Personalised budgets greeted as a leap forward in disability rights

    The introduction of direct payments marked a dramatic change in
    the relationship between social services and service users. But
    last week, the government announced plans to go even further.

    A report from the prime minister’s strategy unit outlines a new
    system for enabling people with physical disabilities, learning
    difficulties and mental health problems to live independently.
    Currently, these groups have their support needs met through
    several budgets within and beyond social care, such as those for
    personal care, transport, employment, housing adaptations, training
    and education, equipment and advocacy.

    The new system proposes amalgamating all relevant funding streams
    into one “individual budget” which the service user could decide
    how to spend, either on their own or with assistance.

    The scheme is set to be piloted over the next three years “within
    existing resources” and the report envisages that it could be
    rolled out nationally by 2012. It adds that the case should be
    considered for submitting a bid to the 2006 spending review to
    enable further pilots. The Department of Health will take the lead
    for the scheme, supported by the Office of the Deputy Prime
    Minister and the Department for Work and Pensions.

    Campaigners have welcomed the individual budget concept. Simon
    Duffy, national co-ordinator of the In Control project, on which
    the government’s idea is based, says it could allow disabled people
    some “meaningful rights” over the money spent on services for
    them.
    “If you think about personalised budgets as simply telling people
    what they are entitled to up front, that seems to me like a pretty
    good idea,” Duffy says. “I would rather be in that position than be
    guessing or being stuck in some ongoing assessment process or fair
    access to care process where I just don’t know what my rights
    are.”

    He says individual budgets would allow people to do new things to
    meet their needs more creatively.

    Linsay McCulloch, deputy chief executive of learning difficulties
    charity Values into Action, describes the idea as a “leap forward”,
    but one that will need a lot of work.

    She highlights how, even after eight years of direct payments,
    people with learning difficulties are still struggling to gain the
    same level of access to them as other client groups and insists
    this must not happen with the new scheme too.

    But with the take-up of direct payments patchy in each of the
    groups covered by this latest report, it remains unclear at this
    stage how the government will prevent individual budgets suffering
    the same fate.

    John Knight, head of policy at disability charity Leonard Cheshire,
    says the report’s high profile will help to avert this. He adds
    that it is important that direct payments continue after the new
    system begins as people should be able to choose between the
    two.

    The tasks of local authorities will be determined by the pilots but
    the report says they should have a “key strategic role” in
    delivering the new system.

    Tim Hind, an adviser to the Local Government Association, says this
    will involve them creating partnerships with the other agencies
    whose budgets would need to be pooled.

    He welcomes the aim to ensure that resources are used to increase
    independence and to avoid situations where a failure to meet needs
    from one budget results in increased spending from another.

    He dismisses suggestions that the new system is about a power
    struggle between councils and disabled people, explaining that
    local authorities are already moving towards empowering service
    users and giving them more control over the services they receive.
    “It’s more about thinking about the role that local authorities
    have in terms of community well-being,” he says.

    Duffy is also optimistic. “From my conversations with senior
    managers in local authorities there are a lot of them who are up
    for it. There will be some people who are frightened and who are
    worried. But there are a lot who want to explore this and do
    realise that this is the way forward.”

    The report says individual budgets will require social workers to
    undergo a “cultural shift” from current service-delivery roles
    towards providing “self-directed support”.

    Duffy sees two key potential roles for social workers in the new
    system: as a broker, to help those who need assistance working out
    how to spend their budget, either independently or for a local
    authority; or a care manager, to let budget holders know how much
    they are entitled to.

    “Social workers’ old role might be rediscovered in this new
    system,” he says. “If you are talking about personalised services,
    you are not talking about off-the-peg services. You need to design
    it yourself.”

    With most of the purchasing power in the hands of disabled people,
    Hind believes the character of local authority and partner agency
    commissioning will change to a strategic one, with the agencies
    ensuring availability of services that disabled people want to
    buy.

    The proposed system would take several years to set up and Duffy
    predicts that more local authority commissioning would be needed –
    and that it would have to be more creative. He says centres for
    independent living would need to be developed for a wider group of
    people, and service providers would have to become competent in
    offering genuinely individual services.

    He agrees that, in the long run, the commissioning role of local
    authorities will change to one of strategic overview, but
    emphasises that disabled people should play a big part in
    this.

    While many in the social care sector support the idea of individual
    budgets, some are wary of the lack of detail. It is hoped that the
    forthcoming green paper on adult social care should flesh out some
    of the proposals and appease some of this concern.

    KEY CONCERNS

    • Lack of detail on extending the individual budgets proposal to
      children and young people.
    • Lack of detail on implementing the proposals on the
      ground.
    • No figures on how much money will be available to implement the
      new measures.
    • Concerns that the report’s 2025 deadline for disabled people
      having access to full opportunities and choices is too far
      away.
    • Comcerms that, with talk of a general election, the report
      could come to nothing.

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