We are at a critical point in time in the relationship between progressive practitioners and the communities with which they work. This is the first of a series of blogs that will explore the current state of social care, user involvement and participation. This particular blog explores the issue of the cuts and questions the government's approach to assessing the impact that they are having on Local Authorities and relationships with service users.
Last week the Audit Commission published its report, Tough Times (Audit Commission, 2011). The report looks at the impact that the government spending cuts are having on Local Authority spending, in particular on the way in which they are managing those changes. The tone of the report is a complex mix of re-assurance and dire warning. Warnings that are especially pertinent for those Authorities in deprived areas, that are most dependent on central government funding. However, the central message of Tough Times is that most LA’s are managing the changes effectively and are adopting a range of strategies in order to do so. Some of these are intended to prevent the cuts from impacting directly on users. These cut prevention strategies would include the use of reserves or the creation of efficiency savings. However, where direct cuts in services have been inevitable they have been carried out in four ways. The first has been to reduce the volume or amount of a service that is available; the second is to increase charges that are made for the provision of services; the third is to reduce the standard of the service that is being provided and the fourth is to change the eligibility criteria for a service so that less people are able to use it.
Whilst Tough Times recognises that consultation is an integral part of successful service planning, the way in which the impact of these strategies affects service users is glossed over, and is evidently secondary to the principal concern of managing budgets. This is indicative of a number of things. The first is the changed remit of the Audit Commission. The decision of Eric Pickles to abolish the Commission and to curtail any research focused activity has meant that the only language and perspective to count is the language of financial audit and Best Value. In this context the voice of service users is quite simply absent from a document that aspires to ‘audit’ the impact of central government cuts and it is at this point that the perspective of the service user needs to be introduced into the discussion.
When the amount of a service is reduced the effect of that action may well be to balance a budget, but it also has a concrete effect upon the everyday life of the user who receives a reduced level of service. This might be a young person who is attending an out of school activity that allowed them to contribute positively to their community, or it might be the parent of a disabled child who receives less support in the home. Equally, changing the eligibility criteria might seem to be a reasonable thing to do in the tough times in which we live, yet it is a budgetary strategy that will change the lives of the people who are affected by it. By moving the eligibility criteria, Local Authorities are required to make decisions about entitlement to support. These decisions are guided by the way in which the government represents and conceptualises the service user. Currently the fashion of governments of most persuasions is to represent service users as consumers.
What is particularly concerning is that through the employment of a range of representational strategies consumers of government services are then be categorised into the deserving and the undeserving. In this way the exclusion of particular groups of service users can be justified on the grounds that the ‘scarce resource’ has to be saved for those who deserve it most. For example the Early Support projects for families with severely disabled children can be identified as a deserving community although the eligibility for accessing the service will be restricted to those whose children are most severely disabled.
Another consequence in the shift in eligibility criteria will be to increase the gap between the number of families who do not meet the initial criteria for access to services and those who are unable to benefit from access to universal provision. Again to use the example of disabled children we have the difference between getting short breaks through a social care service or childcare through a mainstream childcare provider. It may well be that initially a family with a high functioning child with an Autistic spectrum impairment will be ineligible for social care services because their child is ‘insufficiently’ disabled, yet over time an inability to be able to obtain universal childcare and other community activities such as afterschool clubs, will have a long term negative effect on the family’s everyday functioning and long term resilience.
None of this is apparent in the evidence base provided by the Audit Commission report, which only speaks the language of government. Yet in the long term the lack of the voice of service users, will have consequences. In the end the growing community of people who exist in the gap between universal provision and care services will have to return to their local authority as a consequence of their isolation. Whether it is poverty, ethnicity or disability that marginalises that community, the decision to move the eligibility criteria will simply delay the inevitable.
So how do we move from a situation where the impact of the cuts is measured and described in the language of accountancy, when its real consequences are human and embedded in the context of people’s everyday lives? The government’s approach is that service user’s can be empowered to operate as consumers and in doing so make choices which reward and strengthen successful providers and make them more responsive to the needs of families There are a number of problems with this market based argument, the first is that it presumes choice in a context in which it may or may not be available. In addition to this it fails to deal with those who are excluded from service provision on the grounds that they fail to meet the eligibility criteria. As in the rest of society, competition and choice works for those who have money or who qualify for services, but less so for those who have neither.
It is also in this context that freedom of information and transparency are increasingly being seen by the government as a means of facilitating the operation of the service marketplace. Whilst the government is getting rid of the Audit Commission and replacing it with a requirement for local authorities to commission the audit of their own services; the public are to be the driving force through which the information about the functioning and performance of the marketplace is generated. The Freedom of Information Act is seen as the principle means through which this will be achieved. This may seem theoretically plausible to neo liberals, but even if it works the Nett effect will be to challenge and undermine the relationship between service providers and service users, replacing one that is ideally based upon collaboration with one that is based upon never ending demands for performance outcomes and information.
The danger for all of us who want to make things better for people who are at risk of social exclusion is that rather than focusing our energy upon meeting needs, we end up fighting, gate-keeping and campaigning over the scraps of service provision that are left. Meanwhile David Cameron, Ian Duncan Smith, Andrew Lansbury and Eric Pickles simply look on and smile, all the time extolling the efficiency of a market place that is built on struggle and conflict and part paid for by the generosity of the different ways in which we care.
The answer to this challenge for the progressively minded is not simply to do as we are bidden and dance the dance of the puppet masters, but must lie in a transformation of the relationship between the people who are service providers and those who are service users, so that ultimately in these Tough Times it is not our difference that identifies us - but the mutuality of our care.