Considered in Grand Committee
My Lords, in 2011 an order was passed by noble Lords under the Deregulation and Contracting Out Act 1994 to allow local authorities taking part in two pilot schemes to contract out to outside organisations certain adult social service functions. The order under discussion today amends the original order to allow local authorities to continue this contracting out activity in respect of the pilot programmes beyond the period provided by the original order. The pilots are, first, adult social work practices pilots and, secondly, Right to Control pilots.
The social work practice pilots are testing various models of social worker-led organisations undertaking adult social care functions for which local authorities are currently statutorily responsible. The Right to Control pilots are testing the rights of disabled people to manage some of the state support they receive to live their daily lives. As these are established pilots, I will briefly outline each pilot programme before describing the rationale behind the extensions.
The social work practice pilots were announced in 2010 and the programme has been running for more than a year. The scheme has seen the creation of seven social worker-led organisations that discharge the functions of the local authority in providing adult social care services. On a day-to-day basis, the pilots are independent of the local authority but work closely with it and in partnership with other providers. The local authority pays for the services but maintains its strategic and corporate responsibilities through its contract with the social work practices. We are looking at the pilot sites to test the potential benefits of the social work practices, and whether the innovative approaches improve outcomes and experiences for the people who use them.
The programme aims to bring people who need health and care support closer to those who provide the services they need by reducing bureaucracy, encouraging innovation and increasing the personalisation of services. The Department of Health has provided funding of £1.1 million to help the pilots get up and running and to provide initial support. The pilots are an opportunity to test different models to see what works well. They will be fully evaluated throughout the pilot period, with the final report planned for winter 2013. In considering the need to extend the pilots we listened to the advice of the social work practice working group, which incorporates the sites themselves, and representatives from ADASS, SCIE, the Department of Health and the independent evaluators.
There are two main reasons why we seek an extension to the social work practice pilots from their planned end in summer 2013 to 31 March 2014. First, it has taken longer than we anticipated for many of the sites to become established and begin providing services. This point was highlighted in the recent interim report on the pilots published by SCIE. The proposed extension will ensure that the pilot sites have an increased opportunity to feed into the independent evaluation planned to report in winter 2013.
Secondly, my department must own up to the fact that, in planning the scheme, it did not take into consideration that there would be a gap between the pilots ending and the evaluation reporting. Therefore, extending the pilots to 31 March 2014 will ensure that no pilots will need to end before the evaluation has reported, and that users will continue to be able to access the service. The local authority in each pilot area will have the final say on whether sites are extended. This order creates the opportunity to do so.
The Right to Control, introduced by the previous Government in the Welfare Reform Act 2009 and launched in 2010, gives disabled adults greater choice and control over certain state support they receive to meet their individual needs and ambitions. Disabled adults in the pilot areas are able to combine the support they receive from six different funding sources and then decide how best to spend this to meet their needs. The pilot is due to end in December this year and my honourable friend the Minister for Disabled People intends to extend the pilots by a further 12 months to gain more evidence of the benefits during the pilot programme. A public consultation seeking views on the plans to extend the Right to Control pilot ended on 21 September and among those who commented there was solid support for the extension for a further 12 months.
The Right to Control pilots are being tested in seven trail-blazing areas in England. These trail-blazers, funded by the Department for Work and Pensions, are testing the best ways to implement the right and the results will be used to inform decisions about options on the right in future. Since Right to Control was introduced in 2010, a great deal of progress has been made and over 34,000 people have benefited from it. The interim evaluation of the pilot scheme concluded that there was insufficient evidence on which to make an informed decision about the long-term future of Right to Control. The Government concluded therefore that the best solution was to extend the pilot scheme by a further 12 months to enable us to gather more evidence of what works best, both for disabled people and for the local authorities delivering the Right to Control.
