Freedom
of choice is a bit like freedom of speech. Most people would agree that both
are fundamental human freedoms and that they are not absolute – in most cases my
freedom (to choose or speak) cannot extend so far that it affects you
adversely. Another quality these freedoms share is that we don’t appreciate
their importance until we are denied them. Let’s focus on the freedom to
choose.
The Freedom to Choose
When
I first went to secondary school aged 11 the only thing that I was interested
in was sport and the sport above all that I was interested in was football. The
academic side of school life held no interest for me. I’d known I was good at
football from about the age of 8. I didn’t know that I was also a very good
cross country runner; principally because I’d never done cross country until I
went to secondary school.
We
played football matches on Wednesday afternoons after school. The team for the
match would be posted on a notice board on the Monday before the match. There
was a football match on Wednesday 21 October 1970 (yes I remember the date).
The team was posted on Monday 19 October. As usual my name was there on the
team sheet. Unusually, this week, there was a second team sheet on the notice
board. It wasn’t a football team sheet: it was a cross country team sheet; I
was in the cross country team, and the race was to be on Wednesday 21 October
1970.
Thus
it was that I was down to play two different sports, on the same day at two different
venues. As far as I was concerned, I would choose to play football. I did
nothing about it merely decided that I would turn up for the football team
(with the hindsight of 45 years that was not a good move on my part). The
football match was to be held at home; the cross country event away at another
school. I went to the school changing room after lessons, got changed and
waited for the team talk before we went out onto the pitch.
I
never got to hear the team talk. The teacher who managed the football team (let’s
call him Mr G) came into the changing room with a teacher (I’ll call him Mr A) I
did not recognise and pointed to me. Mr A told me that the team bus (cross
country team bus) was waiting for me. I explained that I was down to play
football. Mr A was the senior of the two teachers. He pulled rank on Mr G and
that was that.
Even
with the passage of 45 years (that’s almost half a century!) I still recall how
I felt at 3.45 pm on Wednesday 21 October 1970. I was angry that people in
authority had made a mistake and they were angry with me for choosing what I
wanted to do rather than what they wanted me to do.
I
felt impotent. I explained my actions as well as I could. I wanted to play
football. I couldn’t do both. They wouldn’t listen. A third teacher joined them
and all three told me that I had to take part in the cross country event. I
just could not get them to accept that they had presented me with the choices
of two sports and I had chosen the sport I wanted to play.
There
was also a feeling that I had no control over something which I should be in
complete control of. The way I reasoned things at the time is exactly how I
would reason things now. I accepted that there were things in life over which I
had little or no control – I had little choice over the fact that I had to go
to school, for example. However, there were parts of my life over which I should
be sovereign – such voluntary activities as playing for school teams seemed to
fall into the category of activities over which I was sovereign. But my freedom
to choose had been wrested from me and, at the time, this felt pretty unfair.
The Freedom to Choose Your Home Care
Provider
In
the greater scheme of things, the event recounted above is pretty trivial. The
experience I had was trivial: but having
your freedom to choose taken from you is not trivial. What happened to me might
have been a little unfair (no worse than that); however, when it comes to things that matter, having your freedom to
choose denied is the most egregious injustice. Having your freedom to choose your home care provider is
one of those aspects of your life over which it is of fundamental importance
that your freedom is not interfered with.
Home
care, or domiciliary care as it is sometimes referred to, is care provided in
your home. There is no particular pattern that this care has to take. At one
extreme, it could be just one visit a week for one or two hours for someone to
help you around your home. At the other extreme care could be provided by a
live-in carer. The tasks that carers carry out are wide-ranging. In short, most
things short of nursing care can be covered by a home care provider.
Home
care is usually provided by private companies. These companies may provide
services under contract with social services or directly to individual private
clients. The services provided by home care companies allow you to remain
living in your home for as long as you are able. This is arguably one of the most
important (if not the single most important) contributions that home care
providers make to individual people’s lives – and by extension to society in
general.
There
is little doubt that the desire to remain living in their homes and maintaining
as much independence as possible in their lives are two of the most powerful
factors that motivate people to choose domiciliary care. There are choices, of
course: friends and family may provide care and residential care is an option
for some people.
It
is important that people who need care have the option to choose care in their
homes. But their choices have to go beyond that. It is fundamentally important
that people can choose the company that they want to provide their home care. Put
yourself in the shoes of someone choosing home care. The position is very
simple. The care is being provided in your
home. It is absolutely right that you can choose who comes into your home to provide your domiciliary care.
Personalisation
Everybody has a choice when it comes to choosing home care and this
includes people who are funded wholly or in part by social services.
There was a time, and it was not so
long ago, that the providers of domiciliary care took a paternalistic approach
towards their customers. Paternalism means that somebody else knows what’s best
for you. In the context of domiciliary care, it was usually social services who
thought they knew what was best for you. But things have moved on.
Domiciliary care is now guided by the idea of personalisation.
Personalisation is an approach to
domiciliary care that is the exact opposite of paternalism. Personalisation
recognises that you are the person who knows best what is suitable for you when
it comes to choosing domiciliary care.
Therefore, personalisation places
you at the centre of everything that happens with regard to your care. It’s all
about your independence to choose. Control is handed over to you to be able to
choose what type of care you want, who you want to provide that care for you
and when you want it provided to you.
Personal Budgets
Of course, the obvious question is
how you can have this independence, control and choice over your care if social
services are paying partly or in full for your home care? And this is where
personal budgets come in. A personal budget is a sum of money that is given to you to pay for
the care that you need to meet your eligible needs
If you are found to have eligible needs following a community care
assessment and qualify to have all or some of those needs met by social
services you will be offered a personal budget.
Your personal budget can be held by you or by a friend or relative on your
behalf. It is also possible for a care provider to administer the budget for
you. In some cases, you may want the local authority to administer your
personal budget.
Direct Payments
Once you have been awarded a personal budget, you should also be offered an
opportunity to receive this in the form of a direct payment. Direct payments
work in a very straightforward way. Kent County Council pay an amount of money
into your bank account or onto a Kent Card. The Kent Card is a Visa debit card
and you can find out more details here. You then use this money to buy your care from a
provider of your choice.
Direct
payments put you in charge. You are able to choose the company who provides
your home care. I said at the start that the freedom to choose is something
that we do not realise how important it is until we do not have it. Personal
budgets and direct payments have returned to many people a fundamental freedom
that had been absent.
Garry Costain is the Managing Director of
Caremark Thanet, a domiciliary care provider with offices in Margate, Kent.
Caremark Thanet provides home care services throughout the Isle of Thanet.
Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk.
You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.
