Can you imagine a world with potentially far less social workers, psychologists, care staff, and also less government and semi government agencies and NGOs and institutional settings where those with problems are helped or housed? Can you imagine instead carving up all the money we spend (often very badly) on a whole range of social and related services and give a lump sum or a monthly sum of money to people who need it, and let them decide how to spend the money?

This may start to happen soon in the UK after some trials/experiments of a system called Individual Budget Programming. In essence this means that individual people, be they disabled, elderly or with some kind of need, no longer have to knock at so many different doors to get services, often from the government itself. Instead they get the cash that government would have spent on them anyway and let them choose how they budget, how they spend the money, how they prioritise their lives.

We unfortunately still have very condescending attitudes to those who need services.

And sadly most of only realise this when something happens to us or to someone close to us. We often quite patronisingly assess typical clients (instead of letting them tell us what they want and need) and provide a service and people in need have no recourse, no choice and worst of all no flexibility. All agencies departments and authorities are guilty of this, although they would be loath to admit it. At the Housing Authority we have a system of grants for people with disabilities. We proscribe how the money should be spent and the O.T. decides and makes an assessment as to what claimants can have. Sometimes a family with a disabled member want something that is not on our list or disagrees with the O.T. ’s assessment of what is good for them. I have sometimes overruled the O.T. and listened more to the family who surely should be in charge of their own support, and what would make a difference to their life.

One example from the UK was of a mother who had to go to hospital every summer, had to have her children farmed out to various family members etcetera. It turned out that with this system she was able to use the money for her yearly summer hospitalisation to put in an air conditioner and other items in her home so she didn’t have to leave. It cost the government less, it was less traumatic for the whole family, it was more dignified for the disabled mother. But it could only happen because in this trial she had this individual budget which she could spend on her own priorities.

You can imagine something like that happening here? Instead of having old people stuck in hospital costing a daily fortune, what would be the reaction if you gave those older people even half the money they cost in hospital so they could buy their own hotel plus care? Of course our answer is to build more old peoples’ homes, and we seem to have wasted the opportunity that the St Luke’s Hospital site created and will convert that to another big and expensive institution. Yes some people need an institution but if you gave people the money and the choice would this encourage individuals and families to buy in their own support? It is after all very easy to castigate families who do not look after sick, elderly or disabled relatives, but it is a bit silly that the government will pay a fortune for their care if government people provide the service but nothing, or practically nothing, if family members do?

Of course creating jobs in the public sector is popular with many governments, including the two main parties that are now vying to win on 8 March. When you create jobs you often win voter loyalty. This was done spectacularly in 1987 but it happens all the time subtly or not directly or otherwise. There has in fact been an explosion in spending in this area, but we do need to be much more careful about ensuring money in the social sector goes far more to clients and far less to this mushrooming of professionals in the area, however useful they may be. Money is tight and given the choice between developing and funding a system of individual budgets where people have an active say in their own care and support and leaving things as they are, our consciences appeased but disabled people often disempowered is not the modern way.

It will be hard for politicians, professionals and others to let go of the nanny state. But the truth is that it is very costly and does not always deliver choice, quality or cost effectiveness. Giving older people and people with disabilities and other specific needs the financial choice over their own destinies is the way for a basically caring but condescending society like ours to go, if we dare.

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