A Guest Blog from David Boyle: TOWARDS A CHOICE TO GIVE BACK

[Sarah Lyall]

TOWARDS A CHOICE TO GIVE BACK

 

There is a famous story about a doctor’s surgery with a hedge outside.  I have never discovered where it actually is, but it tells us an important story about the future of choice.

 

The hedge is trimmed once a year in the summer and, when it is trimmed, all these rejected prescriptions fall out.  Patients come out of the door with a prescription they don’t real

ly want and shove it in the hedge. 

 

They are rejected because doctors and patients weren’t able to communicate properly about what was needed and what was wanted.  It is about choice, in other words – but a new kind of broader choice for public services than a narrow concentration on competition.

 

That hedge is a symbol, for me, of the waste in the system when it’s too inflexible, when people don’t get the choices they need – and when they struggle with the mismatch between how the system thinks they should be and how they actually are.

 

For the last six months, and not without getting up early in the mornings to catch trains, I have been conducting the government’s independent Barriers to Choice Review. http://www.cabinetoffice.gov.uk/news/boyle-review-calls-more-choice...

 I have met and talked to a very large number of people involved in schools, healthcare, social care and other services.

 

One of the consistent themes for me has been the transformational power of some of the co-production projects I have met, from Local Area Co-ordination to Turning Point’s Connected Care.  Two of my ten recommendations reflect that, and here they are:

 

Recommendation 4: Replace the current entitlement to an ‘assessment of needs for care and support’ with an entitlement to an asset-based assessment. This would take into account someone’s capabilities as well as their needs and the various informal and community resources available to them, rather than assuming that formal services are the only solution to support needs.

 

This is intended to bring some of the success of Local Area Co-ordination, now being tested impressively in Middlesborough, Derby and other places, to social care assessment.  It means that social care assessment – which is notoriously fraught and formulaic – should be opened up with a much broader and more human assessment, designed to identify assets and informal resources as well as needs, and to avoid the need for formal care packages where possible.

 

It means using the resources that exist in what co-production practitioners call (thanks to Edgar Cahn and Elinor Ostrom) the ‘core economy’ to keep people focused on living the lives they want.

 

The other recommendation is:

 

Recommendation 8: Pilot training for volunteers and mentors in ten existing peer support programmes, mainly but not exclusively in health settings. Evaluation should be carried out over a two year period to examine how well choice, option and navigation support can be provided in that way and the impact that has – with a view to providing peer support much more widely in public services.

 

The review identified the need that people have, especially disadvantaged people – not just for information about choices, though that can be problematic too, but for face to face advice.  They get around eight minutes from the doctor, some support from the social worker doing their social care assessment, but otherwise very little.

 

I don’t believe there is any appetite, or budget, to insert a new layer of professionals into an already complex system.  So what I’ve proposed is to pilot an extension to existing schemes providing peer support from volunteers, so that they’re trained up to provide navigation support – to help people make decisions, find their way around the system, maybe just help them with the internet.

 

During the last six months, I have seen the ways that informal support, provided by other service users, can transform people’s experience – from time banks to the 17,000 volunteer ‘health champions’ across Yorkshire.  It has the potential to do the same for choice.

 

What you find when you talk to people about choice in detail is that the kind of choices they think they are getting are often not what they’re actually being offered. 

 

They want the choice of a consultant who won’t mind them asking lots of questions.  Or to study Spanish at A level when all that prevents them is their school’s timetabling system.  Or to go to bed later than 5 o’clock when their carer comes round. 

 

Basic flexibilities in the system which articulate people can get by being pushy, but which others can’t.

 

This is a broader agenda for choice than just competition – to give people more authority in the system at least to ask if their specific needs can be accommodated.  That is what my recommendations are designed to achieve.

 

I hope this review can make a difference now, but also in the future, by shifting the debate about choice so that it is much broader than just about competition – and much broader than just a choice of provider. 

 

This is what I said at the launch of the report this morning. http://barrierschoicereview.blogspot.co.uk/2013/01/barriers-to-choi...

 

David Boyle has been the independent reviewer for the government’s Barriers to Choice Review.