Carers targeted in next personal budgets push

Personal budgets for carers will be at the heart of the government's new vision for adult care, due next month. Although uptake is patchy, they can transform lives, finds Gordon Carson

(Picture: Mandy and Ron Peponis had a Christmas to remember last year thanks to Surrey’s carers’ personal budget scheme)

Personal budgets for carers will be at the heart of the government’s new vision for adult care, due next month. Although uptake is patchy, they can transform lives, finds Gordon Carson

On the face of it, care services minister Paul Burstow is pushing at a door that’s already half open as he strives to make personal budgets for carers a priority, an ambition likely to be reinforced in the forthcoming vision for adult social care.

Uptake among carers receiving services is already higher than in the overall care system: almost a quarter of carers in England who received carer-specific services in the year to 31 March were given personal budgets, compared with 15% of disabled and 10% of older service users. However, these seemingly promising figures mask a situation where the rate of uptake varies greatly around the country. Campaigners believe many carers are struggling to access any support from social services in the first place – only 25% receive a carer’s assessment, according to the Princess Royal Trust for Carers – let alone self-directed support.

In addition, few carers receive a personal budget that allows them to buy support over a long period, as opposed to one-off direct payments, says Gordon Conochie, joint policy and parliamentary officer at Cross­roads Care and The Princess Royal Trust.

He is not overly optimistic about the chances of success for Burstow’s ambitions, which were set out at last month’s Liberal Democrat conference, particularly with spending cuts looming. “A lot of carers are not assessed or offered support because social workers say, ‘what’s the point, we know there’s no money to support them’, so they don’t even get to the stage of being assessed for personal budgets,” he says.

Graeme Betts, chair of the Association of Directors of Adult Social Services’ carers policy network, says councils are “committed to ensuring that carers can access personal budgets”, but he admits uptake is patchy.

“The feedback from carers is that they either feel ignored or put into the heart of everything and expected to manage very difficult situations,” he says. “Also, carers don’t feel valued as partners all the time, and often feel they are put-upon partners.”

However, Betts believes personal budgets can represent a more efficient use of resources for councils and carers alike, and highlights a situation in Warwickshire, where he worked before moving to Newham, London, this year.

“The carer was caring for her partner with a degenerative disease, and was about to give up employment to continue caring,” he says. “So we put together a personal budget around her and her partner’s needs, and used a lot of telecare to enable her to remain in work.”

Alex Fox, a member of watchdog the Standing Commission on Carers and chief executive of Naaps, which represents small community service providers, says professionals should discuss personal budgets holistically with carers and those they care for. “With the move to independent living, the family side of things can be seen as less relevant,” he says. “Sometimes there’s a tendency to think of families as being barriers to people living independently. But it’s about taking a whole family view of people being interdependent, not just independent.

“Could we have whole family budgets? Lots of families would value a joint discussion about care plans, so perhaps they could be allowed to pool the carer’s budget with that of the person with a disability.”

There was agreement among those interviewed for this article that personal budgets and self-directed support could help counter the well-documented negative effects of a life of caring. For example, more than 80% of carers say caring has damaged their health, according to The Princess Royal Trust, while many also have to give up work. However, it may be that these will not only be delivered by councils, whose resources will come under increasing pressure, but also by community providers using alternative funding streams.

This is already happening in Hertford­shire, where NHS money provides one-off personal funding for carers identified by GPs as being under stress. The scheme, run by charity Carers in Hertfordshire, has helped to pay for gym memberships, massage, laptops and computer courses.

Sue Reeve, chief executive of Carers in Hertfordshire, says spending on individual carers varies from £25 to £1,000, and all 130 GP surgeries in the county have received information about the scheme, which was rolled out after a pilot in 2009.

The funding and demographic challenges facing adults’ services may dictate that, no matter the ambitions of government, the rollout of personal budgets to carers will be incremental, so services such as this could provide respite for carers who do not qualify for ongoing support in the meantime.

CASE STUDY

One-off payment gave Surrey couple a break

A one-off direct payment from Surrey Council’s carers’ personal budget scheme helped Mandy Peponis and her husband, Ron, enjoy their best Christmas for years in 2009.

Mandy has been Ron’s full-time carer since 2001, but had combined caring with employment as a lecturer at the University of Surrey since 1987, when Ron started to suffer post-traumatic stress disorder brought on by his experiences in the Vietnam war.

He is also physically disabled, following type 2 diabetes that went undiagnosed because it seemed to have many of the same symptoms as depressive illness, such as a lack of energy and extensive sleeping.

Although Mandy does not receive a personal budget for ongoing support, she was able to apply for the one-off payment through a community psychiatric nurse. She also chose to have control by opting for a direct payment rather than a break for Ron. Importantly, this meant they could plan together for a joint activity. “If I was somewhere away from Ron I would be worrying about him,” says Mandy.

She started by collecting leaflets on things to do in England, then involved Ron in planning how to spend the funding. “We hadn’t done anything at Christmas since Ron became ill,” she says. But last year they put this right; they attended art shows in London, visited Hyde Park for a picnic, drove around the West End to view the Christmas lights, and on Christmas Eve saw Avatar at the Odeon Leicester Square, their first trip to the cinema for years.

This year Surrey Council is investing £750,000 in one-off break vouchers and £800,000 in direct payments under the carers’ personal budget scheme, says John Bangs, the authority’s commissioning manager for carers. About 1,000 carers will receive direct payments and 500 are taking vouchers for breaks. In addition, about 200 carers in Surrey are receiving personal budgets as part of ongoing packages of support.

Bangs believes the one-off payments enable Surrey to respond more flexibly to carers’ needs, while he sees an increasing role for personal budgets in delivering ongoing support in line with government objectives.

Mandy Peponis has not yet looked into ongoing personal budgets, though she has applied for another one-off payment so the couple can enjoy a Christmas to match last year’s. But Ron suffered a relapse four months ago and Mandy admits this Christmas will be bleak if her application is turned down.

This article is published in the 28 October 2010 edition of Community Care under the headline “Budgets door ajar for carers”

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