One of the authorities delivering the Right to Control has also been testing delegation of its statutory duty to review social care assessments to third parties, such as user-led organisations. Disabled people have often told us that having their support arrangements reviewed by fellow service users leads to greater satisfaction with the outcome and that the support of their peers gives them greater confidence to request a direct payment and to take control of their own support arrangements. The proposed extension will allow the trail-blazers to continue to test the delegation of this statutory duty. In conclusion, we see the proposed extension in the order as a continued commitment to the developing world of personalisation and one that fully supports the aims set out in the recent care and support White Paper and draft Bill.
This order has the support of councils and their representatives, as well as service users and their carers. It will allow the continuation of new and innovative ways of working to the benefit of individuals and their communities as a whole. More importantly, it will also maximise the evidence and outcomes available to the independent evaluation in both programmes. I commend the order to the House.
My Lords, I thank the noble Earl, Lord Howe, for his full explanation of the order before us this afternoon. I find the contents to be unexceptional and it is right to avoid a hiatus in the pilots’ evaluation. The people affected should not have to go back to an old system before knowing whether the Government have decided that they should be extended, so the logic of the order is clear. I will ask the Minister about a couple of points. He mentioned evaluation. In relation to the trail-blazers pilots, he referred to the interim evaluation which, as he said, found the Right to Control had not been extended to a sufficient number of people to provide evidence to inform a decision about the future of the Right to Control approach. Will he say more about the emerging findings as to the impact on disabled people? He made a few comments about that and suggested that the signs so far are encouraging, with some positive outcomes. Could I tempt him into explaining a little more to the Committee?
I also ask the Minister about potential links between the Right to Control trail-blazers and initiatives taking place on public health. Following the debate when the order was first brought before your Lordships’ House in 2011, the noble Earl wrote to Members who had spoken to the order to say that the Right to Control trail-blazer pilot was intended to be run simultaneously with the public health budget pilots. In particular, he mentioned Manchester, where he said that there was one in-depth public health budget site—Manchester—alongside a Right to Control trail-blazer site. I wonder whether he could report anything on that. I also ask the noble Earl what feedback there has been from users of the service on Right to Control pilots.
On the adult social work practice pilots, I understand that the evaluation has been carried out by King’s College London. I have yet to track down any KCL publication on any emerging findings from those pilots. Perhaps the noble Earl could confirm whether anything has been published so far. I understand, however, that the Department for Education has published an evaluation report by King’s College London and the University of Central Lancashire on the original pilots for children and young people in care, in September 2012. That might be of interest in comparing those pilots with the pilots that are now being undertaken. That evaluation, I understand, found mixed views as to whether the pilots performed better than their local authority counterparts, or whether they represented good value for money. Would the noble Earl be prepared to comment on that? Overall, though, we of course support the extension of the pilots.
My Lords, I very much welcome the extension of these pilots. I am not quite sure why the order has to come back to the House; that seems rather strange.
I say that I welcome the extension as somebody who has been consistently critical of the premature way in which the previous Government seized upon the then interim findings of the IBSEN report into personal budgets for social care and proceeded to extend that away from the original client group on the flimsiest of evidence. I am therefore extremely pleased that the present Government are going to take a lot more time and care over these pilots. A lot is changing. A great deal has changed since 2009 when these pilots began, but there is massive, rapid and in-depth change going on in social care. I was talking the other week to a colleague who works for a major national charity and who has done some forward projections of the funding of services of some of the organisations with which she works. Believe me, if people are worried about the American economy and the cliff edge that it is coming to, they really ought to look at voluntary sector funding for the next two years. That is important and relevant, because many of the generic sources of advice to which people in need of social care go are currently under threat. In addition, health and well-being boards are in the process of being set up. That is a major change in the health and social care landscape in which these pilots are taking place. It would be advantageous if the Government were to extend, at least until 2014, its analysis of how these are working.
I will ask the Minister a number of questions on two different schemes. On the social work practice pilots, will the range of analysis go beyond the service provided to individual clients within the pilot period? Will it be a wider analysis which looks at matters such as training of staff and continuity of information provided back to the local authority from the practitioners who are doing the front-line assessments? As part of that, will there be a control group of local authorities to which those local authorities in the pilot group are compared and contrasted?
