Personal Budgets – Some thoughts


I attended some training on Personal Budgets a while ago. It was fairly comprehensive training that was surprisingly well-presented (it isn’t that I don’t always expect good training but sometimes it can be something of a curate’s egg.. ).

It leaves me in the position of being able to now set up pilot Personal Budgets, having a greater awareness of the process. I immediately, during the training, thought of two people whom I felt that this new system could benefit but first to the details.

Individual budgets or personal budgets as they are also known, are a key part of the programme of ‘Personalisation’ of adult care services. It is detailed in the ‘Putting People First’ paper but was first mooted in the 2005 Green Paper, Independence, Wellbeing and Choice. The idea is that the cost of the services will follow the individual and will involve different sets of choices about how that money is spent.

There is no doubt that the moves towards a more fine-tuned way of meeting needs opposed to making resource-led decisions about services that can be provided is a wholly positive outcome.

The idea is that you would start with a Self-Assessment Questionnaire which is completed either independently or with the support of either a care manager or an independent advocate (I am using ‘care manager’ broadly to mean an allocated employee of the local authority/health trust who would usually be setting up the care plan).

This questionnaire is then ‘validated’ by an employee who needs to ensure that the dreaded (in my view anyway) Fair Access to Care Services criteria are met and then a RAS (Resource Allocation System) defines an indicative  budget.

 

This budget is used to discuss a personal care plan with the service user and the idea is that the budget should not be a ‘cookie cutter’ type care plan but should indicate the person who needs the service within the financial constraints, of course. Care can be provided via a direct payment or the indicative budget can be used to purchase ‘in house’ services and a wide variety of mixtures in between. The people that I am considering taking through the process, as a part of the pilot stage, both really would benefit from more mainstream day time activities rather than going to the provided day centres (which are great, in their way, for people who enjoy them – and many do).

One person wishes to do some computer training and keep in touch with family all over the world as his daughter is on the verge of emigrating to Australia and he already has family there. One of the examples given to us during our training referred specifically of someone who wanted a computer and internet access to ‘keep up’’ with the times and I think there is a good case that this would provide this particular man with a much richer life if it were to be provided.

The other person is a woman whose husband is providing substantial care for her. She is subject to very low moods but has expressed an interest in pottery and she is very experienced and skilled in various art mediums. Although the day centres offer art activities, she wants to be challenged and we are looking at a lot of courses across London – however this has financial implications. I am hoping that we can use individual budgets in these contexts.

So we can see how wonderful they could be – however, my fear remains the quantity of paperwork they have generated around them. There is no question that the idea is positive and would provide better services but they are, at present, very far from simple and straightforward. My hope, in my ever-positive light, is that the pilot scheme will iron out and streamline the process – my fear is that in the system that is local government bureaucracy, paper is seen as a good thing and forms as positively exciting! Even in these days of ‘paperless’ offices.

Our trainer assured us that we wouldn’t find the process too draining on our time and days of increasingly caseloads as the people who were able to complete their self-assessments independently, would balance out those who needed a lot of support – however, I think she was gearing that comment towards those who work in general adult teams. My main worry about the new system is that it will be very difficult to plan the time to put together these budgets, although in the back of my head, I am remaining positive overall.

Like Direct Payments the focus seems to be on younger adults with disabilities, those who are able to advocate well for themselves and adults with learning disabilities. My thoughts on returning from the training was that little thought and time seems to have been spent on the consideration of people who may lack capacity in some areas to make judgements about some of the choices that are expected in this process.

I hope very much I am being overly cynical and am proved wrong. Today, David Brindle in the Guardian writes about RAS and its more helpful nature towards informal carers, whose contributions are recognised.   He makes some excellent points and it restores some of that positivity about the process.

I have some niggling doubts in my mind though – perhaps it is reminiscent of the introduction of the 1990 NHS and Community Care Act – when we were promised that ‘Care Management’ would be needs-led rather than resource-led, however, the fact is that those needs became more and more narrowly banded into large block contracts involving very little choice or flexibility.

Plus ca change..