work was focused on voluntary campaigning. It was also a thought-provoking process, one that forced me to question some of my own work over the past 25 years.
I invented ISFs at Inclusion Glasgow in 1996. I set up the organisation primarily to help people with learning difficulties escape from an institution - Lennox Castle Hospital. I was frustrated by the kind of group home services that dominated 'community care', I wanted to show that people could have their own homes, their own support and their own budgets. At this time direct payments was not technically possible, and for many folk it is still hard to see how direct payments really work. But I could see no reason why people couldn't have their own budget, which we could protect. For better or worse I called this budget an Individual Service Fund.
This model of working - where we individualised everything - continues to be effective [http://bit.ly/IndividualServiceFunds] but very few organisations are working in this way. This is all the more surprising because the idea of provider managed personal budgets was a big part of the In Control model of self-directed support which led to the personalisation policy in England. However, despite all the official support for the idea, it has not flourished. Official figures suggest that only 1% of personal budgets are managed using ISFs, and on closer inspection, many of these ISFs look prescriptive and bureaucratic.
Part of the problem seems to be that focusing on the ISF is misleading. The ISF was only a tool that we used to offer people much more flexible support. In fact thinking about what the best organisations are really doing when they use ISFs I have come to think that it would be much better to encourage people to focus on the idea of flexible support instead of focusing on the rather technical concept of the ISF.
Few organisations really offer flexible support, and it far too early to treat the idea of flexible support as some kind of simplistic template for organisational design; however there are certain objectives that any good support providers should want to achieve, that help move us in the right direction:
- Accountability - People should know that we work for them - they are the boss. If they want to walk away then they can, and they can take their budget with them.
- Individualisation - People should be able to tailor their own support to their own needs. Good support is a relationship and we should help people find the right personal assistants for them.
- Creativity - People should be able to use their budgets flexibly and creatively. Together we can discover much better ways to use the budget and get the best possible life.
- Partnership - People should be able to share decision-making. Many people can take on some elements of managing their own support and budget, getting the right balance for themselves.
- Citizenship - People should be as powerful as possible. Often people get stronger as they start to organise, connect and share experiences with others in the same situation.
19 years later I am still not sure whether now is the time these ideas will finally take off. However I do think that many people would benefit if they did - especially many families, people with learning difficulties, people with mental health problems and people with dementia. What people need is not a boss, but a partner, someone who can work flexibly to support them in their community life. ISFs and flexible support are a powerful way to achieve this partnership.
However, when I asked councils why flexible support was not available there was a regular theme that came back: 'We don't trust providers.'
This is an extraordinary state of affairs. Since the 1980s councils have progressively contracted out nearly all social care, yet some councils don't seem to trust the organisations they fund. No wonder these organisations don't work flexibly. And this is a vicious circle. If we start by not trusting someone then we do not build trust, we destroy it - and typically we encourage the very negative behaviours that justify our lack of trust.
The only way out of this trap is to just try trust - to look for opportunities to shift contracting away from a culture of bureaucratic control and regulation and towards flexible support. This is possible, for recent award-winning work in Southwark has demonstrated that councils can work differently with community organisations, to improve outcomes and reduce costs. [http://bit.ly/BetterLives] But it still requires a radical shift in thinking and taking a risk that few have felt able to take.
As the financial crisis in social care grows ever greater, it is likely that many places will increasingly fall back on the old practices of financial control and tighter management to try and make ends meet. However, perhaps we will also begin to see some places embrace trust and liberate community organisations to work in partnership with people and families. If so the time of ISFs may have finally arrived.