On the Right to Control pilots, I was very pleased that the Minister made it absolutely clear that these pilots will work with adults with physical disabilities. These people’s needs are very different from those of a number of other social care clients. That is a key factor which was overlooked in the IBSEN pilots. Differences include the fact that user-led organisations—I presume from what the noble Lord said that he is using the definition of a user-led organisation produced by the Department of Health in, I think, 2008—have at least 40% of their boards made up of users. That is a model that is very prevalent within the world of physical disability; it is not so extensive within other client groups and that makes a distinct difference. Will there be a number of local authorities which are not members of pilots to act as controls in the analysis? My fundamental concern is that at a time of great structural change in the health service and in social care it is not just about the ability to meet the needs of service users who present in the here and now, but about the capacity of local authorities to assess future needs and to think and plan strategically to meet the future needs of people with disabilities. Will that kind of information be drawn from these assessments? That is important.
My Lords, I apologise for my late arrival at this debate; I had my calendar wrongly set. I thought that this session began at 3.30 pm. Eighteen months ago I sat where my noble friend now sits. I was then the junior health spokesman for the Opposition and he, of course, is the spokesman for the Opposition. I raised some queries at that time about the pilots while welcoming the principle. Indeed, I entirely endorse what my noble friend has said in continuing to support the concept of the pilots. Some of those questions touched on the point made or implied by the noble Baroness, Lady Barker, in relation to the changing landscape of the health service, with which we are all too familiar. The question now arises of what impact, if any, those changes have for the operation of these pilots. Will they, for example, now come within the remit of the health and well-being boards’ assessment of the joint strategic needs? Will the role of commissioning groups now be embedded in the process? Previously, of course, the PCT would have had responsibility for the health input into these arrangements. The PCTs are virtually defunct and will be over the cliff edge to which the noble Baroness referred very shortly.
I think that I also raised evaluation on the previous occasion. The document that we then considered said that the trail-blazers,
“will evaluate the best ways to implement the Right to Control”,
in relation to that aspect. The question arises as to whether that evaluation, while obviously being sensible for the trail-blazers to undertake, will be the only evaluation? Will there be a collective evaluation of the experience nationally? Will local authority health scrutiny committees be encouraged to report—I suppose that they could in any event, of their own volition—on what is happening locally in order to feed back to the department on progress? It would help to know something about that.
One other aspect of the landscape has of course changed dramatically in the past year. We now have a situation in which local authorities—social services authorities—face dramatic reductions in their budgets. My own authority, Newcastle, will have to find, over the next three years, £90 million a year, which is just over a third of its current budget. Similar positions will be found no doubt in many other social services authorities up and down the country. For all the good intentions of this pilot, it does not seem possible that these new approaches can necessarily be financed to the degree that was originally intended. Does the Minister have any thoughts about the financial position?
The noble Baroness talked about funding the voluntary sector. However, the voluntary sector will also inevitably suffer from cuts across a range of services that the sector has helped to provide, sometimes in very innovative and useful ways. Although I welcome the extension—it is obviously a sensible move—there are clearly question marks about some of the details of the operation, particularly about how this project will stand in the context of the very significant cuts, from which it will be impossible to shield all the social services provision that local authorities would wish to make.
My Lords, I am grateful to all noble Lords who have spoken. In particular, I thank the noble Lord, Lord Hunt, for his welcome of the order and its content. I shall do my best to answer as many questions as I can and follow up those I am not able to answer in writing, copying to all speakers.
I begin with the trail-blazers and the Right to Control, which is where the noble Lord, Lord Hunt, began. He asked in particular about the evaluation of the programme. The interim evaluation was published in February this year and showed that disabled people are benefiting but that there is simply not enough evidence to make a decision on wider rollout. Clearly, an extension of the kind that we seek will give us more evidence. The early signs are positive but that does not provide the basis for a robust decision on permanent arrangements.
