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Last Updated: Monday, 10 December 2007, 13:33 GMT
A revolution in social care?
By Clare Murphy
BBC News health reporter

Man pushing a wheelchair
It may even be possible to hire your neighbour to help you out
The government has announced what it hails as a revolution in social care.

Money will now be placed directly into the bank accounts of those entitled to help, meaning they can pick and choose both the kind of care they want and who they want to provide it.

So for instance, instead of meals on wheels, an elderly person could - in principle at least - use the money to pay for someone to come in and help with the cooking.

Instead of respite care for a disabled person, the money could be spent on a holiday.

Chris Moon-Willems, who took part in one of the pilot schemes for the new programme, helped her elderly parents to hire their own carers. "We now act as employers," she says.

She is a great supporter of the new system, which she says provides much more freedom and flexibility to those who need support in their homes.

The scheme, Putting People First, will be rolled out across the UK from next April. It will involve an extra 520m on top of the existing social services budget over the next three years, and according to the prime minister, puts "real control into the hands of those in care and their carers".

But concerns have been raised as to who will benefit, and whether it is really wise to place potentially complex decisions into the hands of some of the most vulnerable members of society.

Market forces

There will of course be restrictions on how the money is spent, and safeguards against people dipping into the budget for items one would be hard pressed to describe as care related.

"There's no point in having money in your bank if actually you can't purchase anything
Imelda Redmond
Carers UK

The money is paid into a bank account which is separate from the individual's own current account: under the pilot scheme, every month the local authority received a statement, detailing how the money has been spent.

It must only go on items which have been agreed in a care plan, but this could include anything from membership fees to a local club in place of attending a day centre, or a hotel break instead of respite care.

When it comes to services such as cleaning, cooking or providing personal assistance, those entitled will be able to employ who they wish: while the details have yet to be finalised, it is not unfeasible that a relative or neighbour could be engaged to take on these tasks.

But the idea is also that care agencies will rise to the challenge: offering better value services to the individual in order to claim a piece of the multi-million-pound pie.

Who gets what?

Community and campaigning organisations have broadly welcomed the plan as a well-intentioned step in the right direction. But there are concerns as to how it will actually pan out in practice.

For one, will the services that people need be effectively provided by the market?

"There's no point in having money in your bank," says Imelda Redmond of Carers UK, which represents relatives of those who need care, "if actually you can't purchase anything,"

The other issue is how the decisions will be made.

Lord Victor Adebowale of Turning Point, which provides services to people needing care said that even the most vulnerable people can cope with a degree of complexity when it comes to working out the services they need.

"But they must be given the necessary structures and resources," he stressed.

What role charities and community organisations will play remains somewhat vague.

There has been much talk of their providing advocacy, information and support, but at least one major charity said they had yet to sit down with ministers and work this out.

Not for you

And this is not, in any event, for everybody: the new scheme does not appear to widen the existing social services net.

There are lots of people out there who need lots of care
Brendan Paddy
Age Concern

People already have to undergo assessment as to whether their needs are great enough to warrant help, and there is also strict means testing. Putting People First will only cater for those people currently entitled to funded care.

Campaigners for the vulnerable have long complained that councils are increasingly rationing social care, restricting it to the most needy.

According to one recent report by the Learning Disability Coalition, by next April, three quarters of councils will confine help only to people with "critical" or "substantial" needs.

Brendan Paddy of Age Concern said while this new scheme was welcome, it would not address one of the most critical problems.

"There are lots of people out there who need lots of care," he said. "And at present, many needs are simply not being addressed."

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