Personal budgets, and direct payments in particular, can enable those within the social care system to use funding in innovative ways. But support planning and a well developed provider market are needed to make the process work effectively
Personal budgets are not offering those who need help from social care services as much choice and control as they could, Ipsos Mori’s qualitative study published for the National Audit Office has found.
Personal budgets aim to provide users with greater choice and control over their care, and the government wants all users of adult social care services to be in receipt of a personal budget by 2013. Users can receive a direct payment, have their budget managed by their local authority or a third party, or get a combination of these two.
The devil is as always in the detail; not all personal budgets are the same. Our study found that very few managed budgets really provide choice and control to their users. Their care provision usually continues in the same way as prior to the move to a personal budget. This raises concerns that some local authorities could be recording service users as recipients of managed personal budgets to achieve the government target, but not enabling people to take advantage of all that personal budgets can offer.
Many who receive care and support say they are primarily concerned with the quality of care they receive – but they are not always aware of what they could be missing out on by not getting choice and control over their care and support. Indeed, the study found examples of people who were given choice and control over their care and achieved much better outcomes than was possible under their previous service provision, and were happier with their lives as a result.
In most of the six local authorities involved in the study, only direct payments seemed to offer genuine choice and control.
However, some of those receiving care say they feel put off from taking up a direct payment by the added responsibility and the work involved, for instance to recruit, employ and manage a personal assistant. More importantly, some take up direct payments without being aware of the risks involved, until things go wrong with the person they have hired. The lack of information and support available to face up to these risks and responsibilities leaves some budget users in vulnerable situations.
Support planning is therefore instrumental in enabling those receiving a personal budget to get the most out of it. Unfortunately, some local authorities do not yet have enough capacity to offer effective support planning to all their personal budget users.
The move towards personal budgets and self-directed support in social care represents a massive cultural change, not just for the person receiving care, but for the workforce tasked with delivering it. Local authorities will need time to train their staff and adapt their work practices.
Personal budgets in adult social care offer great potential for people to achieve better outcomes, but much work is still needed to ensure that this is more consistently the case. In particular, more needs to be done to improve information provision, advice and support for budget users, and to develop the market of care service providers locally.
The recent restructuring and budget cuts that many local authorities adult social care services have experienced do not make the task any easier.
Claire Lambert is associate director at Ipsos Mori. Forty-eight face-to-face qualitative depth interviews were undertaken with users of personal budgets across six local authorities in England, plus six telephone depth interviews with the lead professionals on personal budgets in these authorities. Fieldwork took place between May and July 2011.
