The NAO found that the department needs a better understanding of the different ways personalised care can be implemented, in particular when taking into account different funding concerns.
Personal healthcare budgets, introduced in 2007 and made mandatory for all eligible users in April 2015, can be managed by local authorities, a third party that commissions services for users, or given to users and their carers as a direct payment.
The department hopes personalising commissioning will increase value for money by improving patient outcomes. But the NAO said that cash-strapped local authorities, who have seen a 7% real-terms reduction in spend on adult social care since 2010, on the other hand, are focused on cutting costs, potentially putting those same outcomes at risk.
Despite its emphasis on improving patient outcomes, the NAO found the department doesn’t have a full understanding of how personalised care can lead to improvements for users.
“Giving users more choice and control over their care through personal budgets and direct payments can improve their quality of life, but much of the positive evidence for personalised commissioning of adult care services is old,” explained Amayas Morse, head of the NAO.
The watchdog said that under some circumstances personalised commissioning can reduce the cost of care. For example when some 120,000 users use their direct payments to employ assistants to provide personal care rather than using home care, this is generally cheaper, it noted.
However, as acknowledged in The Care Act guidance, this is not always the case, and responding to users’ needs and their desired outcomes can increase the cost of care too.
Despite this, the department has not investigated how services can be personalised when money is tight or whether local authorities, some of whom the NAO found to be struggling to support and manage their local care markets as well as might be expected, can achieve the spending reductions they have forecast without putting user outcomes at risk.
“It is unclear how government will square the circle of local authorities having to deliver personalised care while substantially reducing spending,” said Meg Hillier, chair of the Public Accounts Committee, noting that local authorities are relying on these savings to balance their budgets.
She said more needs to be done to ensure the DH fully understands how to deliver personal budgets before implementing plans to extend them into healthcare more widely.
A DH spokesman said the department takes its responsibility to understand system-wide pressures and the impact of personalised commissioning seriously, and that it would consider the NAO’s report carefully.
He added that the department made clear the cost of personalised care packages would vary and it was not their responsibility to check local authorities’ efficiency plans.
Izzi Seccombe, community and wellbeing spokesperson for the Local Government Association, highlighted the increased funding pressures local authorities face.
Significant savings need to be made and recent measures, such as the ability to raise council tax by 2%, do not go far enough, she said.