Individual budgets gathering steam

Lady in wheelchair getting into car. P30, 20 March issueIn the immortal words of the late, great, soul singer Curtis Mayfield: People get ready, there’s a train a-comin’ you don’t need no baggage – you just get on board.

This is the express train of personalisation, which is rapidly building a head of steam and powerful momentum. The message that adult social care will increasingly be characterised by choice, flexibility and control over the support provided is repeatedly being emphasised by ministers and officials alike.

The findings from the independent evaluation of the individual budget (IB) pilots – due in the spring – are eagerly anticipated, but regardless of these the roll-out of the personalised approach will begin on 1 April with the first steps towards the transformation envisaged by the concordat Putting People First.

Pilot evidence

The research evidence from the pilots will be invaluable in shedding light on how to do things (and what to avoid) it will not be answering the question of whether IBs (or personal budgets) are the way ahead – that is already a given. Some naysayers are objecting to this inverted approach to “evidence-based” policy and practice development, but before leaping to judge it is important to recognise some important developments. First, the IBs have not been taking place in a vacuum since they were established two years ago, other events have been continuing apace.

The IB pilots are only a fraction of a much wider trend in the growth of different approaches to self-directed support. The model that underpins the IB concept was developed by In Control, and the majority of English councils (107) are now members of In Control. The pace of change is striking: in June 2006 there were just 414 people who had a personal budget by March 2008 there were 3,871. Moreover, only six of the “top 10” authorities with the highest numbers of people controlling their personal budgets are IB pilot sites.

In parallel to In Control is the emergence of the “Dynamite” model of self-directed support for young people, and of the “Taking Control” programme in children’s services (in advance of the formal piloting of IBs for families with disabled children). The point is clear – personalisation is developing its own unstoppable force, and the IBs are only one part of this wider picture.

Conference plug - 20 March issue p 30Emerging evidence from In Control, and from the IB pilots alike, has pointed to the positive impact of self-directed support on people’s quality of life, albeit that full evaluation will need to be conducted on a longer time scale, and across the full range of people using personalised care. This should be a focus for – among others – the recently established Self-directed Support Research and Evaluation Group.

There are sceptics who think that personalisation is just the latest fad in social care, and that if they keep their heads down and ride it out, it will pass. They are surely wrong. This is not a top-down model of reform conceived in Whitehall, but a framework that has grown from the preferences of people who use services. The desire for choice, control and flexibility in how resources can be used to meet support needs comes from people’s experience of services that have too often failed to deliver or help them live their lives.

Neither is personalised care a single one-size-fits-all model indeed it is infinitely adaptable. For those people who want direct control and to manage a budget for themselves, that should certainly be an option, but it will not be compulsory. People will be able to choose for a third party, or a broker, to manage the budget on their behalf, or for the local authority to act as proxy and case manage the budget. The choice that people make will depend greatly on how the offer is made and the support, information and advocacy that are offered to support them in their choices.

Change at all levels

The scale of the transformation that will be required cannot be overstated. Change will be required on all levels and the biggest challenge is probably to the culture and organisational conservatism of many councils (and of some social workers) leadership and commitment have got to be shown by directors of adult social services and senior managers. The Putting People First Concordat published in December, and the follow-up local authority circular both make it clear: personalisation is not an option, it is the way forward, and will become – in the terminology of In Control – the “standard operating system” for social care.

The government has given an unequivocal commitment to making this the “cornerstone of modernised public services”. In future “everyone who receives social care support, regardless of their level of need, in any setting, whether from statutory services, the third and community or private sector, or by funding it themselves, will have choice and control over how that support is delivered”. This is the clarion call to adult social care. People get ready.

Melanie Henwood is an independent health and social care consultant

This article appeared in the 20 March issue under the headline “Here to stay”

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