The social care concordat
Putting People First set out the ambition that all social care
users should have access to a personal budget, with the intention
that they could use it to exercise choice and control to meet their
agreed social care outcomes. Personal budgets can be taken in a
variety of ways:
● As a notional allocation of funding - a transparent amount of
money, where the individual can exercise a degree of choice over
how it is spent.
● As a direct payment - this mechanism has been available since
1997.
● Or as a mixture of the two.
Some councils are linking a number of income streams together,
such as Supporting People and community care, within the existing
legal framework to give a greater level of flexibility to the
individual. This alignment of income streams is likely to be tested
further for disabled people, in pilot sites following passage of
the
Welfare Reform Bill later this year. This is sometimes called
the amount available to the individual, to allow them to influence
or control the spend, in a way which helps them best meet their
needs. It is a conscious attempt to shift control away from the
provider – often offering a fixed range of services – to allow the
individual to design the services, frequently non-traditional,
which best meet their agreed outcomes and agreed care plan.
Evidence from piloting and early adoption shows that some people
will use the new flexibilities to design very different services,
while others value the ability to adjust more conventional packages
to deliver a service more responsive to their own needs.
In many places,
a
resource allocation system (RAS) is used to determine the size
of the personal budget transparently, so that the service user
knows at an early stage what resources are available to them in
their personal budget allocation. In that way the desired outcomes
drive the spending. Personal budgets can be deployed in a number of
ways:
● By the individual.
● By the care manager.
● By a trust.
● As an indirect payment to the third party.
● Held by a service provider.
The personal budget holder is encouraged to devise a support
plan to help them meet their personal outcomes. Assistance in
developing this plan can come from care managers, social workers,
independent brokerage agencies and family and friends. Once a plan
has been devised support can be purchased from:
● Statutory social services.
● The private sector.
● The voluntary sector.
● User-led organisations.
● Community groups.
● Neighbours, family and friends.
People can use their budgets to use a wide range of services,
including traditional social care, as long as the service meets
agreed outcomes and is legal.
The approach to personal budget has been informed by the
experience of direct payments and, more specifically, by the
individual budget pilots.
Individual Budgets
In 2007-8, individual budgets based on a number of different
income streams were trialled in 13 English local authorities.
Research into the effectiveness of the pilot schemes was conducted
by the Individual Budgets Evaluation Network (Ibsen). The Ibsen
study and other research studies, conducted both in the UK and
internationally, have been reviewed in order to draw out messages
that will help inform the future development of personal
budgets.
User outcomes
The pilots identified that:
● People with mental health problems reported a higher quality
of life and potentially better psychological well-being. There
were, however, some barriers to entry for this group.
● Younger disabled people gained greatest satisfaction and
reported higher quality of care and greater opportunities to build
support networks.
● People with learning disabilities were more likely to feel a
greater degree of choice and control with the scheme.
● Older people reported lower psychological well-being than of
those in the comparison group. In international studies older
people have expressed concerns about the quality of information and
support on offer. However, follow-up work with older people has
identified greater acceptability and the carers' study identified
greater satisfaction among older people and their carers.
Frontline staff
Staff expressed concerns about determining the legitimate
boundaries of social care expenditure and managing the potential
financial and other risks at the same time as being responsible for
safeguarding vulnerable adults.
Personal assistants
More than half of those on individual budgets in the pilot
scheme chose to employ personal assistants and all groups that made
this decision reported positive outcomes for satisfaction, quality
of life, social integration and health.
Support and brokerage
The types of support needed can be broadly identified as:
● Help with managing money and accounts.
● Accessing the required services.
● Employing and managing staff.
Research suggests the involvement of an independent broker who
is able to draw on a wide range of resources, such as family and
the local community, to develop a care package shaped to individual
needs, can play an important role in simplifying the process.
Cost
What research is beginning to indicate is that personal budget
schemes from social care funding may have the potential to produce
savings for both social care and the NHS but that it can be
challenging to achieve the alignment with health funding which is
necessary to meet the support needs of individuals, particularly
continuing health care for those with complex needs. The
forthcoming pilot schemes for personal health budgets are likely to
test out these issues further.
There is an assumption that personal budget programmes would
improve choice for ethnic minority users of services, but research
is yet to investigate this fully.
Rural issues
Potentially, personal budgets would work well in a rural context
where there may be a lack of conventional services to purchase but
the evidence base on this is still emerging. While take-up of
direct payments by people with physical and learning disabilities
tends to be higher in areas with lower population density, there
may be problems with recruitment and retention in the same
areas.
Families and carers
Family and carers are central to personal budget initiatives, as
they provide unpaid care and support. Findings from the Ibsen pilot
study, backed up by findings from a Carers UK survey on carers'
experiences of direct payments, show that, overall, it appears that
personal budget schemes for people using services can have positive
effects for carers and families. Clearly they need to be involved
in assessment processes and have access to the right information
and advice as well as to support services.
