Personalisation , Personal Budgets and Demos

I have a lot of thoughts on the push towards the personalisation agenda in general, unsurprisingly as care and support planning plays a large role in my job.

Over the last week, a variety of meetings that have taken place which have pushed this issue to the forefront of my mind locally and have given me time to pause and think, not only about the focus of the agenda and where we are along the path but also where we are going.

It has been frustrating. As I noticed in a Twitter-related conversation yesterday, the language almost seems to have a form of it’s own. I start mentioning PBs, IBs, SDS, RAS, ISF, SSAQ, DP (see Glossary below)  assuming the person beyond knows exactly what I mean in each of those circumstances and you realise how over-complicated what should be a fundamental principal about putting the keys to the power dynamic into the hands of those who use the services.

Rumbling in the background is the government agenda to push personal budgets (PB) as a way to deliver ‘personalised’ care and a push into ‘health budgets’. I think there have been a number of issues that have either not been addressed or pushed under the proverbial carpet in the meantime.

I have tried to express some of my frustrations internally but often came up against the ‘you are either for us or against us’ mentality to those promoting the push towards personal budgets for all at any cost – so by raising criticisms and concerns, that automatically seemed to push me into the ‘controlling professional’ category who obviously just didn’t want to relinquish what I saw as my ‘right’ to dictate forms of care to service users and carers. I dispute that of course. I was one of the few care managers who actively moved many people onto direct payments historically. I am very well aware of the benefits of direct payments but the move towards direct payments for all I felt, was pushed by a few particular groups of people and I was concerned that it was moving the universality of self-directed support away from a large group of people I work with who do not want direct payments regardless of how much support is offered.

I was delighted to read over the past day or so, a report by Claudia Wood called Tailor Made – it’s a long document and my reading has so far been on a superficial level (warning – um. if you are going to print it out  be aware that it’s.. er.. well over 200 pages.. )

It is a document that almost made me cry with joy because it addresses in a more coherent and less histrionic way than I have, exactly my concerns about the way the personalisation agenda has been couched while remaining (as I am) absolutely positive about the process and idea.

We have been too fixated (and Paul Burstow is guiltiest of this) of pushing personal budgets delivered through direct payments as the ‘gold standard’ option of providing self-directed support.

As Wood says in the executive summary

‘The emphasis placed on direct payments as a primary form of personal budget is too restrictive and risks excluding large numbers of people who do not have the capacity or desire to use a direct payment. No one should be excluded from having a personal budget if they wish , but to make personal budgets as accessible as possible for all groups and in all care contexts, we need to think beyond direct payments as the only, or even the preferred, form of personal budget’

For me, Wood expresses clearly my own thinking on this matter. So much energy has nationally focussed solely on direct payments as a delivery mechanism (which is fantastic for some) that local authority managed budgets have become a second-best, second-class service and ‘transferring’ support from standard support to a ‘so-called’ personal budget managed by the local authority has been a fallacy and a lesson in tick box culture at its worst. The issue is that it is  social workers, yes, like me, who have been complicit in this deception. I tick a few boxes and automatically Mr Smith has a personal budget managed by the LA where previously he had a directly provided care package. The delivery is the same service, by the same people in the same way,  but now, after these boxes have been ticked (because he expressly does not want a direct payment) – he is suddenly on the local authority ‘figures’ as having a managed personal budget.

Whereas Mr Brown next door, who has a service of the same cost but a direct payment, is able to access a personally chosen personal assistant and goes to a sports centre instead of a day centre etc etc.

This seems inherently wrong but it is merely because the managed support is so poorly serving Mr Smith. The answer isn’t to give Mr Smith a direct payment because – and this is the issue that Burstow seems to ignore – he doesn’t actually want it.

Wood writes

‘Local authority commissioners… must.. scrutinise their ‘managed budgets’ processes, to ensure they deliver choice and control and are not part of a tick box exercise’

Finally, it feels that someone ‘out there’ is listening to our worries and genuine concerns about a system that seems to have been designed to deliver inequity.

She goes on to say

‘An inclusive personal budget strategy is… one where more innovative uses of personal budgets are developed’

And that, I think is the key. We have had direct payments for a long, long term. Where the real innovation is needed is on pushing out new ways of delivering personalised care within the context of managed budgets.

Wood helpfully specifies the different ways that personal budgets can be used saying

‘There are six forms of personal budget used in social care in England

- a direct payment (held by individual)

- an indirect payment (held by a trusted other – eg a friend of family)

- a trust fund (held by a trust of people)

- a brokered fund (held by a professional broker)

- an individual service fund (held by a provider)

- a care managed fund (held by local commissioners) ‘

and then goes on to say

‘There is a danger.. that as the Scottish and English governments focus on direct payments as the default and preferred modus operandi for personal budgets (in social care at least), people may assume these other forms of personal budget are not capable of ‘real’ personalisation.

This can become a self-fulfilling prophecy, with providers spending less time developing their systems for these other forms of personal budget and them becoming tokenistic forms of personal budget, which do not offer real control’

If Claudia Wood were in the same room as me, I would applaud her. THAT for me is the crucial point in all of this. I want to deliver more personalised services but the only tools I have been given within my local authority are direct payments (or indirect payments)  or care managed fund. All these other options have been theoretical and none have developed any flexibility.

