Mary Dejevsky: Competition among carers won't help your granny

Even I, free spirit that I fancy myself to be, would baulk at 'managing' my help to this degree

Care for those who are elderly or disabled is an expensive business. And with the bill forecast to soar in coming years as we of the fussy, post-war generation press for our contributions' worth, ministers are understandably casting around for new solutions. The latest presented by the Health Secretary, Alan Johnson, yesterday could be summarised as "hand out the public money, and run".

From April, millions of pensioners and some younger disabled people will be given cash to buy in care, according to their own assessed needs and priorities. The guiding principle is independence the Blairite word, "choice", I note, has been eschewed. And, in principle, the innovation cannot be faulted. It should allow many more elderly people to stay in their own homes for longer, even if they need quite a lot of help.

The idea is not new. It was pioneered in Greenwich and several other places more than a decade ago, to a generally positive reception. And it can transform people's lives. It means that, rather than relying on the quixotic rotas of social services departments, you are able to welcome the same trusted carer from one day to the next.

It means that someone will come at the time you, the client, want them to come, thus bringing an end to days where granny might have to wait until midday to be helped out of bed, only to be helped back again by someone else before dusk. It could mean choosing to order in from the local takeaway once a week rather than being allocated, say, three "meals-on-wheels". It could entail help to go shopping or meet friends at the pub, rather than four hours of closely defined "home-help".

Certainly, if and when I need help to stay in my flat, I would much prefer to set my own priorities within a budget, rather than being a supplicant, dependent on what sundry ill-co-ordinated branches of Social Services deemed to fit their own timetable and budget. Many people probably think the same way.

For the personalised cash system to work, however, principle and practice must be aligned. And this is where my qualms set in. For the system outlined by Mr Johnson relies on a sufficiency of services that, at present, is simply not there.

Imagine receiving your cash and setting your priorities; where do you begin? If you want basic help with, say, getting up, bathing, or visiting the shops, do you place an ad in the "help wanted" section of the local paper or the internet? And if you do, what guarantee is there that the people offering their services are honest, have relevant experience, and will not sue you for their back injury if you need lifting?

Will the search for a carer become something like the middle-class quest for a good nanny, where there is fierce competition on pay and perks and the best are recruited by word of mouth and "poached"? And what happens to wage rates (and your buying power) when, as is likely to happen, the supply of "new" Europeans peters out?

Responsibility, not least for the paperwork, is another question. Will you technically become an employer, even if you engage only a couple of people for a small number of hours a week? Will you then need liability insurance? Will you be expected to pay National Insurance - or risk paying "cash in hand"? Earlier schemes were based on vouchers, which people exchanged for services provided and verified by the council. When Mr Johnson says cash, this is what he means.

Councils are, it appears, are being invited to "spin off", "farm out" or "subcontract" you choose the word their Social Services. The councils will then become primarily regulators of the private-sector "not for profit"? agencies that may or may not spring up to fill the gap. It will be for you to weigh their comparative merits and complete the reams of necessary forms.

Is this really how you hoped to while away your twilight years? Even I, free-spirit that I fancy myself to be, would baulk at "managing" my own help to this degree. I would either have to employ someone to do it (a new paid-for "service", no doubt), or struggle on without. From the Exchequer's point of view, of course, the lower the take-up the better.

In conclusion, I invite you to complete this sentence, contained in a BBC report of Mr Johnson's proposals. "According to the Government, the changes are designed to ..." Now what would you say? Allow more people to stay in their homes? Give more people more control over their lives? Not a bit of it. I regret to say that "the changes are designed to create more competition among care agencies."

Forgive my scepticism, but more competition among care agencies will not, by itself, improve the quality of granny's life.

m.dejevsky@independent.co.uk