The personal gets political, by Jamie Bartlett

6 Nov 09
JAMIE BARTLETT | Councils and care providers must understand how individual budgets will be used so they can tailor their services

Councils and care providers must understand how individual budgets will be used so they can tailor their services

The statement that adult social care is going through the most dramatic reform since the Beveridge Report is so oft-repeated that we are in danger of forgetting what this implies.  Social care transformation encompasses several strands – an increase in preventive services, a reduction in out-of-area placements and so on. But it is the introduction of personal budgets that monopolises the attention.

Thousands of older and disabled people have been offered a personal budget, and around 500 a month are taking them up. By 2011 at least one-third of all recipients of publicly funded care services in every local authority will be offered one.

Putting purchasing power in the hands of service users can lead to a better service for them, at a lower cost to the taxpayer. Other departments – and shadow ministers and advisers – are watching closely.

But behind this new dynamic is the blood, sweat and tears of practical change, as rhetoric crashes into reality. Within five years, 1.5 million people could be using personal budgets. Service providers are wondering how they will survive without the security of block contracts; and councils are working out what it means for their current commissioning relationships.

The most obvious question of all is: how will people who hold a personal budget want to spend it? The problem is, of course, we don’t know. The early indications from people already using them are not representative. Personal budgets have been disproportionately taken up by people with learning disabilities and often individuals who were quite unhappy with the services they were getting. Hence the early stories of people spending their personal budgets on football season tickets, which excited and terrified in equal measure.

Last month, Demos, together with Barchester Health, Castlebeck and four local authorities, launched the At your service report, which looks at how the introduction of personal budgets might affect the social care market. Between December 2008 and July 2009, we surveyed 263 people who were using health and social care services – but did not have a personal budget – to explore what prospective budget holders knew and thought about personal budgets.

Three immediate general findings stand out. First, there was a general lack of knowledge about what personal budgets were – approximately four in five knew either ‘nothing’ or ‘very little’ about them. Among older people, this was nine in ten. Unsurprisingly, therefore, people responded that they would need a lot of assistance in managing their own care, specifically knowing what to spend it on; extra help managing it; and, interestingly, help to spend it appropriately.

Secondly, half of people we surveyed said if they had a personal budget, they wouldn’t change anything. For many people – older people especially – change will be slow. Nonetheless, there is no room for complacency – half of our participants do want to change at least some aspect of what they get, and between 5% and 10% ‘completely’.

Thirdly, the research suggests there will be a sharp increase in demand for certain types of services. More people will want access to personal assistants, leisure services and education.

This all spells big changes in the social care market place.  It will become more varied, more unpredictable and more dependent on people’s changing demands. In short, it will become more like a market.  Providers will need to ask themselves whether their current services will be taken up and whether they will need to change them.

It will be no easier for councils, who have their work cut out to make sure that people are prepared to make the transition and that there are alternatives ready if they are not.  As they loosen their grip on direct service purchasing, they will have to ensure there is a vibrant market ready to respond to people’s needs. This will move commissioning from market-making to market-shaping.

At your service begins to explore these challenges ahead. We are planning to generate more in-depth market intelligence with other local authorities over the next 12 months. Social care is becoming a service where the individual gets more choice and control than ever before: we need to find out what they intend to do with it.

Jamie Bartlett is head of the independence programme at Demos

Did you enjoy this article?