I want to see as much effort nationally in developing new ways of delivering services through all these methods and I want Burstow to at least read this report to have an understanding about why he seems to be fixated on the ‘direct payment or bust’ preferred model.

Of course, when it works, it is fantastic but we need more work on the other models too to ensure an equitable system for all needing care.

As for the report, there is so  much more in it than I’ve touched on about personalisation in residential care particularly. If you have any interest in the subject read it.

GLOSSARY

PB – Personal Budget (delivered by social care – (or health in the future)

IB – Individual Budget (envisaged to include different income streams eg health + social care budget)

SDS – Self Directed Support

RAS – Resource Allocation System (‘points’ that are translated into cash to make an ‘indicative budget’ after an assessment)

ISF – Individual Service Fund where a provider holds the budget on behalf of a service user

SSAQ – Supported Self Assessment Questionnaire – the way that needs are often assessed initially.

DP – Direct Payment

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10 Comments to “Personalisation , Personal Budgets and Demos”

  1. http://www.guardian.co.uk/society/joepublic/2011/oct/21/welfare-reform-disabled-people

    You either work or you’re worthless, as for PIP replacing DLA it will mean only those with significant physical difficulties will get it, and only to pay for carers for personal care. Mental health is being increasingly excluded, self-harm for example is being excluded as a descriptor – in which case why bother having ‘danger to self’ in the MHA, if it’s not deserving of welfare support then why section people for it? As people lose DLA they won’t be eligible for Direct Payments, at the same time travel cards are being withdrawn. They might as well offer state assisted euthanasia for anyone who’s sick/disabled/unemployed..

  2. I have a personal budget under camden councils implementation of the personalisation agenda: “Better Care Choices”. It took over a year from application to payment for this budget to be approved.

    I am considering moving house to a neighbouring borough.

    If I do move, I will lose this personal budget and need to reapply to the new Local Authority.

    Camden will continue to pay my personal budget for 6 weeks after I move in order to give the new Local Authoritytime to process me. However there is no garuantee that I will receive the same level of personal budget in the new Local Authority, or even that I will qualify at all.

    I use my personal budget to attend a mental health day service, and have a contract with them that I will attend for a set period.

    If I move and do not receive the same level of personal budget I will be unable to afford to attend the day service and may have to default on my contract with them.

    I feel trapped in my local authority, and unable to move.

    There needs to be more ‘joined up thinking’ between Local Authorities in the implementation of the personalisation agenda.

  3. I just find the whole thing ridiculous, needing a ‘personal budget’ to attend a day service which you have to be determined enough to apply for and wait for – cancer patients don’t have to do this – when my uncle attended a centre for a bath, hand massage and social contact with other patients he didn’t have to apply and wait for a budget to do so. I’m told some local Mind centres could start charging people to attend groups which means they may have to be in receipt of a Direct Payment. What next – personal budgets/Direct Payments for peer support?!

    • indeed, the service I attend is run by westminster mind. Currently it is free to users from westminster (they have funding from the council for 20 users) but soon that funding will be removed and all users will be expected to pay via personal budgets and the like.

      Because I do not live in westminster I already have to pay for the service via my PB.

      Under new legislation, only people in the severe or critical catagories of need will be eligable for a personal budget, which in turn means that people with moderate need will be unable to access this service. ‘Fortunately’ Camden has assessed me to be in the severe catagory so I am entitled to support, but many people will be losing the support they rely on in the next couple of years thanks to the personalisation agenda.

      • So many people are going to be left with bugger all, just discharged back to GP’s from CMHT’s which means zero support, and will not be viewed as serious enough to qualify for anything. Everyone is losing everything bit by bit – service support, Incapacity, DLA, travel cards, only abject crisis of the near sectionable kind counts for anything and even then only for a fixed period, there is no ongoing support.

  4. I agree Simon it is death by cuts and exclusions, I’ve never known so many people say to me privately and directly ‘in these circumstances I will take myself out because life will no longer be tenable’. I feel so helpless because I’m not a CAB trained advisor, solicitor etc, I don’t possess the skills which would be useful to them. Sometimes I think *if* people reach the point of no return for them then their last words should make it clear exactly as to why they have felt they’ve had no choice but to take that route. At least that way it can’t be officially denied

  5. The cuts are biting hard, that’s for sure. The eligibility criteria are rising higher and higher and the focus has been very much on the direct payment models of support but that doesn’t change the brutal facts that there is less money to provide the support that is needed.

    It isn’t the personalisation agenda per se that has created these problems however the focus has exacerbated them by making services (like the day centres) chargeable where they never were.

    The route we seem to be going down is turning everyone into a consumer with a price attached to everything even if they don’t want to be.

    • Personal budgets also have the side affect that it is easier to make ‘invisible’ cuts to social care. It creates a buffer zone between the cut and the final result.

      Individuals being paid less does not have an easily calcuable affect on particular services (though it obviously does have a serious effect), and it’s easier to put resistance to such cuts down to greed.

      Cuts to a commissioning budget on the other hand have obvious immediate impact on services, which is easier to organise opposition to.

  6. Physical healthcare isn’t as complicated as this though, and there are millions to pay ATOS and for endless appeals, a lot of money is wasted

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