Rethinking Personal Budgets in Social Care

Reading Community Care, I saw that NLGN (New Local Government Network) have published a report stating that the ‘rush towards personal budgets’ must be slowed down.

I’ve tried unsuccessfully to find this report on the NLGN website but haven’t been able to do so am reliant on the third party reports from Community Care but I thought it raised a number of issues that are worth pondering.

The author of the report, Daria Kutsnetsova says in the article

.. in a lot of cases, personal budgets do not mean choice and control for service users because people are not given the choice of direct payments. Their budgets are handled by a care manager, which can be a choice in the personal budgets system, but in many cases it is not a choice and people are receiving the same care they were always receiving, she said.

It’s just called a ‘personal budget’ to push this government target,” she added.  (my emphasis)

I could have saved her a lot of time and effort and told her exactly that in within five minutes of meeting her without her needing to carry out the research as, within local authorities, we’ve known very well that the targets are being met not by rolling out better ways of working but by fiddling around with paperwork and leaving most service users with service delivery that is no different to how it was in the previous system and we are merely calling it a ‘managed personal budget’ but I am glad the research has been evidenced and will be reported – even if I can’t find the actual report! I would only dispute that the choice of direct payments IS given – certainly in the situations I work in but often it is neither not wanted or not appropriate if someone is not able or willing to manage the direct payment themselves.

So we have a two tier system of delivery. Those who get better, more personalised services and those who get exactly what they have been getting for years with a different name and more complicated paperwork. Magic. A personal budget.

How did this happen? How was this allowed to happen in the so-called ‘transformation’ process?

Here’s my theory – and it isn’t backed up by a think tank or research.

We have had direct payments for years – going back to the Community Care (Direct Payments) Act 1996 and predating that the way the ILF (Independent Living Fund) was administered shadowed the system of direct payments. Coming into the new ‘agenda’ wasn’t completely ‘new’ because the system had been in place and we knew what worked and more importantly, we knew what wasn’t working at that time back in the 90s.

We knew direct payments worked very well with adults with physical disabiltiies and adults with learning disabiltiies because they had greater amounts of funding linked into their needs and often much stronger advocacy support if necessary.

We knew that service users in mental health services and older adults were behind these groups in terms of take up.

But when the agenda pushed forward, it pushed forward in a blinkered and unadventurous way and no effort at all was made to engage the groups of users where there had been a lack of direct payments previously.

So now, years later, think tanks are actually realising this. I could have told them this 5/6/7 years ago (and in my defence, I actually did).

Community Care states

The think-tank’s analysis of council data showed that each additional direct payment issued to someone with a learning disability between 2002 and 2012 added between £15-25,000 to a council’s overall expenditure on learning disability services. Care for people with learning disabilities accounts for more than 23% of the adult social care budget, the report added, and represents the fastest growing part of that budget in the past five years.

Think about that £15,000-25,000 extended to older adults needs and you’ll see where the difficulty comes in on a practical level and why we may be being blinded by false hope in relation to this agenda. Perhaps, whisper it quietly, there’s a reason why the same effort wasn’t put in to extending the programme and delivery into other groups and it is related to those figures.

This week, the Alzheimer’s Society also published a reportabout personal budgets  but it focused (unsurprisingly) on the lack of take up of direct payments of people with dementia. I have found the report this time but haven’t yet had time to read through it extensively.

One of the points I did pick up (and this reflects my experience in this area) is that people with dementia are being pushed to fit into a system that hasn’t been designed to meet their needs.

I’ll quote directly from the report as it puts it perfectly.

.. people with dementia can find the process of acquiring and using personal budgets difficult. In particular the current system appears to have been geared towards particular service users. … some organisations felt they were still struggling to develop their processes and systems, along with mainly concentrating on service users categorised as having physical or learning disabilities or older people

See – no mention of mental ill health either but the report continues.

There was a strong message that local authorities were not ready to look at personal budgets for people with dementia as it was to be seen as ‘too complex’ and ‘too risky’

I think a lot of those points carry over in mental health services in general.

So how did this happen? I think we have been badly served by the Department of Health and various organisations concerning themselves with devising policy around the roll out of personal budgets. They had their own agendas rather than the agendas of all service users at heart and wanted their own model of personal budgets to be rolled out – rather than looking – 10 years ago, not right now, not today, at what needed to be done to make the system fair.

It’s taken a long time to get this point across that replacing one ‘one size fits all’ type of care management for another type of ‘one size fits all’ care management isn’t the answer if there is no increased sophistication that can allow more flexible support planning and service delivery for all – but I think.. possibly.. the message might finally be getting through.

The frustrating thing is that I saw this from the ‘front line’ five or more years ago and have been trying to say it ever since. So much for cutting edge research! Better late than never though – mission now is to actually use this evidence and deliver.

If there is ever a claim to be made for more creative, more collaborative planning of services and service delivery it is this. I believe we would be at a different point if more people had been not only better consulted but listened to more intently when these policies were being devised.

One thought on “Rethinking Personal Budgets in Social Care

  1. My thoughts about this issue are that it has been presented in such a way that it is difficult to be critical of it. Who wouldn’t want greater choice and control? Of course people would want that but here is my question; SDS, personalisation etc involves service users services packages of care changing, regardless of how well change is managed it is a threat and I am not sure how much attention has been paid to how threatened people feel. Perhaps the low take up in some areas relates to this. Equally this appraoch benefits government and LA’s financially so it is unsurprising they are getting right behind, especially in these thin times.
    There is also the issue about vulnerable people being assessed by whom? In my experience it is not always social workers, sometimes it is a range of professionals and para professionals, services are then delivered by another range of providers, some charities, some social enterprises others private businesses. The market place becomes swamped and I am not always sure that purchasers are guarnteed quality, nor do purchasers always seek quality.
    We seem to have forgotten that one of the defining charactersitics of the people who recive SDs is that they are vulnerable, they often rely on good quality non partisan advice and can we always say that this is what people recieve? I’m not convinced. Finally and this is my major point whay has happened to the state’s responsibility? to society’s responsibility to vulnerable and disadvantaged people? The state should have a greater role than that of a broker / enabler otherwise the state can be accussed of ibeing complicit in increasing vulnerability.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s