One of the liveliest debates in social care at the moment concerns how personal budgets benefit different groups of people in different ways. Investigating this issue in Essex, we found that while personal budgets nearly always contribute to a positive experience for all, there was a marked difference in the benefits derived by older people compared to other users.
For more than three years, the Office for Public Management, in conjunction with Essex County Council and user-led disabilityorganisation ecdp, has been working with social care users in Essex examining the impact of personal budgets on the lives of the people who use them. With the government wanting all those eligible to be on a personal budget by April 2013, there is a pressing need to understand the impact of personal budgets and how best to support people in using them.
The rationale behind personal budgets is a simple yet powerful one: to empower social care users by giving them greater choice over the services they receive. In practice, this enables people to take direct control over the money allocated to them. They can use this money to pay for traditional care services, such as a personal assistant or carer, as well as less conventional services, including leisure activities and opportunities for personal development.
We observed that many older personal budget holders and their families prefer to use the new system to purchase more traditional forms of care, in more positive ways. For example, a lot of older people use the increased choice their personal budget offers to secure consistent, flexible daily care from the same carers or personal assistants; whereas previously they were reliant on whoever the care agency happened to send at whatever time.
Older users also benefited from being able to employ someone directly, rather than relying on family members, citing the positive effect they felt this had on their dignity. One husband, who no longer had to act as the main carer for his wife, said: “As a man dealing with a woman, I find it’s [washing and bathing] not the sort of thing I want to do, but when a woman comes in and deals with another woman it’s totally different … I feel that that is the right way to be.”
On the other hand we found family members, who manage personal budgets on behalf of younger people with learning disabilities, instead favouring employing someone with intimate knowledge of their child’s needs, often a family member themselves. A mother of a young person with learning disabilities told us: “I tried different people but Sarah is a very, very difficult child … So I’ve got to use my other daughter because she listens to her, she’s strong with her, she knows her, she’s confident with her.”
We also found that personal budget holders of working age were far more inclined to use the system creatively to access community services; such as swimming, bowling, gym membership, or theatre trips. Some even reported how these activities have had a significant positive impact on their physical health, as well as making them feel more independent and improving their overall wellbeing.
Inevitably, when introducing a new system on this scale there are going to be areas for potential improvement. The processes of securing, setting up and especially reviewing a personal budget can be more difficult and protracted than users would like. For those people who have independent sources of support – such as user-led, or advocacy organisations – these issues can be mitigated or avoided. But not everyone has this access.
The local market also has a big role to play in ensuring the services wanted by budget holders are available. After all, a personal budget is only as useful as what it can be spent on, and supply in some cases needs to catch-up to demand.
Overall though, what we’ve seen in Essex has been incredibly encouraging. The lessons we’ve learned have already been used to make the system better for the people who live there. We hope the findings of this study can be used to support service users, local authorities and providers across the entire country, to ensure the continued roll-out of personalisation is a successful and empowering process.
Sanah Sheikh is an associate fellow at OPM and specialist in qualitative research with vulnerable and ‘hard-to-reach’ groups