The latest examples of the NHS copying failed social service experiments are the introduction of personal budgets and NHS trusts looking at becoming social enterprises.

‘Many now see personal budgets as a backdoor way of getting families to top up budgets’

Personal budgets – where the client is given the money to purchase their own services – was first piloted in social services to great effect for people with a physical disability. The problem came when the government insisted that personal budgets should be made available to those over 65.

The number of people was overwhelming. Unlike the people who had a disability, there was no great enthusiasm among older people to take responsibility for organising and purchasing their own care. In a climate of financial austerity people began to realise the money they were allocated was insufficient to meet there needs.

The government’s overambitious targets forced local authorities to introduce watered down versions of the model, so many people had a personal budget in name only; their care package remained the same, they continued to use the same traditional services from the same narrow range of providers, all that was different was that they now had a social work assessment that expressed there needs in financial terms.

While personal budgets were officially promoted as increasing people’s choice and control, many now see them as a backdoor way of getting families to top up budgets.

Acceptable privatisation

Social enterprises were seen as an acceptable way of outsourcing services while avoiding the accusations of privatisation. An in-house social service home care service could become a not for profit organisation in which employees were shareholders. The idea was that staff would share in the success of the organisation, employees would have a greater say in how the business was run and there would not be the huge pay differentials found in the private sector.

Freed from the bureaucracy of local government and with reduced overheads, these organisations could be competitive. Whilevery attractive to labour authorities keen not to be seen privatising social services the idea has not taken off from the small pilots dotted around the country.

‘Governments have a history of imposing what hasn’t quiet worked in one area of the public sector on to another’

The private sector is more competitive. Giving staff more say means they can veto changes to their basic pay, overtime rates, number of payed days holiday or sick pay. If they don’t have these powers and are told that the alternative to changes in pay and conditions is redundancies then they say “how is this different to working in the private sector?” Social enterprises may be more open about decisions but unless they are competitive there is no profit to share out at the end of the year. A modest profit in a small private sector company translates to a new car for the owner and a Caribbean holiday for the senior managers – the same money shared equally between all staff in a social enterprise is a new pair of shoes.

While an NHS trust could become a not for profit organisation it difficult to see how such large, complex organisations could share decision making with all staff or how they could adopt an egalitarian approach to status and pay when the gap between a porter and a consultant is so big.

Successive governments have a history of imposing what hasn’t quiet worked in one area of the public sector on to another in the hope that this time it might just work. What next: local eligibility criteria and rationing?