In Control

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= open healthcare experiment in the UK, where patients are put in charge of their 'social care'


Charles Leadbeater, the author of We Think, and Hilary Cottam, have written an essay, which is also the start of a research project on open healthcare by Demos, on a significant social care experiment in the UK, which puts patients in charge of their care, according to what we would call a Partner State model. The article describes the benefits, but also the difficulties, of making this model work, and should be read in full. Here are two snippets with the essentials.

The Experiment

“In Control run by a social enterprise for the Department of Health which helps young people with learning disabilities take control of their own care. Everyone going on In Control gets their own annual budget - the cash equivalent of what they would have got in services - and help to decide how to spend it on the kind of support they need. Caroline and Joe quickly drew up a plan to get to school on the bus, with the help of two fellow sixth formers who were studying for care qualifications. Joe was happy. He and Caroline were managing the risk rather than the department, so the social workers were content. And as Caroline puts it : “You give me ten pounds and I will make sure it goes much further for Joe than any local authority.” Joe and Caroline Tomlinson, and the other families enlisted by Wigan council onto the project found their relationship with public services was transformed. Where once they were dissatisfied, complaining consumers, in an adversarial relationship with service providers and professionals, they found themselves turned into participants and co-investors in finding better outcomes for themselves. They sought and paid for professional advice and support, but within the context of their own plans. In the past, all too frequently, it had felt the other way around: Joe and Caroline fitted into plans and strategies drawn up by the professionals, trying to bend their lives to fit within the provision the council made available.”

Preliminary conclusions:

“It is often assumed that the public have to rely on professionals to deliver public services because in the economic jargon there is an information asymmetry: the doctor or teacher knows more than the patient or pupil. Yet the families of these children have fine grained knowledge about what they really need: when they need two carers to support them and when only one will do; what risks to take on a trip out to the zoo and so on. The In Control initiative draws out this latent, tacit knowledge of users that is largely kept dormant and suppressed by the traditional delivery approach to services in which professionals are largely in control, assumed to have all the knowledge and so consumers are largely passive because they are assumed to lack the capability of taking charge of their own care, health, learning or tax.

Caroline Tomlinson summed up the benefits of In Control, this way: “You get longer term funding. Its not week-by-week so you can genuinely plan for how you will use the money. It gives you something to build around - for example planning a trip out that you might save up for - rather than just managing the service, getting by. It gives you much greater flexibility to commission the mix of services you need, when you need them.” (

More Information

  1. Public Services 2.0
  2. Health Services 2.0