Author: Simon Duffy
People need Tapered Control, different levels of control, depending upon their needs and circumstances. A system of Tapered Control was developed along with Individual Budgets and Self-Directed Support, in order to give people the right kind of control for them.
In the UK, aside from the benefit system, public services have almost always been delivered through publicly controlled professional services. Only since the 1990's has government started to provide services through other organisations and individuals and only since the 1996 Direct Payments Act has it been clearly legal to provide a service by providing an individual with the direct funding to purchase support for themselves. The very limited and relatively recent nature of these reforms may explain why there is often confusion about the different kinds of control options that should be available.
One of the most basic misunderstandings of personalisation has been to assume that it also requires the individual citizen to take full control of their Individual Budget, to employ their own support staff or take other extreme degrees of control over their own lives. This is not true and to take this view would be to build a degree of unnecessary inflexibility into the system.
In fact increased personalisation demands tapered control - different degrees of control to allow for different situations and different individual needs:
- Direct Payments - this is a citizen controlling their own funding directly as cash.
- Indirect Payments - this is where a trusted representative controls the budgets as cash.
- Individual Trusts - this is a legal body set up to manage funds for someone on their behalf, particularly useful if someone is going to lack capacity to manage funding for themselves for an extended period of time.
- Community Brokerage - this is where a community organisation manages someone’s budget on their behalf, brokering services or providing cash as required.
- Individual Service Fund - this is where a support service manages someone’s budget for them. Often this is done by treating that funding as ‘restricted’ and managing it subject to clear rules - this an approach which can be used by statutory services themselves.
- Professionally Managed Fund - this is where people choose to have their fund managed by a care manager or lead professional, who can commission suitable support for the citizen (as discussed above).
These systems of control do not need to remain static. For instance it is possible for people with fluctuating conditions to use ‘living wills’ to shift control dynamically as their condition changes. It is also possible for the lead professional to determine that a particular system is no longer working and to shift control to a different point. However public services often further complicate the questions of control and co-production because those services are themselves complex and people often find they need a number of different kinds of support, entitlement or service. This is particularly true for people with mental health needs who very often receive many different forms of support from some or all of the following:
- National Health Service
- Local authorities social care - family or adult services
- Tax-benefit systems
- Employment support systems
- Housing systems
On of the critical areas of confusion around Tapered Control is the rather confused approach to mental capacity in England. Although the basic law is built upon sound principles - in particular the assumption of capacity for all - the implementation of supports and systems around people is not consistent. Social services, health, benefits and the courts all use different approaches which makes support for people who need some form of appropriate representation unduly complex.
The publisher is the Centre for Welfare Reform.
Tapered Control © Simon Duffy 2011.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.