Older people on council-managed personal budgets have limited choice and control over their support because their budgets are often of low value and authorities restrict how they can be spent.
That was the message from a study into three councils by York University’s Social Policy Research Unit, which said managed budgets had only provided a “minor increase” in personalisation over traditionally-commissioned care packages.
The study was prompted by the preference of most older service users for council-managed budgets over direct payments and some evidence that the latter deliver better outcomes for clients.
Managed budgets were usually spent on council-commissioned home care, and the study found that there were several factors limiting service users’ level of choice and control.
Low value of budgets limiting choice
The biggest cause was the low value of managed budgets, which mostly only covered essential personal care, limiting the scope for money to be used flexibly once these needs had been met.
However, this was exacerbated by commissioning practices that limited people’s choice of provider and council restrictions over the way the way budgets were spent.
While service users technically had a choice of providers on councils’ framework agreements, often just one care agency was able to respond to a referral from a new client, with particular restrictions in rural areas.
Creative support planning thwarted
Though support planners encouraged service users to “think outside the box”, they could not guarantee preferences could be met because of the lack of choice, leading some to question the value of creative support planning.
Councils also placed restrictions on the use of budgets. Providers in two of the areas had to seek council approval to make changes to support plans, limiting their responsiveness to service users, while agencies also reported restrictions on what councils would fund.
Agencies also felt restricted in using time banking, which enables service users to go without or shorten home care visits and use the time saved at a later date. Providers said they feared councils would reduce the level of the personal budget if they used time banking, while some were paid per visit, meaning there was no saving in having shorter visits.
Individual service funds, under which council-managed personal budgets are held by the provider, who agrees how they should be used with the service user,, have been promoted as a way of increasing choice and control for this client group.
However, while two of the study councils technically used ISFs, in both cases budgets were still held by the council, and some providers felt unable to change support plans without council consent.
About the study
The study took place in two unitary authorities and one county council thought to be innovative in their approach to personalisation, from January 2011 to December 2012. The research team warned that the study “may have limited generalisability, particularly in current fast-moving practice environments”.
However, it made a number of recommendations including for providers to have greater freedom to amend support plans without council authorisation, and for greater flexibility to be given to providers and service users, for example through time banking.
Picture credit: Burger/Phanie/Rex Features