By Caroline Abrahams
It is becoming increasingly challenging to deliver personalisation as demand for social care progressively outstrips the resources the government is making available.
The Care Act 2014 gave personal budgets a big push, stating for the first time that everyone with an eligible need for social care should be given one.
This was in keeping with the view that personal budgets are an effective mechanism for putting the philosophy of ‘personalisation’ into practice.
However, comments from many respondents to a survey undertaken earlier this year by Community Care, supported by the Care and Support Alliance, suggest that the choice personal budgets are designed to offer is rapidly disappearing.
Councils are clamping down on how this money can be spent, increasingly requiring it to be used only for ‘personal care’ in the narrowest sense. To be clear, as long as the budget is spent on meeting eligible needs, the individual should have flexibility about how to spend it. Instead, certain activities are being excluded arbitrarily.
Care Act guidance on personal budgets
Chapter 11 of the guidance deals specifically with personal budgets. It states (paragraph 11.3) that the personal budget is “the mechanism that, in conjunction with the care and support plan, or support plan, enables the person, and their advocate if they have one, to exercise greater choice and take control over how their care and support needs are met.”
This includes having a choice over who is involved in developing the care and support plan for how the personal budget will be spent, including from family or friends; and having greater choice and control over the way the personal budget is used to purchase care and support, and from whom.
The guidance also outlines the importance of transparency, timeliness and sufficiency in calculating the personal budget. Paragraph 11.29 states that the person “should have the maximum possible range of options for managing the personal budget, including how it is spent and how it is utilised”.
Numerous examples were given of councils prohibiting people from spending their personal budgets as they might wish. Excluded activities included transport, social activities, shopping, housework, washing and ironing, gardening, cooking (apart from microwaving), food and drink, equipment, trips and holidays, and university courses.
The aim of saving money in order to spread the social care jam more thinly was clearly the rationale for these restrictions. Respondents suggested that in some cases, costs were being shifted elsewhere; for example, onto Attendance Allowance or onto other benefits so an expense, such as help with domestic tasks like shopping, had to be paid out of the person’s income; or onto the NHS in the case of anything that could be deemed ‘a health-related need’ (e.g. funding travel to the local MS centre).
In some cases such strict limits on where social care starts and ends makes things nearly impossible to do in practice, for example:
“The money cannot be used to pay for a personal assistant’s lunch when they are supporting them out to lunch, so the service user has to eat alone or the personal assistant pays out of their own money.”
“Direct payments can be used for the care a service user needs during an activity but not for an entrance fee for the support worker, nor bus fares or other expenses incurred by the support worker that are not related to personal care. This leads to individuals having to pay these additional costs for the support worker in order to have the support.”
Some comments suggested that the restrictions were resulting in people’s wishes being ignored, limiting their ability to live a meaningful life:
“All leisure activities that don’t have employment outcomes are now excluded. Spiritual needs to worship in a community are not funded (for example, transport to church).”
“The personal assistant is not funded to wash and style a person’s hair after they have had a shower. This should be a privately funded arrangement with a hairdresser. The personal assistant is also not funded to feed the dog or let it out.”
Some respondents to the survey also expressed serious concern about what they regarded as the undermining of the original purpose behind personal budgets:
“My local authority states that direct payments cannot fund transport or social activities. That is not backed up in any policy documents, so it is basically a self-fulfilling statement which means new/ less experienced social workers don’t even apply for those items and the status quo remains.”
“There is an emphasis on traditional care services, any leisure activities or more bespoke arrangements are heavily scrutinised and unlikely to be agreed, except in exceptional circumstances.”
“There is a constriction on choice, creativity and recognising the diversity of people’s needs and priorities.”
The often quoted, archetype example of the benefits of personal budgets is of a young man with complex disabilities who chose to spend his personal budget on a caravan by the sea. He and his parents used it at the weekends and during holidays. This worked well for all of them and ultimately it saved money too, as well as improving the young man’s outcomes. However, it is notable that one respondent to the survey said their council had specifically prohibited personal budgets being spent on caravans.
Of course, against the context of acute pressures on social care budgets, it is not surprising that managers should be seeking to save money wherever possible.
Last year, the National Audit Office called on the Department of Health to investigate how these savings were affecting the delivery of personalised care and service users, but this challenge was not picked up. It is now time for an honest and open debate, with councils at the fore, about the challenge of delivering personalisation as demand for social care progressively outstrips the resources the government is making available. That would serve those who need care well and arguably councils too.
Caroline Abrahams is charity director of Age UK and co-chair of the Care and Support Alliance. The CSA represents 80 charities and campaigns for a properly funded care system.