Direct payments stall despite evidence of better outcomes

Direct payment levels in England have stalled in the past year despite evidence that they are associated with better outcomes than council-managed personal budgets, major research into personalisation has shown.

While personal budgets are generally having a positive impact for most users, there are wide variations between councils in both take-up and user outcomes.

The findings come from two major studies into the state of personalisation: an Association of Directors of Adult Social Services survey of progress at 132 of England’s 152 councils, issued last week; and the Personal Budgets Outcome Evaluation Tool (Poet) survey of 1,114 users and 950 carers, published today.

While personal budget numbers in England doubled from April 2010 to March 2011, to almost 340,000 – 35% of eligible users and carers – nearly all of the 2010-11 increase came in the form of council-managed budgets, found Adass.

Overall, 67% of users were on managed budgets as of April 2011, with 26% on direct payments.

However, service users on direct payments they managed themselves “reported significantly more positive outcomes than people receiving council-managed budgets”, found the Poet survey, commissioned by the Think Local, Act Personal Partnership and produced by personalisation charity In Control and Lancaster University.

This was also true of older people, despite them having less access to direct payments than younger adults.

The Adass findings sparked concerns that some councils were allocating people nominal personal budgets without offering them choice and control.

Care services minister Paul Burstow urged councils to do “much more to ensure that as many people as possible are receiving their personal budget as a direct payment”, in line with government policy.

In Control chief executive Julie Stansfield said: “It is critical that local authorities remember that personal budgets will only deliver good outcomes for people if they truly offer choice and control and do not simply become a ‘box ticking’ exercise.”

The Poet survey found personal budgets were “likely to have generally positive impacts” on users and carers.

Most service users reported personal budgets having a positive impact in 10 out of 14 outcome areas, including staying independent (76%), being in control of your support (72%) and mental well-being (63%).

However, the survey, which received significant responses from users and carers in 10 local authority areas, found a “pervasive variation across councils in the outcomes reported by personal budget holders and carers”.

Outcomes were better where service users were informed about the value of their personal budget, fully involved in the support planning process, alongside family carers, and relatively free of constraints and bureaucracy.

However, the proportion of users who were told the value of their personal budget per week ranged from 61% to 92% across local authorities.

There are also wide variations in take-up, with 20% of authorities having more than half of eligible users and carers on personal budgets and 14% of councils having take-up of less than a fifth, found Adass.

“Progress is varied and it’s time for all councils to step up to the plate if we are to achieve the [government’s target of having all users on personal budgets] by April 2013,” said Adass president Peter Hay.

“There can now be no doubt that for the most people, personal budgets can and do work, particularly as direct payments and especially when implemented well by councils,” said Think Local Act Personal chairs Richard Jones and Miranda Wixon. ” “At the same time, continuing and urgent action is needed to ensure all can benefit – wherever you live and whatever your needs – and that expensive and restrictive processes are streamlined to improve experiences and efficiencies.”

“The current situation is very challenging, given significant financial pressures. However, this makes effective delivery of personal budgets even more important – use of resources must be optimised to improve outcomes, choice and control.”

The findings follow evidence of declining faith in personalisation among social care professionals due to cuts and increased bureaucracy, from Community Care and Unison’s 2011 personalisation survey.

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Related articles

Adass survey

Poet survey results

Community Care and Unison survey results

The state of personalisation 2011