Clients praise personal budgets but criticise social worker input

Families report improved independence and choice from self-directed support but bemoan lack of social worker continuity and conflicting messages from practitioners, finds three-year study.

Picture credit: Burger/Phanie/Rex Features
Picture credit: Burger/Phanie/Rex Features

 

Messages for social workers and managers

  • Families strongly valued having a single social worker as their point of contact for information on using personal budgets; the absence of this created stress;
  • Some service users had received conflicting information from different social workers about how they could spend their budget;
  • Some service users had a poor experience of reviews, including because they felt they were being reprimanded for not spending budgets correctly;
  • Families felt that being confident, articulate and able to negotiate were the most important skills in ensuring personal budgets worked for them;
  • Social workers are unclear about how far they should be monitoring the way clients spend personal budgets;
  • The primary challenge facing practitioners was “selling” personal budgets but they were finding this easier over time.

Source: Longitudinal study of personal budgets for adult social care in Essex final report

 

Personal budgets are delivering improved outcomes for service users but families are “frustrated” by changes in their social worker and inadequate and conflicting information from practitioners.

That was the message from the final report of a three-year, qualitative study into how personal budgets managed by service users are working in Essex, commissioned by the county council and carried out by the Office for Public Management and edcp (formerly Essex Coalition of Disabled People).

Improved outcomes

After two years’ receiving personal budgets, service users and family members said their care was better because of the greater choice and control they had over services, with some changing providers with which they were not happy.

For many, personal budgets had increased opportunities to get out of the house and socialise and boosted independence, including because being able to employ a personal assistant made them less reliant on family.

Positive factors

Factors behind positive experiences included having good family and social networks, to manage personal budgets for service users and provide advice and advocacy. People who could contribute their own financial resources to their support were better able to make the most of personal budgets, as it enabled them to meet a wider range of needs.

Also, families said that being confident, determined and articulate were the most important skills in managing personal budgets; some felt that these skills had enabled them to secure personal budgets of greater value from the council and more flexibility over their use.

Variable experiences of social workers

However, the report said that service users and families “had variable experiences with social workers”, with some saying that practitioners were unable to dedicate much time to them.

While they wanted a single point of contact who knew their circumstances and whom they could get in touch with easily, they found that social workers assigned to their cases changed or were difficult to contact. This meant they were unable to have their needs reviewed when they felt this was necessary or they were forced to explain their circumstances to several people.

Families and service users also reported receiving conflicting information from the different social workers with whom they came into contact. This meant some had been told they could spend their budget in a particular way, only to be told at the review stage that they were not spending it correctly.

This was reflected in interviews with practitioners, who said they found reviews difficult because they often had to tell service users they were not spending their budget in the right way.

Practitioners also said it could take six to eight weeks for service users to start receiving their personal budget because of the “bureaucracy” involved, which could lead to the person’s condition deteriorating.

They also reported that their biggest challenge was “selling” personal budgets, particularly to older people coming out of hospital for whom the prospect of managing their support could be overwhelming. However, they said that selling had become easier over time. They were generally strongly supportive of personal budgets, which they saw as improving outcomes.

Key recommendations

Recommendations from the report included that:

  • There needs to be greater clarity among practitioners and service users about what people can and cannot spend personal budgets on;
  • Communication protocols should be reviewed to reduce the amount of time service users spend trying to get in touch with frontline staff for information and advice on using personal budgets;
  • Practitioners and service users should be given much greater clarity about reviews including: when they should be instigated and by whom; what changes in circumstances families need to report to the council prior to the review; the difference between the review and the ongoing process of “light-touch financial monitoring” of personal budgets by staff.
  • Practitioners should not conduct reviews by phone and must ensure they have had a chance to fully engage with a service users’ support plan before conducting a review;
  • The set-up process for personal budgets should be shortened to prevent service users from deteriorating while they wait and to free up practitioners’ time.
  • The council should seek to boost its capacity in support planning, providing information and advice on using budgets and reviewing support, by exploring how far community or peer support organisations can carry out these functions alongside council practitioners.
  • To help increase personal budget uptake, the council should report internally on take-up rates across teams, and “buddy” practitioners with more experience of setting up personal budgets with those with less experience.
  • The council should provide service users who lack the skills required in managing budgets – such as negotiation and financial literacy – with training and development in them.

About the research

The study focused on personal budgets managed by service users, rather than the council, and reported in three stages from 2009-12. Twenty service users or family members who were started receiving personal budgets in 2009 were interviewed at all three stages; a further nine were recruited to take part in the final part of the study.

Researchers also interviewed council practitioners and providers in stages two and three, with seven practitioners and 17 providers interviewed in the third stage.

The study’s aim was to “develop an understanding of the lived experiences of people that have been managing personal budgets for themselves or their families over a
number of years”. This is in contrast to other studies that have used much bigger sample sizes but covered a much shorter time period.

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Lamb scraps 100% personal budgets target

Direct payment numbers stall amid hike in personal budgets

Special report on the state of personalisation in 2012 

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