The noble Lord asked about the trail-blazer programme in Manchester and its link to public health. Officials in the Department for Work and Pensions and in my own department are working closely to ensure that the lessons from both pilots are gathered and shared. If I can provide him with any further information on that I would be happy to do so in writing. In general, we expect that the extension will provide further management information and case studies that can illustrate the potential efficiencies and the difference that the Right to Control has made to disabled people. We will also be able to capture more lessons learnt during the extension period.
The noble Baroness, Lady Barker, asked about having a control group against which to compare the results from trail-blazers. I will write to her on that point also. However, the main source of evidence will be from the service users themselves, some of whom will have experienced care under normal arrangements. It is on their feedback on the benefits that they see from the Right to Control that we will take decisions.
Turning to the social work practice pilots, the interim report was published on 2 November this year and is available on the Social Care Institute for Excellence website for all to see. It is perhaps worth outlining what we hope success will look like under these pilots: better quality of service; greater work satisfaction for staff; greater satisfaction for service users and their carers through better outcomes; greater community involvement on the part of service users, both individually and through partnership with user-led organisations; greater community cohesion through more joined-up services, because we see the SWP acting as a catalyst to encourage wider partnerships within a locality; more opportunities for volunteering; less bureaucracy and greater efficiency in systems and procedures; and integration of services. If we can capture all those benefits, the pilots will have proved their worth.
On the evaluation of SWP, the social care workforce research unit at King’s College London is independently evaluating the programme for the department. The evaluation is making good progress, with interviews with practitioners almost completed. To date, 47 participants have been interviewed from across the seven sites, including: leads from host local authorities, managers, social workers and other staff in pilots; consultants employed to assist the development of pilots; and local NHS and voluntary sector stakeholder organisation representatives. The next steps include collating evidence on user outcomes and satisfaction and data on finance processes of the SWPs. As I have already said, the final evaluation report is due to be completed towards the end of next year.
The noble Baroness, Lady Barker, asked me whether the evaluation of SWP would extend beyond the range of services that are normally encompassed. Certainly, the evaluation will also cover the effect of SWP on social workers and other practitioners, as well as on users and carers, and how the features of SWP differ from the usual practice control group. Again, if I can elaborate on that in writing, I will.
The noble Baroness also asked about other local authority services. Access to these is agreed between the local authority and the SWP as part of their contract. The SWP’s budget will reflect a proportionate transfer of funding, including corporate costs, so the SWP will be expected to make its own arrangements for support services and placements. It may also make arrangements to access those specialist services that the local authority may provide that have not been included in the funding transfer—for example, sensory impairment or HIV/AIDs—and this type of arrangement would be set out in the contract.
The noble Lord, Lord Beecham, asked about the relationship with the local authority particularly in the “new world” as we are moving to health and well-being boards. In general, both now and into the future, the local authority needs to maintain a close relationship with the SWP as it retains ultimate responsibility for the services delivered and the actions taken by the SWP, but it also needs to allow the SWP scope to innovate and make decisions about the best packages of support and services for the people in the SWP, and how to provide these. We expect the local authority to monitor the outcomes of the SWP, identifying issues early and providing support, while allowing the SWP sufficient autonomy to decide how best to meet the needs of the people with whom it works. It could well be that in many cases it will be appropriate for the SWP to engage with the emerging clinical commissioning groups to ensure that both health and social care provided to service users is joined up. We would certainly expect that to take place in appropriate instances.
The noble Baroness, Lady Barker, and the noble Lord, Lord Hunt, referred to the children’s pilots. We have noted the experience of the children’s SWPs and will take into account the learning from these pilots. However, adult SWPs are very different from the children’s version and as such should not be viewed in the same light. Adults’ services have worked in a mixed economy for a longer period and to a greater extent. Additionally, we have our own independent evaluation yet to report, so by not extending the pilots until this has been received would be at odds with transparent and evidence-based policy-making.
I should also have said in answer to the noble Lord, Lord Beecham, that health and well-being boards will oversee the health and support provided in their locality and the SWP is one way of providing the services agreed by them. But perhaps I may follow up the question of finance in writing after this debate.