Simplifying the personal budgets process for older people and adults with mental health issues

 With proper guidance about how a personal budget might be used, older service users can enjoy more fulfilling lives

The Social Care Institute for Excellence presents findings from research into supporting older people and adults with mental health problems using personal budgets

Case study: ‘Budget helped David socialise’

Joanne cares for her husband, David, who has depression and in the past has tried to harm himself. She has always prioritised his safety and finding ways to manage risks.

She had been concerned for his whereabouts, although, she says, “he has never been a risk to anyone else, at times he has been a risk to himself”. She was also constantly worried about him disappearing.

David’s social worker carried out a care assessment, asking him and Joanne questions to find out what support they required to meet their individual needs. This identified that David required support to go out and socialise. Once the social worker was aware of this, they suggested that David used a personal budget to hire a personal assistant to support him on outings. This enabled him to join an indoor bowling club in the village where the couple live and he now goes there three afternoons a week.

Joanne says that at first David was accompanied to the club, but as he began to feel more confident and made friends, he was able to go alone.

Eventually, David felt able to tell people about his mental health problems and Joanne was reassured that his friends at the club would let her know if he was having problems.

Joanne says: “Three times a week I get the freedom to do what I want to do knowing that he’s with people who would contact me if anything were to go amiss with him. And I’ve got the confidence to know that I’ve got a couple of hours to myself and he’s safe.”

Analysis

David’s case (case study above) contains many of the challenges that Scie’s report, Keeping Personal Budgets Personal, attempts to address. It was launched after an evaluation of the Department of Health’s individual budget pilot sites, which found that, although individual budgets could give people a greater sense of control and satisfaction with services, there were differences in the uptake and outcomes for older people and people with mental health problems.

Liz Newbronner is director of Acton Shapiro, one of the organisations that carried out the research, which involved local authorities, service users, practitioners, and support provider organisations.

She says: “Before this research there had been a lot of work done on the impact of personal budgets, but this looked in more detail at the processes of implementing a personal budget, and how these could be tailored to individual needs so that they work well for the service user.

“In this case we looked closely at older people and people with mental health needs and we found that, although the outcomes for different users may vary, the approach people wanted and the way they wanted to be treated was similar. This means the practical tips produced by the research can be taken on board by anyone who may be working with someone who needs a personal budget.”

Personal budgets were introduced as a key element of personalisation and, as the number of people using them grows under the government’s Think Local, Act Personal agenda, the biggest task for practitioners is ensuring holders receive a service that is tailored to their needs in terms of both processes and outcomes – hence the title Keeping Personal Budgets Personal. For example, no one should assume an older person is any less likely to want a direct payment (in which the personal budget holder manages their own money in cash) than a younger person.

Each personal budget holder should be given clear information about what is involved and, if they have capacity, should be able to make a decision based on their individual needs.

In David’s case the social worker took time to get to know David and his wife, Joanne, and find out what was important to them. This enabled the social worker to use their knowledge to suggest ways that these individual needs could be met, giving David his independence and Joanne some time to herself.

Key messages

Overall, the research highlighted a number of key themes and issues for the implementation of personal budgets, including:

● Promoting personal budgets and access to clear, accessible information.

● Integrated working and information sharing with health.

● Active outreach to marginalised communities through trusted networks and groups, which could include community groups or local services provided by voluntary sector organisations.

● Support plans accounting for carer role, and including a contingency plan within the budget of each individual.

● Improving the supply of support and service providers to enable choice.

● Maximising control regardless of how the personal budget is managed.

● Offering choice in the support available to manage the personal budget.

One of the challenges practitioners have found in implementing personal budgets for older people and people with mental health problems is that it may take longer to explain options to them.

Andrew Wells, who works in the Putting People First team in Lincolnshire, has been supporting staff who offer personal budgets to service users. He agrees that it can take time to get right, but the improved outcomes make it worthwhile.

“One of the most important aspects of implementing personal budgets is making sure that people understand the options that are available to them,” he says. “Providing clear information for service users that explains the benefits will help staff to implement these changes and save time.” Wells adds that his team is working with commissioners, providers and local community groups to come up with creative solutions to relationship working that will meet service users’ individual needs.

“For example,” he says, “we are developing an e-marketplace that people who use services and staff can use to easily find information about what services are available in the local area such as community support groups or lunch clubs. The e-marketplace can then be used by individuals and staff to offer choice and control around a variety of options available within their communities to meet individual’s outcomes.”

Wells says this manner of implementing budgets has been particularly successful. He cites some work carried out with an older man who was feeling isolated. Traditionally staff may have suggested the man should spend a couple of days a week in a day-care centre. “But after talking through his options with him,” says Wells, “the social worker found out that he didn’t particularly like social gatherings with people he didn’t know.” Local partnership working enabled the social worker to suggest that the man used his personal budget to buy a computer and take part in Age UK’s local silver surfing group, which trains older people with computers. “The gentleman now uses his computer to talk to his grandchildren on Skype,” says Wells.

Wells’s experiences of implementing personal budgets are common. Liz Newbronner says that the process of explaining the options available may be time-consuming. “However, [practitioners] preferred the outcome-focused approach and the flexibility it offered compared to traditional services, and said the time was well spent once they could see what a difference it made to people’s lives.”

Practice implications

The research indicated a number of steps which can be taken to avoid ­personal budgets becoming too administrative and complex and to promote person-centred working. The implications of this for personal budget practitioners includes:

● Acknowledging the central importance of the relationship between personal budget holders and the practitioner who supports them to plan their care and support. This human factor cannot be underestimated, so giving staff support, information, training and time to work properly with personal budget holders is crucial.

● Personal budget holders and carers need the freedom to get information, advice and support from other sources, but this should not be at the expense of the continuity that a practitioner can provide.

● Devolving as many aspects of the personal budget process as possible to local teams, support planning organisations and personal budget holders themselves has the potential to not only improve staff morale but also to reduce administrative costs and provide a more flexible and responsive service.

● A successful personal budget process isn’t just about what the local authority does. It requires a series of effective partnerships between both individuals and agencies, and these take time to establish.

FURTHER INFORMATION

➔ Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers,

➔ Personal budgets briefing: Learning from the experiences of people with mental health problems and their carers,

➔ Personalisation films on SCTV

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This article is published in the 7 April 2011 edition of Community Care under the headline “Simplifying the process of personal budgets”