Direct payments and personal budgets are a central part of the personalisation agenda, the drive to give service users choice and control over the care services they receive.
What are direct payments?
Direct payments are cash payments given to service users in lieu of community care services they have been assessed as needing, and are intended to give users greater choice in their care. The payment must be sufficient to enable the service user to purchase services to meet their needs, and must be spent on services that meet eligible needs.
They confer responsibilities on recipients to employ people, often known as personal assistants, or to commission services for themselves. Service users can get support in fulfilling these responsibilities from direct payment support services commissioned by local authorities, often from user-led organisations.
Direct payments are available across the UK and to all client groups, including carers, disabled children and people who lack mental capacity. However, they cannot be used to purchase residential care or services provided directly by local authorities.
What are personal budgets?
Personal budgets are an allocation of funding given to users after an assessment which should be sufficient to meet their assessed needs. Users can either take their personal budget as a direct payment, or – while still choosing how their care needs are met and by whom – leave councils with the responsibility to commission the services. Or they can take have some combination of the two.
As a result, they provide a potentially good option for people who do not want to take on the responsibilities of a direct payment. Personal budgets have been rolled out in England since 2008, with a target of providing every service user with one by 2013. In Scotland, where they are known as individual budgets, there are also plans to roll them out, under the country's self-directed support strategy.
What is the role of social care professionals?
Social workers and other care staff play a number of roles in the delivery of direct payments and personal budgets.
- Decision-making - helping service users decide whether a direct payment or council-managed personal budget is right for them.
- Assessment and resource allocation - assessing service users' needs, or supporting them to assess their own needs, and allocating a budget to meet them, based on a resource allocation system.
- Reviewing the size of a personal budget - social workers may feel that a person's personal budget is insufficient to meet their needs, in which case they would take the case to a council funding panel.
- Support planning and brokerage - drawing up a support plan in partnership with the service user and their family, and providing information on or sourcing services to implement the support plan (brokerage). While these functions are often carried out by council social care staff, some argue that they are better provided by external, specialist organisations, including user-led organisations.
- Review - keeping a service user's support needs under review.
How many people are using personal budgets and direct payments?
As of April 2011, 35% of eligible users and carers in England - 340,000 people - were using personal budgets, according to the Association of Directors of Adult Social Services. In a third of these cases, the recipient had taken their budget as a direct payment and in the rest the council was managing the personal budget.
In Scotland, 3,678 people were receiving a direct payment as of 31 March 2010, a 22% rise on the previous year. However, this figure is small compared with the 66,222 people receiving home care in the country at the same date.
In Wales, as of 31 March, 2010, 1% of older users of community-based services (552 people) and 9% of younger adult service users (1,908 people) were using direct payments.
Take-up across client groups
As the Welsh figures illustrate, direct payments have traditionally had a higher take-up among younger adults - notably people with learning or physical disabilities - than older people.
Figures for 2010 in England, from the NHS Information Centre, showed that 10% of older people were on personal budgets, compared with 23% of working-age adults with a learning disability and 20% of physically disabled adults of working-age. However, the figure was even lower for people with mental health problems of working-age, at 5%.
There are ongoing efforts to boost take-up among people with mental health problems and older people. For example, the Dementia Choices scheme run by the Mental Health Foundation is looking at how people with dementia can benefit from personal budgets.
Extending personal budgets
There are also initiatives to test how personal budgets would benefit homeless clients and to people who misuse substances.
In England, personal health budgets are being tested to give people with mental health problems or long-term conditions control over resources spent on their healthcare. These are due to be rolled out from October 2012, though concerns have been raised by mental health professionals and service users over their potential to improve outcomes.
The personal budgets concept is also being extended into other government funding streams used by disabled people through the Right to Control initiative, which is being tested in seven areas.
This is designed to give disabled people control over resources for their social care, employment support, housing support and equipment and adaptations, to enable them to shape how the money is used.
How successful have direct payments and personal budgets been?
A number of studies have shown significant benefits for service users from personal budgets and direct payments:
The National Personal Budget Survey found that 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, relatively free of constraints and bureaucracy, and where they had a direct payment rather than a council-managed personal budget.
However, the number of people using direct payments in England stalled from 2010-11, found the Association of Directors of Adult Social Services.
There are concerns that councils are looking to maintain control over resources by managing personal budgets themselves, rather than giving service users a direct payment. However, social workers have also raised concerns that some service users are not being given full freedom to choose a council-managed budget, as a result of some councils making direct payments their default option.
Bureaucracy and the implementation of personal budgets
Despite the links between less bureaucracy and positive outcomes for service users, the implementation of personal budgets has been beset by excessive bureaucracy.
Three-quarters of adult social workers said there was more bureaucracy in their role as a result of personalisation, found Community Care and Unison's annual 2011 survey on personalisation.
Explanations put forward for the increase in bureaucracy include councils having multiple assessment processes, combining legally required professionals assessments with supported self-assessments.
The situation has sparked repeated calls for the processes involved in personal budgets to be simplified.
Community Care special reports
The state of personalisation 2011
The state of personalisation 2010
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Further reading:
Social Care Institute for Excellence
In Control
iMPOWER
Local Government Improvement and Development
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