Individual budget evaluation and frontline staff

The Individual Budget Evaluation Network asked social care staff for their verdict on IBs. In the second of three articles, Network member Jill Manthorpe reveals the results

In my previous article, we discussed Individual Budgets Evaluation Network’s findings that many service users welcomed IBs. But the pilots also had an important impact on staff.

Community Care’s major exclusive survey of social workers revealed that social workers are equally divided in their views on whether personalisation is the right direction for social care.

Our evaluation also explored the views of staff at the frontline of care management who had actual experiences of individual budgets. They were a crucial source of data, talking to the researchers about their practice and many completed a diary to capture the impact of IBs on their day-to-day work.

Staff support

We found that most staff welcomed the aims of IBs and thought that they could improve the lives of people using services. Social workers and care managers were aware of the current limitations of care management and direct payments and the constraints these imposed on people using, or considering using, publicly funded social care services.

Assessment processes did not change greatly during the pilots, although there was more emphasis on working with people using services to identify desired outcomes, through a process of self- or joint-assessment. It was not easy to integrate information from other sources, including from Supporting People teams, in the same authority. In addition to the views of service users, contributions from family members, care co-ordinators and sometimes advocates could lead to conflicting perspectives about needs and outcomes. This process of making such conflicts explicit could help practitioners clarify actual levels of family support and pinpoint areas of risk of harm.

Not surprisingly, working with a new and evolving system such as IBs involved many changes for practitioners. However, in all pilot areas many practitioners identified the principles underlying the new approach as a welcome reinvigoration of social work values. They said that these reminded them of what they came into social work to do. On the other hand, some were concerned that their professional skills were being eroded, to the detriment of people using services. These apparently contradictory findings were aspects we wanted to explore.

What emerged was that practitioners were sometimes uncertain about the legitimate boundaries of social care expenditure within a support plan. They were also aware of the financial and other risks sometimes involved in achieving desired outcomes, while at the same time being responsible for safeguarding adults in vulnerable situations.

Adult protection or safeguarding staff told us they had only become gradually involved in the development of IBs in their localities. This left frontline staff without guidance or opportunities to debate the practice of safeguarding within the new agenda.

More time spent with clients

Practitioners with IB holders on their caseloads spent more time than others on completing assessments with service users, assessing carers’ needs, planning how IBs were to be used, and training. However, this may have been because of the additional time needed to develop systems in a pilot exercise and the time needed for these tasks might therefore fall in the longer term.

Other issues were not so frequently identified as impinging on frontline practice but were beginning to emerge when working with people wanting to use IBs whose needs spanned NHS and local authority responsibilities. Despite the intention that IBs should incorporate resources from different funding streams, practitioners were faced with legal and accountability barriers that made integrating funding streams very difficult.

Once needs are assessed and a budget agreed, the next step is working out how to use the IB to help people meet their desired outcomes. Because IBs offer greater choice and flexibility than other systems (such as direct payments), this stage was time-consuming for practitioners, although this was relished by some practitioners as creative and empowering. Care managers often assisted people find ways of meeting their needs. They frequently worked with user-led organisations or advocates. Most frequently, practitioners helped a person to find services rather than with working out the initial plan in great detail.

Several pilot sites employed (or redeployed) staff to work exclusively on this task but it was often independent brokers that found the services, while care managers did the detailed planning. The evaluation found that some people using IBs believed they developed better relationships with specialists, but there were longer waiting times for their services.

This raises questions about the type of professional development and support that will be needed for staff working with IBs, including the development of specialist skills in support planning and brokerage. Training departments were thinking this through at the time of the evaluation.

Wide responsibilities

Many of the training staff were conscious of their very wide responsibilities in developing the skills required for social care transformation across the sector, not just in local authorities.

Monitoring and review systems in most sites were no different than those for people receiving conventional social care support, but these varied a great deal. Differences tended to focus on the achievement of desired outcomes rather than purely on whether they were being delivered as intended. Many practitioners were concerned about the risks of abuse, mistreatment or financial exploitation of service users – which might be higher if they were paying friends or relatives to provide support without Criminal Records Bureau checks.

Duties of care seemed less clear and some practitioners perceived this aspect of IBs to be in tension with responsibilities for safeguarding adults in vulnerable situations. There were rarely clear mechanisms for monitoring or identifying risk once IB support packages were in place.

Some pilot sites were reviewing their policies on risk, with staffing changes planned to improve safeguarding. Whether this happens remains to be seen.

The Social Care Institute for Excellence’s Rough Guide to Personalisation declares that “now is the time for social workers to move away from gatekeeping and resource management to advocacy and support tasks”. The evidence from the pilots supports the complexities of this process.

Staff with experience of individual budgets said:

● IBs could improve life for services users and reinforce social work values.

● Practitioners working with IB holders spent more time assessing the needs of service users and carers, planning how IBs use, and training.

● There is a tension between the financial and other risks sometimes involved and safeguarding responsibilities.

● There is concern that professional skills were being eroded.

● The boundaries of social care expenditure in a support plan are unclear.

● There are legal and accountability barriers to incorporating different funding streams into IBs.

Jill Manthorpe is director of the Social Care Workforce Research Unit. Other members of the Individual Budgets Evaluation Network team contributed to this article.

The views expressed in this article are those of the authors and do not necessarily represent the views of the DH which commissioned the report.

The evaluation of the individual budgets pilots, published last month, was commissioned by the DH and 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. Members of the team are Sally Jacobs, Martin Stevens, David Challis, Ann Netten, Caroline Glendinning, Martin Knapp, Karen Jones, Nicola Moran, José Luis Fernandez, Mark Wilberforce and Jill Manthorpe.

Other Community Care articles by Jill Manthorpe

This article published in the 13 November 2008 edition of Community Care under the title ‘Individual Budgets on the frontline’

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