A few weeks ago at Community Care Live, I (Martin) did a light-hearted mind-reading trick with my audience of mainly adult social workers. I asked them whether they felt personal budgets were benefiting the people they supported and asked them to divide themselves into pessimists, optimists and those in the middle. I then asked people questions about why they had placed themselves in each group before showing some slides about delivery challenges and possibilities that largely replicated their comments. This suggests to me that we now have a pretty consistent understanding of what is working and what needs fixing with personal budgets.
It was also very noticeable that very few identified themselves as pessimists on personal budgets with a relatively even split between optimists and those in the middle. This surprised me a little as it did the chair, Mithran Samuel. I guess we were both thinking that those at the sharp end, having to deal with building personalisation at a time of reducing resources and too much silly bureaucracy, may be entitled to a little pessimism. It was heartening though to see the resilience and determination of our profession and their commitment to personalisation, not as a government policy, but as a means to help people get better outcomes.
The mind-reading findings are largely replicated by the latest Community Care personalisation survey, which follows on quickly from the National Personal Budgets Survey (NPBS) undertaken by In Control and Lancaster University and published by Think Local Act Personal. This gives us a chance to put the findings side-by-side.
The NPBS used the Personal Budgets Outcomes Evaluation Tool (Poet) to ask local people using personal budgets about their outcomes and experiences – over 3000 personal budget holders and carers from 22 authorities responded. It is interesting to explore where the views and experiences of personal budget holders and social workers coincide and diverge. At a local level this is how Poet is used – local practitioners, managers, personal budget holders and carers come together to look at the data alongside their experiences and practice in order to agree how to make improvements.
Community support needs
Over two-thirds of social care professionals in the Community Care survey said they needed more training in relation to helping people build personal and community networks and in relation to knowledge of local or non-traditional services. Looking at the Poet data, accessing community was the area in which the fewest personal budget recipients reported good outcomes.
Here the experiences of social workers and personal budget recipients are aligned. Looking more closely at the responses to Poet, those people who said their views had been taken into account in support planning were more likely to report good outcomes in accessing their community. When helping people support plan, listening and responding to them seems to be important in helping them build community connections.
It comes as no surprise and is a now consistent finding that social workers complained strongly in the Community Care survey about bureaucracy, with two-thirds saying that assessment paperwork was too complex for potential personal budget users to complete themselves. Here again there seems to be a shared experience with people using personal budgets and their families.
The key themes to emerge from the free text responses by carers and personal budget recipients in the Poet survey were around similar frustrations with various forms of bureaucracy and restriction. This is in itself a concern but more so when you consider that it is increasingly clear that good processes clearly leads to good outcomes. For example, those people responding to the Poet survey who reported that the self-directed support process was easy were significantly more likely to report good outcomes than those who said the process was difficult.
It should be clear to local authorities that their staff and the people they serve are speaking with one voice: there is an urgent need to simplify processes and to make sure the view of disabled and older people are heard in planning.
Social workers optimistic – but less so than disabled people
On the issue of outcomes more than twice as many social care professionals in the Community Care survey believed that, in the medium-to-long-term, personal budgets would be of benefit to people than did not. This is consistent with last year’s findings and might surprise some in the context in which personal budgets are being implemented.
Social workers are less confident than those in receipt of personal budgets in the Poet survey, however. It might make social workers feel better to know that personal budget recipients in the survey reported significantly positive responses in a majority of life domains. The difference in levels of confidence between personal budget recipients and practitioners is consistent with survey responses in those areas where Poet has been used with staff.
Reform – don’t scrap – the RAS
The issue of resource allocation systems (RAS) continues to be a great source of concern in the Community Care survey and we feel that this issue is finally starting to come to a head in councils. We know that personal budget users and carers feel the same.
It is particularly worrying that only one in 10 social care professionals responding to the Community Care survey said the RAS was easy for people to understand. The transparent, early allocation of resources is key to personalisation working well. Without this transparency and openness, personalisation is in danger of being merely another policy reform where little really changes.
Our fear is that a combination of the dire resource situations councils face and frustrations with complex RAS systems may lead to some councils throwing the baby out with the bathwater. At a time like this it is really unhelpful when commentators simply say RAS aren’t working without offering any serious alternative. They ignore the reality that there always has been some form of RAS – usually secret. Abandoning the principle of people knowing what money is in their budget is likely to seriously undermine the sharing of power that is at the heart of personalisation. Indeed both the Poet survey and the evaluation on personal health budgets confirm that for many, this is an important factor in predicting outcomes.
In Control has worked for a decade trying to help local authorities be bold in their personalisation strategies, but RAS has proved to be one of the hardest challenges of all, with a tendency to bureaucratise. There are many different approaches being taken across England and they continue to evolve. In the autumn, In Control will be inviting councils who understand the need to retain the core principles of self-directed support to work with us on a “RAS Challenge”.
We propose to work with people to develop RAS approaches, using a simple ready reckoner matrix to produce an indicative budget linked to set funding levels that people can plan within. This can easily be developed from existing personal budget costs. Going forward we believe three key principles are vital:
- Transparency: The RAS methodology must be in the public domain at a community level.
- Simplicity: The process must be simple and the individual and their family must know how the decision was reached for them.
- Sufficiency. The local authority must publish clearly the outcomes they will support people to achieve and the budget must be enough to reasonably achieve these.
Martin Routledge is head of operations and John Waters research and evaluation lead at In Control
More on this year’s Community Care personalisation survey
Training gaps, cuts and paperwork damaging personalisation, warn social workers