Is the drive for more personal budgets a cover for service cuts?

Ministers want more users to access personal budgets but councils must convince sceptics that this is not a cover for cutting services, reports Jeremy Dunning

(pictured: Peter Koudellas has used his budget to support his hobbies of art and photography. Pictured with his mother Maria. Pic by Neil O’Connor)

Ministers want more users to access personal budgets but councils must convince sceptics that this is not a cover for cutting services, reports Jeremy Dunning

“It’s disgraceful. We need to be far more critical of public services. Why are they not willing to let go of control?”

These are the words of care services minister Paul Burstow as he bemoaned the fact that only 13% of adult service users and carers in England had access to personal budgets in 2009-10.

Burstow’s ambition is for all users to be on a personal budget. And this is likely to form a cornerstone of the government’s forthcoming vision for adult social care and “concordat” with local government leaders on delivering the personalisation agenda.

The jury is out on whether he was right to focus on the percentage in such a fashion, though sector leaders agree numbers ought to be higher.

Burstow’s belief, shared by the Association of Directors of Adult Social Services, is that personal budgets and the personalisation agenda improve the quality of care for service users by increasing choice. He told Community Care this month: “Our view as a government is that more direct payments, more personal budgets will open up the possibility of far more providers, far more organisations to provide the support that people actually want.

“It really allows a greater diversity of providers to come into the marketplace to meet need. Choices can expand significantly if people actually have access to these resources and make those decisions for themselves.”

The Labour government set councils a milestone of having 30% of service users on personal budgets by April 2011, one of five priority areas for the delivery of personalisation.

There is broad agreement that most authorities will meet this, and Adass president Richard Jones says it is now looking towards 100% take-up within two years.

In theory, this target is achievable as councils transfer existing service users to personal budgets after annual care reviews, though for many it will be a step-change. Half of councils had less than 10% of service users and carers on personal budgets in 2009-10, while one in eight had more than 20%.

There are many reasons for this variation, says Jeff Jerome, national director for social care transformation, who is tasked with helping councils deliver personalisation. These include the speed at which councils embarked on implementing personalisation; the level of priority given to the different milestones; some councils finding the delivery of personal budgets difficult and some building too much complexity into the process.

Slow performers pick up the pace

But there is evidence that slow-performing authorities are picking up the pace.

“There are more local authorities taking the baton,” says Andrew Tyson, adult social care lead at In Control, the charity that has pioneered personalisation. “My recent experience is that some of those who were slowest to pick it up are saying this is happening and we need to do it properly.”

However, the proportion of service users on personal budgets is not a measure of the level of choice and control they have over their care and support, and social care leaders say the focus on the 30% target has not been helpful.

“With hindsight it was a misleading indicator,” says Andrew Cozens, group strategic lead for adult social care at the Local Government Association.

Choice and control

He says the forthcoming adult social care vision and revised concordat will reassert the significance of choice and control.

Delivering this will require peer-based support or brokerage to help service users make more creative use of resources and a range of options in the market to allow them to purchase services that make a difference.

Where there may be difficulties for the personal budget and personalisation agenda is in public opinion at a time of swingeing cuts to council budgets on the back of last week’s spending review.

These cuts are unlikely to affect rollout of personal budgets, but there is a danger that personalisation could be perceived as a cover for social care cuts. The closure of day centres in some areas on the back of personalisation is giving this view currency.

Jones says: “The financial pressures will require some very tough decisions and a step-change in what we’ve done to date.”

Social care consultant Jeremy Cooper, of iMPOWER, acknowledges that councils will have to strike a fine balance between saving money and maximising choice, and will have to get the “narrative right” when selling this to the public.

“This is ‘we are making the system fairer and more transparent but we are also going to be taking more money out’. Getting that story out will be tough.”

Comments on CareSpace, Community Care’s online forum, echo these difficulties. Nedd Ludd Carer, a carer and blogger who looks after a disabled son, says: “We’re being forced to take direct payments against our will. Personalisation is the only game in town now, and its one-size-fits-all matrix doesn’t suit everyone.”

This suggests there is still work to be done to win over the hearts and minds of sceptics, which is where Burstow’s ambitions may face their toughest test.

Case study: ‘It’s a big change for staff but also for customers’

Manchester is a frontrunner when it comes to personal budgets, which it refers to as individual budgets.

In 2009-10, 59% of service users and carers in Manchester were receiving a budget, the highest figure in the country. It was one of the 13 individual budget pilots from 2006-7, which has given it longer to develop self-directed support.

In Manchester, all new entrants into the adult care and support system receive a budget by default, which they can take as cash, as a virtual budget managed by the council or as an individual service fund managed by a third party.

Community Care research has found that a significant minority of social workers are sceptical about the benefits of personalisation. However, Manchester says social workers have embraced the change and the main challenge has been getting service users to do the same.

“Authorities have to understand this isn’t just a big change for staff and the workforce but for customers as well,” says Diane Eaton, head of business development for adult social care at Manchester Council.

“You’ve got to work at the customer’s pace and you’ve got to put support measures in.”

Among support services are payroll services, a criminal checking service and a peer support system. It has also been trialling training for personal assistants.

Service user Peter Koudellas, 54, began receiving a personal budget in 2008.

Koudellas, who has learning disabilities and a number of health problems, lives with his parents and needs help with most of his personal care needs. These are met by family members, particularly his mother, Maria, 78. He also has a personal assistant who sees to his social needs, such as attending an art class or museums.

This has worked better for Peter than traditional day centres and he has used his budget creatively. He even bought a digital camera, which has led to him exhibiting his work, shot when out and about with his PA.

Earlier this year he spent a week away from his parents for the first time and used part of his budget to rent a holiday cottage in south Wales, instead of traditional respite, with his sister providing the support.

The result has been a growth in his self-confidence and independence, while his mother has time for herself.

She says: “Peter and I go to an art class on Mondays and his PA comes with him to support him so I can get on with my work. I couldn’t have done that in the past.

“I’ve said it’s time for me now. As regards Peter, it’s improved his life and he’s a different person.”

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