Paul Clifford, CEO from FACE Recording & Measurement Systems explains the benefits of Resource Allocations Systems (RAS).
I was not pleased to be informed in 2007 that in the new world of personalisation, a sheet of A4 was all that would be required for needs assessment, and the prediction of resource requirements – especially as we had undergone a rigorous accreditation process to ensure that our tools met national standards for holistic person-centred assessment. We decided to stand by our belief in the value of high quality assessment and to modify our tools to meet the new requirements of personalisation and resource allocation.
Resource allocation systems (RAS) got off to a bad start because they were so intimately bound up with one predetermined ‘solution’ – an InControl-style self assessment. The result was that, rather than first considering the problems a RAS could solve and then looking at possible solutions, councils started off with one of many possible solutions – and tried to wrestle it into a shape that worked. Frustrated at their inability to do so, some retreated from resource allocation systems altogether – still without ever having considered the core problem.
However, the issues that personalisation was intended to address remain. So now is as good a time as any to reconsider resource allocation systems: what are they, do they work and can they help social care move forward?
Modelling the relationship between needs and costs
The fundamental problem that a RAS addresses is the relationship between needs and costs. The strength and predictability of this relationship is an empirical question and there is no guarantee that it is strong enough to predict costs at an individual level. This distinction between individual and population prediction applies in many walks of life: people who are more competent are generally better paid but few would expect to accurately predict an individual’s salary based upon a few questions on skills and experience.
Similarly, there is a strong relationship between lifestyle and health, but insufficient to permit prediction of an individual’s health status. However, a resource allocation system has to be able to provide an accurate indication of the likely costs of an individual service user’s support. The key question is whether this is possible or not.
How can resource allocation systems be used?
As well as providing indicative budgets, resource allocations systems are capable of helping councils address difficult issues. They can help ensure:
- consistency and proportionality of allocation relative to need;
- that local policy decisions regarding such areas as social participation and respite care are accurately reflected in support planning; and
- that overall costs remain within budget.
They also have broader applications, such as outcome measurement and evaluating the cost effectiveness of interventions such as re-ablement and telecare. More fundamentally, they can help councils move towards a single model of allocation that covers all traditional ‘care groups’.
At a broader policy level they can support health and social care integration by ensuring that funds are not ‘doubly-allocated’ across health and social care, and by identifying individuals who may be eligible for continuing care. Whilst at a population level a good RAS supports; the equitable management of health and social resources; demonstrates equity of allocation and can help predict future costs.
This is no small list of applications and it would be a shame if the legacy of political entanglement resulted in failure to consider such benefits. For example, some have partially blamed resource allocation systems for the failure of personalisation, based on the weakness of the ‘£ per points’ methodology advocated by
InControl (Slasberg et al 2012). This ignores wider factors that have slowed personalisation – such as the collapse of the economy and cuts in social care funding.
Personalisation is inevitably bound up with macroeconomic conditions. In times of extreme famine NGO’s give everyone in a starving village 1 bag of food, regardless of personal circumstance. As scarcity recedes, flexibility increases and it is possible to give those in most need a little more. Similar logic must surely apply to social care: so if we don’t evaluate the progress of personalisation in the context of current adverse economic conditions we risk throwing out the baby with the bathwater. In times of scarcity a rigorous approach to allocation becomes even more necessary, to help ensure fair allocation of such resource as there is.
Conclusions
Properly-designed resource allocation systems work and have a potentially important part to play in shaping the future of health and social care and the evolution of personalisation. They help address a central task of social care, that of managing the relationship between needs and costs. As such they are part of the solution to delivering a truly personalised care system.
References
Slasberg, C., Beresford, P. & Schofield, P. (2012) ‘How self directed support is failing to deliver personal budgets and personalisation’,
Research, Policy and Planning 29,(3), pp. 161-177. Clifford P., Saunders R, Gibbon L (2013) Modelling the relationship between needs and costs: how accurate resource allocation can deliver personal budgets and personalisation. Research, Policy and Planning 30,(2), pp 107-120.
Paul Clifford
Research Fellow, School for Social Care Research
Hon. Senior Lecturer
UCL, London
