Centralisation is a concept in management that is all about delivering efficiencies, control and standardisation. McDonalds is a good example of centralisation at work, allowing you to go into any McDonalds in the world and know in advance exactly what you are going to get. Centralisation is the opposite of localisation.
Centralisation works well for many sectors especially where human preferences and personal outcomes are secondary to cost cutting and profit maximising.
The social care sector is a people dominated sector which is all about the human touch, looking after and encouraging those who need help, to live the lives they want to live in the place they call home. Unfortunately, and counterintuitively, it is a sector in Ireland that is dominated by centralisation and top-down dictums.
This means that the care and support provided is very much from a standardised template, irrespective of the personal circumstanced or needs of the people involved. This lack of personalisation is bad for the people involved but it’s also bad for the state, as it commits resources where they are not always needed. This standardised approach often throws common sense out the window and reduces the person involved to a client or service user, rather than treating them as a citizen with capacity and rights.
This centralised approach is propagated by our tendering system which promotes the large corporate provision of home care, as it is large corporates who can dedicate large departments to submitting intricate tenders and then managing the complex reporting and administration which follows. To make matters worse the system then pits corporates against corporates, encouraging them to find ways to reduce costs rather than deliver great services. It reduces everything to a financial transaction and a strict contractual oversight where anything outside the contract is invalid and of no use.
The results of this system are plain to see.
· Rising home care waiting lists because of a severe shortage of carers due to the fact that caring is not an attractive career. The easiest way to compete for these tenders is to keep carers pay rates low. Perversely though and as can be seen by publicly available accounts, the profitability of these corporate providers is very healthy.
· Increased box ticking and reporting but less practical and personalised support for people receiving care.
· Increased bureaucracy but less relationships and the human touch. The starting point for care is one of mistrust and the assumption that capacity doesn’t exist in the person needing care. Problems are solved by more rules, regulations and penalties.
If our home care system is to become fit for purpose, we need to bring back in trust, choice and a more human approach. The best way to do this is to move away from centralisation and start to delegate.
Delegate to communities, to families and to people themselves. The starting point should be the assumption that a person needing support has capacity and in many cases are experts in their own care and needs.
On the carer side we need to recognise that the two principal pillars of great care are one, happy well paid motivated carers and two, continuity.
We need to recognise that many of these great carers will come from local communities and so we need to ensure that local communities have the structures, knowledge and resources to enable and empower these carers and develop local solutions.
We need to get rid of our present commissioning system that basically sells off older and disabled people to the most efficient corporate provider at the lowest possible cost. We need to start treating people who need care and support as citizens with rights, personal needs and who are capable of making decisions about their lives. If we can trust people and families to fill out tax returns surely we can trust them to make decisions about their care and support?
The introduction of real personal budgets is the best way to start this movement away from centralisation and towards delegation and the transfer of decision making to the local.