The Individual Budget Evaluation Network’s recent report found that IBs worked well for most groups. In the first of three articles, Jill Manthorpe, (pictured) part of the network, discusses the findings
We will look back on individual budgets (IBs) as a central plank in the transformation of social care. This is because they demonstrate real people can have greater flexibility and say in the support they need. IBs are not new, but because they build on the experiences of direct payments and In Control, they are the “big idea” in personalisation for many people.
The Department of Health invited councils to pilot IBs and 13 sites were selected. All were expected to begin offering IBs by April 2006. Funding was provided and the Care Services Improvement Partnership (CSIP) gave regular encouragement.
In theory, the following key principles underpinned the pilots:
● IBs were to be implemented within local authority adult social care budgets.
● Users were to have greater opportunity to contribute to their own assessments, which were to focus on what outcomes they wanted rather than establishing eligibility for specific services.
● Users would know the value of their IB before they began planning their support arrangements. Methods developed by In Control were suggested as the basis of an allocation system to determine the resources each individual should have.
● The pilots would test the opportunities for integrating into an IB any extra funding streams to which an individual was entitled. Funding streams included in the pilots were: Supporting People, Access to Work, the Independent Living Fund, Integrated Community Equipment Services, and Disabled Facilities Grants.
● Councils were encouraged to test several options for receiving and managing IBs, including direct payments, trust and third party arrangements, accounts with provider organisations and management by a local authority care manager.
● IB holders were to be encouraged to use them to purchase a range of specialist and non-specialist services, including those that were provided by commercial and voluntary organisations. Unlike direct payments they could be used to pay friends and relatives. IB users would need to know the costs of different services, receiving help with planning how to use their IB.
So what happened? There are some many positive stories about the difference IBs made to people’s lives. But these are, of course, only part of the picture.
In order to see what worked, for whom and at what cost, the Department of Health commissioned researchers from three social care research units, collectively know as the Individual Budgets Evaluation Network (IBSN), to complete a major evaluation of the pilot projects. The evaluation took place between April 2006 and March 2008.
The evaluation ran a randomised comparison study of outcomes with 1,000 participants across the 13 areas. The results were analysed along with the findings from qualitative interviews with: IB leads, service users and carers, care co-ordinators, team managers, providers, commissioning staff, and training and safeguarding staff.
The following findings compare users of IBs with similar individuals receiving traditional services:
● People receiving an IB were more likely to feel in control of their daily lives.
● IBs were cost-effective for care outcomes, except for older people.
● Mental health service users reported significantly higher quality of life.
● Younger physically disabled people reported receiving higher quality care and were more satisfied.
● People with learning disabilities were more likely to feel they had control over their daily lives.
● Older people reported lower psychological well-being with IBs, perhaps because they felt planning and managing their own support was a burden.
Social care services encountered four important challenges across the pilot sites (see box above). Resources were a key issue, both in terms of setting IBs at the correct level for service users and in how those resources could be used. Identifying what resources were available was also a concern.
The evaluation concluded that IBs have the potential to increase control and improve outcomes at similar or less cost than traditional services, but there was such a difference between groups that it was clear one size would not fit all.
Work is needed to find out what happens to older people over time if they choose to take up an IB, and whether IBs are more acceptable to them if support continues for longer or if it is offered differently.
Likewise, the key finding that people with mental health problems seem to benefit from IBs may have many implications for community-based services in the NHS. The impact of IBs on the whole system of health and social care will need rapid re-engineering of service responsibilities if social care is not to take on new budget commitments. The links with NHS services are wider than this and remain uncharted territory.
The evaluation concluded that a national debate on the principles underlying systems of resource allocation should start, not just one that is focused on the costs of social care over the long term. This would provide greater clarity on the legitimate uses of adult social care funding and on managing boundaries with the NHS, and would also tease out what might happen with the aspiration to link social care to other funding streams.
Complexity of care
The field of social care is much more complicated than other areas, of course, and so any learning will have to take on board the complex webs of means testing, legal rights and empowerment, and resource allocation systems, which were all very evident in the piloting of IBs.
Service users and carers appreciated the possibility of a wider range of creative responses to their priorities, but they also liked being able to use flexible budgets within care management, perhaps because this seemed a very stable and expert anchor when needs fluctuate and other supports are unpredictable. In other words, they appreciated a personalised approach as well as a personalised system.
The evaluation of the project was published last month.
Four key challenges for social care
The issues faced by the councils that took part in the pilots
● Allocating resources fairly and appropriately – it was hard to take support away from people or reduce funding already allocated.
● Establishing legitimate boundaries of expenditure, including anticipating possible concerns about the use of public funds and setting out responsibility for things not working out.
● Meeting responsibilities and duties for the safeguarding of adults in vulnerable situations (at the time of the study the Mental Capacity Act 2005 was not implemented).
● It was difficult to make progress with integrating additional funding streams into IBs, because of differences in eligibility criteria, resource allocation principles and accountability. Most progress was made with Supporting People but progress in integrating the other funding streams will require central policy action. On the other hand, difficulties were encountered because NHS resources were excluded from IBs.
About the research
The evaluation of the individual budget pilot, published last month, was undertaken by the Social Policy Research Unit at the University of York, the Personal Social Services Research Units at the Universities of Kent, London School of Economics and Manchester and the Social Care Workforce Research Unit at King’s College London.
Have your say
What do you think of IBs and are you and your team ready for personalisation? Give us your views
The author of this article:
Jill Manthorpe is director of the Social Care Workforce Research Unit. Other members of the Individual Budgets Evaluation Network team contributed to this article.
Published in the 6 November 2008 edition of Community Care magazine under the headline Individual Budgets – the story so far