Staff requirements
Training for frontline staff and first-line managers is
essential to the success of personal budget schemes, especially
those who work directly with the person using the service and
involved in decision making. Valuable areas to cover in training
include good assessment practices, equality and diversity awareness
and effective risk management to enable a balance between ensuring
choice and control and supporting and safeguarding those who lack
capacity or have particular vulnerabilities.
Conclusion
The value of personal budgets is widely recognised, alongside
the need for the support, advocacy and brokerage service
infrastructure, including user-led organisations. The government's
social care reform grant is injecting substantial funds into the
system (£520m over three years) to encourage the development of
these services, but more needs to be done. Evidence is clear about
the benefits to some groups of social care users but it is
important to ensure that everyone using social care has the ability
to benefit. Emerging findings from the UK are reflecting what the
international research suggests: that there is no single personal
budget scheme blueprint suitable for all adults needing social care
support. They are one approach to personalising adult social care
and need to be responsive to individual requirements.
Practitioners'
messages
● Personal budgets are part of the
strategy to provide personalised, responsive care. They can be
deployed and managed in a number of ways, including a direct cash
payment, a notional amount or a mixture of the two.
● The individual budgets approach provides
users of services with monies from a range of funding streams with
which they can develop their care plan and buy services, although
research has shown that there were significant challenges in
aligning and integrating funding streams within existing
legislative frameworks.
● All personal budget schemes are working
to balance safeguarding and risk .There are risks at organisation
and individual level.
● Personal budgets have the potential to
be cost effective and increase satisfaction among some users of
services. Younger disabled people and some people with mental
health problems derived the greatest benefit from the scheme in the
IB pilots, but the outcomes for older people and people with
complex needs do not yet appear to be so positive. These groups may
need more time and support so that they can get the best from
personal budget schemes.
● While personal budget schemes can bring
benefits for carers and families, support arrangements are needed
to ensure successful implementation.
● Frontline staff may feel unsure about
handling new responsibilities. There is strong evidence to show
that frontline staff and first-line manager training is vital for
the successful implementation of personal budget
schemes.
Links
● SCIE Research Briefing 20: The implementation of individual
budget schemes in adult social care
● http://www.scie-socialcareonline.org.uk
● National Centre for Independent Living
http://www.ncil.org.uk
● The Ibsen project - National
evaluation of The Individual Budgets Pilot Projects
●
Independence, Choice and Risk: a guide to best practice in
supported decision making (DH)
●
Putting People
First Personalisation Network
● Putting People First:
Measuring Progress
RESEARCH
ABSTRACTS
Author: JOSEPH ROWNTREE
FOUNDATION;
Title: Rethinking social care and support:
What can England learn from other countries?
Reference: York: Joseph Rowntree
Foundation, 2008. 12p.
Abstract Draws on the experiences
of other countries and sets out a number of principles that should
underpin reform of care and support arrangements in England. The
paper summarises some of the key features of social care; these
features are important in determining the appropriate balance
between collective, welfare state responsibilities and individual
or market responsibilities for social care; spells out a number of
principles that should underpin the funding and organisation of
social care and support in England, illustrated with lessons and
examples from other countries.
Author: ARKSEY Hilary; KEMP Peter
A
Title: Dimensions of choice: a narrative
review of cash-for-care schemes
Reference: University of York. Social
Policy Research Unit, 2008. 25p, bibliog
Abstract This working paper
presents the results of a narrative review of the international
literature on "cash-for-care" schemes whereby users purchase care
rather than receive in-kind services. The paper looks at the
primary research evidence in order to examine four questions that
are of central importance to social care policy: what can be
chosen, what are the barriers, what are the facilitators to
exercising choice, what are the outcomes of choice?
Author: GLENDINNING Caroline; et
al
Title: The individual budgets pilot
projects: impact and outcomes for carers
Reference: University of York. Social
Policy Research Unit, 2009. 113p, bibliog
Abstract Individual budgets sit at
the heart of government policy for improving choice and control for
people needing social care support. Individual budgets bring
together a number of different funding streams and offer a
transparent way of allocating resources to individuals. Knowing the
level of resources at their disposal can help individuals plan and
control how their support needs are met. Individual budgets are
being piloted in 13 local authorities across England. The
implementation is being supported by a team from the Care Services
Improvement Partnership (CSIP).
Author: MICKEL Andrew
Title: Where to start with individual
budgets?
Reference: Community Care, 8.1.09,
pp32-33
Abstract Ealing Council was one of
12 councils running the Dynamite initiative which aims to introduce
individual budgets to users with no experience of centrally
provided adults' services. In Ealing, eight young people with
learning disabilities are taking part in the pilot. This article
looks at the experiences of the staff and families
involved.
Author: GREIG Rob; DOWSON Steve
Title:Going for brokers.
Reference: Community Care, 19.2.09,
pp.26-27
Abstract The
use of individual budgets is increasing the profile of care
brokers. The authors, from the National Development Team, look at
how the training and regulation of brokers should be
improved.