The implementation of personal budgets in mental health has been “hampered” in some areas by the transfer of mental health social workers from local authorities into NHS teams, research has revealed.
Managers at two of four sites that took part in a study on the implementation of personal budgets said that the transfer of social work functions had stifled progress, with some councils accused of neglecting their mental health leadership role after the moves. Personal budget implementation is generally the responsibility of local authorities.
“Once they [transferred] the staff over, there appeared to be more of a culture in [the local authority] of saying ‘we’ve given our resource to the trust, this is for them to manage mental health now’,” said one respondent working at a site where uptake of personal budgets was described as ‘very low’.
A number of councils have pulled their social workers out of NHS trusts in recent years, amid ongoing debate in the social care sector on the merits and drawbacks of integrated mental health teams.
John Larsen, head of evaluation at Rethink mental illness and the study’s lead author, said that personal budget delivery in mental health required strong leadership from both health and social care.
“When you have real integration with effective joint leadership it can work really well, but what we are finding in many cases is that the social sides of mental health have been taken over by the NHS.”
“Those areas are struggling to implement personalisation because it is coming from a social model but there isn’t the presence of social care leadership to support its implementation. You need commitment from both sides,” added Larsen.
The study, published in the Journal of Mental Health, found that a range of cultural and organisational issues had “impeded” the adoption of personal budgets in mental health.
Some local authorities said they felt “powerless” to influence the practice of social workers who had been transferred to the health service, while NHS managers often felt constrained in how they could alter the way social care funding is being used.
The introduction of personal budgets had also “exposed tensions” between the conflicting value bases of medics and social workers, researchers found.
Respondents said that senior managers had “an important role” to play in prompting change and driving personalisation. Leaders who had “insider” knowledge of both health and social care systems and experience of bridging potential divides were seen as the most effective.
“We conclude that to ‘sell’ personalisation managers may need to give voice to its values, and they need to find ways for their own staff to ‘own’ the change as part of a wider commitment to practice improvement,” the study said.
Personal health budgets are being rolled out in the NHS but it will be up to local commissioners to decide whether to offer them to people with mental health problems.
Phase two of the study – where researchers are interviewing people in receipt of personalised care, frontline staff and carers – is currently underway. The findings will be published later this year.Andy McNicoll is Community Care’s community editor