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    Can blind people cycle?

  • Posted on April 1, 2016 by

    Adult social careYes, according to Daniel Kish. He’s a blind Californian who uses echolocation. He creates a mental map using sound, rather than by sight. With lots of practice, he learnt to ride a bike – on public roads, safely – a feat many regard impossible for the blind.

    There’s tentative evidence that human echolocation is a thing.

    In social care-speak, Daniel Kish is using an asset-based approach. He’s using his strengths (good hearing) to meet his need (blindness). The opposite is a deficit-based approach. This is using outside support to meet a need.

    The asset-based approach underpins personalised commissioning, which aims to support people by growing their strengths to meet their needs.

    Personalised commissioning has a history. This is the struggle of people to get the care they need. Disability campaigners, against a “one size fits all”, institutional model of care, fought for direct payments. The idea of giving social care money to the person in need – for them to spend on their own care – was not the done thing in most of England. In the 90s, however, a handful of local authorities began selectively offering them.

    Recognition of direct payments, and the wider idea of personalised commissioning, grew. In 2007, the Government introduced personal budgets: a sum of money allocated to a person in need. The person in need can manage the budget themselves, with direct payments. Part of the personal budget, or all of it, could be managed by a third party.

    On 3 March, we published our report on personalised commissioning in adult social care. There’s support for personalised commissioning across local government and adult social care. It’s seen as giving meaningful control to people in need. However, the proportions of people receiving a direct payment vary widely across England. People also face different levels of take-up according to their primary support reason. Younger people with physical or learning disabilities are the most likely to have a direct payment, with older people and those with mental health needs the least likely.

    Recent evidence suggests that the way personal budgets are implemented is key to users benefitting. Support should be available when needed, and the budgets should be aligned to their circumstance. This may be difficult given the austerity pressure on care markets. Most people that get personal budgets are satisfied with their care. However, in some local authorities, people with a direct payment service are less satisfied than those with a local authority managed service.

    Although the Government intends personal budgets to be sufficient to meet user’s needs, and account for reasonable preferences, local authorities face pressure to cut spending. We found some authorities that couldn’t afford to raise costs above their authority-commissioned rates. A few had tried new approaches to care markets – sometimes with modest savings. Three quarters of adult social service directors are expecting savings.

    February’s local government finance settlement lets councils raise money for social care via the adult social care council tax precept. However, it may not be enough to alleviate the pressure. For example, costs from the Care Act’s new burdens, and the national living wage, may overtake any savings authorities make with personalised commissioning. Some authorities are already struggling to support their care markets. We saw authorities reducing their numbers of providers; and some providers under financial pressure from potentially unsustainable fee rates.

    Ultimately, some authorities are transforming their care services around personalisation. Others face stiff challenges in the face of financial pressure. We’ll have to wait and see how authorities respond – and if the changes in support help people in need achieve better outcomes.
    Chris Woolley

    About the author: Christopher Woolley is an analyst in the local government team. He’s worked on adult social care studies into the Better Care Fund, Care Act implementation, and personalised commissioning. Chris is a member of the statistics discipline, part of the Methods, Economics and Statistics Hub.



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