Older people are less satisfied with individual budgets than other service user groups, according to the recent evaluation of the Department of Health’s 13 individual budget pilots.
The study, published last month, warned that older people reported being stressed and anxious and said that individual budgets (IBs) felt more like a “burden” rather than giving them control of their lives.
They weren’t the only ones who found it difficult to cope with change – care co-ordinators were also reported as being less confident in developing flexible and creative support plans for older people and other groups.
Restriction on spending
In addition, the scope for spending money on the small things that can drastically improve quality of life – such as social outings or help with the gardening – was restricted, because older people tend to require a higher level of personal care and received the same level of funding as younger people.
Age Concern’s Zena Ambrose has kept tabs on the progress of IBs and shares some of these worries. “It could also be that older people are feeling anxious about it because they’re not being given a choice and told this is what they have to do,” she says.
But after a rocky start, it looks as if local authorities are now rising to the challenge. Since the IB evaluation ended last December, the DH’s Care Services Improvement Partnership (CSIP) has been following up progress and identified a number of improvements.
IB users among older people rising fast
CSIP’s findings, outlined in a report, Making Personal Budgets Work for Older People, will make encouraging reading for councils.
The number of older people now taking up IBs is “rising fast” as councils find ways of overcoming obstacles, the report finds.
Bernadette Simpson, personalisation adviser at the DH, and Martin Routledge, national programme manager for Putting People First, hope councils can learn from the CSIP findings.
“Talking to the pilot sites recently, things have moved on enormously,” says Simpson. “All the people I’m in contact with are very positive about how successful individual budgets are now with older people.”
Time to be convinced
She suggests that one of the reasons for this progress seems to be that older people initially weren’t keen on participating in what they saw as an experiment and took time to be convinced. “Once the authority had changed all the mainstream systems, older people came on board very willingly,” she says.
Routledge points out that IBs are just part of the wider personalisation agenda and urges staff who are already used to dealing with direct payments to draw on their experience. “The critical question is how IBs are implemented for older people. Our experience is that if they’re implemented well, people can seriously benefit,” he says.
Routledge points to the importance of explaining to older people how they can take control of their money in different ways. “They often don’t want to take on the responsibility of being an employer themselves,” he says.
Admin back up
Routledge cites examples where older people have the option of having their accounts managed by the council. In one of the pilot sites, just over a quarter of older people getting IBs chose this and councils had to set up “robust” administration and support to make this happen.
The progress report also highlights the need for councils to address gaps in the market – particularly in the private sector – for services older people want to buy.
“The failure of the market to provide the types of products and services that older people look for has been seen as a contributory factor to maintaining the status quo,” it says.
Simpson points out the importance of stimulating the local care market to tailor services to individual needs.
“One of the things has been a big change in block contracts and allowing people to have their own individual contracts with providers,” she says. “That’s happening in a number of places now and it seems to be working extremely well.”
In Manchester, one of the pilot authorities singled out for praise in the progress report, contracts for home care contractors have been tailored to the personalisation agenda, with providers running localised services with flexible hours.
Director of adult social care Caroline Marsh says much of the council’s success is down to development of what she calls a “whole-systems approach” before the IB pilots, which received strong political support from councillors.
As part of this, Manchester created a re-ablement service to provide intensive support in the first six weeks of an older person asking for help and, as a result, funds that previously went on personal care have been freed up.
Marsh says: “You can’t do little bits in isolation – we wanted a whole planned and managed transformation of the way we do things. More than 40% of people who have re-ablement in Manchester don’t need long-term support, and of those that do, over 50% have reduced care.”
Small things, she points out, can also make a big difference for older people. Some may not think that people over 80 would use webcams for keeping up with their friends, but they can and do through IBs. “Our staff are now more confident in suggesting new things to do – people are buying computers to do shopping online and social networking, or scooters to help them get out and about. Buying services we wouldn’t have provided before, like gardening or having the house redecorated, frees up the carer more often than not.”
Invest in infrastructure
Her advice for local authorities implementing IBs for older people is unequivocal: “You have to be prepared to invest in capacity to support it.” She points out that Manchester created a team to support the process of change. “We would never have done this if we had expected people to manage the change as part of their day jobs. We’ve got more than 2,000 IBs in place now, and 647 of those are older people. When the evaluation research was done, there were just 89. It’s grown after a lot of work in re-designing the system.”
John Dixon, president of the Association of Directors of Adult Social Services, has been involved with the IB pilot at his local authority, West Sussex. Like Marsh, he has learned some valuable lessons along the way, so does he think that IBs will be rolled out successfully for older people across the country?
“I think they will,” he says. “Already it has moved out way beyond the original pilots. Nobody has the complete answer, we’re all finding our way and learning from each other.”
For expert information on IBs go to https://www.communitycare.co.uk/Articles/2008/10/23/109083/personalisation.html