Personal budgets emphasis ‘risks excluding complex needs’

The emphasis on providing personal budgets for all risks failing to deliver personalised care for people with the most complex needs, a report from Demos warns today.

The study, sponsored by Sue Ryder Care, warned personal budgets in general and direct payments in particular may not be the most effective way to provide personalisation for groups including people with palliative care needs, with reduced capacity or in collective settings.

It raised concerns that the government’s target of having personal budgets for all council-funded service users in England by 2013 risked “excluding those less able or willing to engage with the personal budgets process from the personalisation agenda”.

Calling for a “personalised approach to personalisation”, it said a wider range of approaches should be adopted beyond personal budgets to ensure person-centred care for all.

Those with the most complex needs often needed services that cut across health, social care and housing, which it was difficult for personal budgets to integrate, found the report.

The government’s emphasis on having most people on direct payments risked excluding those who lacked capacity and leaving other types of personal budget – such as those managed by councils, providers or families – under-developed.

Although it said personal budgets could work in residential care – as the government intends – other ways of personalising care could be pursued such as giving residents a democratic say in the running of homes.

It said relationships with staff were key to delivering personalised care for those with the most complex needs, highlighting the importance of reducing turnover and a positive staff culture that encouraged risks and choices on the part of service users.

It also pointed out that specialist palliative care was the “gold standard of personalised care” despite personal budgets being difficult to administer in these settings.

The report’s recommendations included:

● For providers to receive support to transform their financial systems to enable them to offer service users individual service funds to give them choice over their support.

● More training for staff in helping people make decisions towards the end of life.

● Increased support to help people move from residential care into supported living.

● Giving care home residents the right to have a say over key aspects of homes’ running, including recruitment.

● For recruitment and retention policies to prioritise an enabling and empowering attitude on the part of staff and good relationships between staff and service users.

The report was welcomed by Think Local Act Personal, the sector coalition charged with supporting the delivery of personalisation.

Programme manager Martin Routledge said that it raised “important issues” and that it was right to broaden thinking about personalisation beyond direct payments and personal budgets.

He added: “We can see the benefits of direct payments, that more people could benefit than now but there will be some people who won’t benefit from a direct payment. No-one should be forced to take a direct payment. We should ensure the council-managed [personal budgets] option is authentic. An important way of making sure that this is the case is for local authorities to use some means of checking from the perspective of people and their families what the outcomes are and their experiences and make changes.”

The Demos report is being released at the National Children and Adult Services Conference, which opens today.

See more stories on the NCAS conference 2011

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