Personalised budgets greeted as a leap forward in disability rights

The introduction of direct payments marked a dramatic change in
the relationship between social services and service users. But
last week, the government announced plans to go even further.

A report from the prime minister’s strategy unit outlines a new
system for enabling people with physical disabilities, learning
difficulties and mental health problems to live independently.
Currently, these groups have their support needs met through
several budgets within and beyond social care, such as those for
personal care, transport, employment, housing adaptations, training
and education, equipment and advocacy.

The new system proposes amalgamating all relevant funding streams
into one “individual budget” which the service user could decide
how to spend, either on their own or with assistance.

The scheme is set to be piloted over the next three years “within
existing resources” and the report envisages that it could be
rolled out nationally by 2012. It adds that the case should be
considered for submitting a bid to the 2006 spending review to
enable further pilots. The Department of Health will take the lead
for the scheme, supported by the Office of the Deputy Prime
Minister and the Department for Work and Pensions.

Campaigners have welcomed the individual budget concept. Simon
Duffy, national co-ordinator of the In Control project, on which
the government’s idea is based, says it could allow disabled people
some “meaningful rights” over the money spent on services for
them.
“If you think about personalised budgets as simply telling people
what they are entitled to up front, that seems to me like a pretty
good idea,” Duffy says. “I would rather be in that position than be
guessing or being stuck in some ongoing assessment process or fair
access to care process where I just don’t know what my rights
are.”

He says individual budgets would allow people to do new things to
meet their needs more creatively.

Linsay McCulloch, deputy chief executive of learning difficulties
charity Values into Action, describes the idea as a “leap forward”,
but one that will need a lot of work.

She highlights how, even after eight years of direct payments,
people with learning difficulties are still struggling to gain the
same level of access to them as other client groups and insists
this must not happen with the new scheme too.

But with the take-up of direct payments patchy in each of the
groups covered by this latest report, it remains unclear at this
stage how the government will prevent individual budgets suffering
the same fate.

John Knight, head of policy at disability charity Leonard Cheshire,
says the report’s high profile will help to avert this. He adds
that it is important that direct payments continue after the new
system begins as people should be able to choose between the
two.

The tasks of local authorities will be determined by the pilots but
the report says they should have a “key strategic role” in
delivering the new system.

Tim Hind, an adviser to the Local Government Association, says this
will involve them creating partnerships with the other agencies
whose budgets would need to be pooled.

He welcomes the aim to ensure that resources are used to increase
independence and to avoid situations where a failure to meet needs
from one budget results in increased spending from another.

He dismisses suggestions that the new system is about a power
struggle between councils and disabled people, explaining that
local authorities are already moving towards empowering service
users and giving them more control over the services they receive.
“It’s more about thinking about the role that local authorities
have in terms of community well-being,” he says.

Duffy is also optimistic. “From my conversations with senior
managers in local authorities there are a lot of them who are up
for it. There will be some people who are frightened and who are
worried. But there are a lot who want to explore this and do
realise that this is the way forward.”

The report says individual budgets will require social workers to
undergo a “cultural shift” from current service-delivery roles
towards providing “self-directed support”.

Duffy sees two key potential roles for social workers in the new
system: as a broker, to help those who need assistance working out
how to spend their budget, either independently or for a local
authority; or a care manager, to let budget holders know how much
they are entitled to.

“Social workers’ old role might be rediscovered in this new
system,” he says. “If you are talking about personalised services,
you are not talking about off-the-peg services. You need to design
it yourself.”

With most of the purchasing power in the hands of disabled people,
Hind believes the character of local authority and partner agency
commissioning will change to a strategic one, with the agencies
ensuring availability of services that disabled people want to
buy.

The proposed system would take several years to set up and Duffy
predicts that more local authority commissioning would be needed –
and that it would have to be more creative. He says centres for
independent living would need to be developed for a wider group of
people, and service providers would have to become competent in
offering genuinely individual services.

He agrees that, in the long run, the commissioning role of local
authorities will change to one of strategic overview, but
emphasises that disabled people should play a big part in
this.

While many in the social care sector support the idea of individual
budgets, some are wary of the lack of detail. It is hoped that the
forthcoming green paper on adult social care should flesh out some
of the proposals and appease some of this concern.

• Improving the Life Chances of Disabled People from www.cabinetoffice.gov.uk

KEY CONCERNS

• Lack of detail on extending the individual budgets proposal to
  children and young people.
• Lack of detail on implementing the proposals on the
  ground.
• No figures on how much money will be available to implement the
  new measures.
• Concerns that the report’s 2025 deadline for disabled people
  having access to full opportunities and choices is too far
  away.
• Comcerms that, with talk of a general election, the report
  could come to nothing.