5.5 Fears and realities
What fears about the introduction of one mechanism for personalisation - self-directed support - have members of the social service workforce expressed? Manthorpe et al. (2011) asked workers about their fears:
It is interesting that, as Jill Manthorpe has pointed out in the same article, the concerns expressed are mainly about the idea of people having control over individual care budgets. She points out that there are many other aspects of personalised services that seem much less controversial to social services staff, such as reducing people’s loneliness and isolation, encouraging inter-generational support and activity, investing in community services, and enabling people to have more personal control. Indeed, it appears that there is wide support for personalisation and the move from a service culture of 'one size fits all' to giving people greater control over their lives (Slasberg et al., 2012) One of the health practitioners involved in a pilot of self-directed support in the NHS in Scotland said:
“...We have our boxes and we fit people into them, we have lost our way. SDS has helped get back to basics...”(Self Directed Support in Scotland, 2012)
In Scotland, UNISON, the major public sector union, has confirmed its support for the principle of independent living and is generally in favour of the Social Care (Self-directed Support) (Scotland) Act and its principles. However, it also says that service users will only have ‘real choice’ if local authorities have enough money to give people to purchase the care that they need. UNISON has raised concerns about the impact of increasing privatisation of social care services on staff wages and terms and conditions:
UNISON believes that cheaper care is often inferior care, based on paying staff lower wages and allowing less time for the service to be provided, in effect a race to the bottom. This is further privatisation of social care staff, often by the back door.(UNISON Scotland, 2012)
Inevitably, perhaps views about the wider introduction of self-directed support in Scotland are divided, with optimism about the impact on service users, carers and practitioners tempered by a mix of concerns about jobs, bureaucracy, resources and possible risks to service users ( see Section 4 ). For example, concerns have been expressed in the voluntary sector that, unless there are sufficient resources to support change, personalising people's support may have a negative impact on pay, morale and conditions for staff (Cunningham and Nickson, 2011).