“Well, you wouldn’t want your GP giving you a triple bypass.”
So said a colleague of mine at a recent conference for Autism Professionals – we were discussing personalisation and the need for autism specialist support.
Her point was a straightforward one – that people on the autism spectrum are best supported when their staff understand autism and specifically how it impacts (often in a unique way) on that individual’s life. No problems there then – until our discussions turned to trends in current commissioning that appear to support neither individual choice or the role of specialist providers.
What could be termed a “genericism” is creeping into the national picture of commissioning.
Whilst individuals and families who can manage personal budgets may have a wide range of choice, those who rely on local authorities to organise their care may find they struggle to access providers who are highly specialist in meeting their specific needs. Cost pressures are understandably key here but also the ideology that every hour of support is largely the same (and thus can be purchased en masse at the lowest price point possible). This then plays out through the increasing trend to tender very large volumes of support provision to often very small lists of approved providers (who may often feel pressured to meet a rage of needs other than those that they are truly skilled in understanding).
Of course there are local areas where commissioning practice is excellent but I believe that a downward pressure on cost is now really impacting upon where smaller specialist agencies are able to operate.
This is a worrying situation for people such as those on the autism spectrum who need truly skilled and informed support to meet a range of sensory and communication needs. For groups such as this especially, one size can never fit all. Making the case for specialist services should never be about justifying unreasonably high costs but neither should commissioning for the most excluded members of our communities be a race to the bottom dictated by price alone. Indeed there is much evidence to suggest that the wrong kinds of support can lead to increased costs over time.
I believe it is also time for us as a sector to challenge what I call the concept of “uncritical independence”. By this I mean the canard that greater “independence” leads to both reduced cost for commissioners and better outcomes for the individual. This is, to say the least, “untested”. Nobody would argue that people who need support should be as independent (and in control) of their lives as possible, but if that means (as it does for many adults with higher functioning autism especially) living alone, anxious, unemployed and feeling misunderstood is this independence really empowering?
The diversity of needs in our communities needs a diverse marketplace of providers who can deliver personalised services via well trained staff. As a sector we will do well to make the argument for this. As specialist providers know, there is more to an hour of support than simply meeting the most basic of human needs.
Pete Cross is Head of Strategy with Autism Care UK, a national provider of support to adults. Views expressed are his own. Details of Autism Care UK can be found at http://www.autismcareuk.com and on Twitter @autismcareuk