The Disgrace of Individual Budgets


I have a few words for Paul Burstow, the Minister responsible for Care Services, who is appalled, according to Community Care, about the low take up and roll out of personal budgets in Adult Services – the take up is so far only 13%.

He said to his party’s conference

“It’s disgraceful. We need to be far more critical of public services. Why are they not willing to let go of control?” He was speaking at a Liberal Democrat conference fringe session on social care and the government’s Big Society agenda.

Excuse me for a moment while I scream with frustration.

Back.

NOT WILLING TO LET GO OF CONTROL?

What does he think that the lack of roll-out is to do with a nefarious political plot to hold on to the control aspect?

No, it’s not. It’s all to do with poorly adapted and poorly administrated systems and piloted exclusively in teams and departments that were ‘easy’.

Where are those 13%? I can bet they are with adults with physical disabilities and adults with learning disabilities where a lot more resources and efforts had been pumped into direct payments so they had a sound base to start on.

That 13% is also likely to include older adults who have capacity and families to help advocate for them.

We have some quite rightly wonderful accessible easy read documentation for the forms with beautiful pictures that show who effective support planning can be in the learning disabilities field – but where is the real research for people who may lack capacity to make decisions due to dementia – for whom the same type of documentation is not relevant because in general, those who are support planning will have much less time and much less money to ‘be creative’.

Where the systems have not picked up is with those who do not have the families and friends who are able to invest a lot of time into creating personalised packages – of the people who do not have the capacity to manage and organise their own care – for whom the system of individual budgets will not change anything too dramatically.

I wish Mr Burstow would meet and talk with people who actually DO the job to understand the difficulties, rather than meeting and talking to people who manage people who do the job or people who write the policies or people who audit accounts.

I want to give up control. Believe me I do. It might mean some respite in the constant stream of care management duties that spring up incessently. Sometimes though, it isn’t all about retaining control but maintaining quality as well. Sure, if a capacitious decision is made, all is well and good and the right remains, as it should, with the end user, but where there is a decision that needs to be made on behalf of another person, the choices are already limited.

Why should someone have a potentially poorer service through a provider agency because they are not able to manage a bank account and do not have anyone who can assist them – sure, theoretically the local authority can hold the account but who makes the decisions about PAs and flexibility?

There is little doubt that high quality regular care provided by a small group of people or person is the favoured option for those that have successful care packages. People whose direct payments have been most successful have worked because of the people they have employed directly as often as not. However this is not a service which is offered through this system to people who lack the capacity to act as employers and who either don’t have families or don’t have people who can do this on their behalf – they still remain with agency providers which most people agree offer a poorer service.

This is my gripe and my main upset with this system. It is inherently discriminating and providing a poorer service to people who don’t understand the systems. If social workers had caseloads of 10, we might be able to do this on someone’s behalf but it is not possible with the workloads that are carried in older adults services.

So the people who ‘can’ get a gold star service and the people who ‘can’t’ get exactly the same as they always got.

That is both demoralising and unfair. It makes me cynical of the whole system and those who advocate it because perhaps if this could have been thought through at the time, we wouldn’t be lagging so far behind of targets.

Sure, I’ve been to the training, I know about the trust funds that can be created to manage care but how many people in older adults’ services are going to have packages that pay enough to establish and operate a trust fund as well as paying for it’s maintenance. The answer is not very many.

The way the  roll out has been managed, stinks. For people it works for, it works very well – but there are many people whose needs and wishes have not been able to be accounted for in the way the forms have been written and the way the processes work. That might be unique to the local authority I work in – it must work well somewhere.

But these lavish statements of Mr Burstow, they grate incessently and I say that as someone who would love this system to work but who is ground into dust by the ways it has been implemented.

11 thoughts on “The Disgrace of Individual Budgets

  1. You have said just what I would have said, if I were as good as you at expressing what I think. I will join you in screaming. I too am ground into the dust. Your analysis is just right. Think some saw personalisation as a way of saving money, eg; families doing it for themselves, when in fact only a small number can/will. Some who have support, get a rolls-royce service, for others “personalisation” is a hollow sham. The expected cuts will make it even worse and who will everyone blame? No prizes for guessing that.

  2. Thanks for this – good perspective from social work viewpoint. From carer/disabled viewpoint picture is a little different. We’re seeing Personalisation being used to enforce service reductions in the name of ‘fairness’ – ‘there’s not enough money to go round so we’re going to reduce your good service down to the poorer level of everyone else.’

    A good example of the mindset is the presentation we’ve just had a coppy of from our local head of commissioning – the 7 steps to a personalised service START with ‘how much money’ and are FOLLOWED by ‘what service can you get.

    For a carers perspective and context, I blog as Ned Ludd, carer at http://nedluddcarer.blogspot.com/

  3. Yes very well said. I would dearly love to beable to go down the road of personal budgets for my son but for the reasons you have mentioned i have not.
    I also would love to see this system work for all.

  4. Exactly how I feel about IBs. You are very right in what you say about the piloting. If there was any politics it was at that stage; the Authorities and managers participating didn’t want to be the ones to drop the ball on what was/is a flagship scheme or to be the nay-sayers round the table so they took the easy options rather than trialling IBs across a wider range of SUs. From people very involved in the project I got a feeling that they believed this would be ok too as they had a ‘if they build it they will come’ outlook i.e they felt that the best strategy was just to get as many people as possible as quickly as possible on IBs and hope that the care market, third sector, and communities would respond to the stimulus of IBs and that this would mean by the time it came to implementing IBs for SUs with less straightforward needs there would be much more of a framework in place.

    Obviously this was a huge leap of faith and it has it meant that several years into the project serious questions about IBs have not been even asked or addressed.

  5. Thanks for all the comments.
    Ned and Casdok, it’s useful having the perspective of carers. My concern is that there is a greater assumption and expectation being made of informal carers in particular and while some will have the ways and means to do this, others will not and I hope it doesn’t set up a means for people to have to feel guilty about what they might or might not be able to do for close family members.
    Ruth, thanks for your support. I sometimes feel that I’m railing against the perceived wisdom of increased self-directed support but I am actually in favour of that – you can be in favour of the principle and despair at the practice.
    Neil – as you may have picked up, the piloting is a big bugbear of mine because I raised it as an issue in my borough a couple of years ago.

  6. I’m a ‘service user’, a person with disabilities both physical and mental, and I have a long term mental illness; I’m also adult, intelligent, eloquent, white, male, from a middle class background and know where to go to get support and advice on many things, so I ought to be one of those who could access personal budgets most easily.

    What’s a personal budget?

    Until I had read this blog post I had never heard of the term and it’s a bit difficult to access any service of which one has no knowledge.

    Now I have heard of Direct Payments, I asked my social services department about them – note I had to ask, I was not told – and was assigned a social worker who assessed me as needing two hours per week of support. This seemed fine, two hours isn’t much but it’s better than nothing, social services would pay the money into a bank account and I would pay a support worker with whom they had put me in contact. Until I then discover that social services will be claiming the money back off me.

    I was not so naive as to believe that my council would be giving out free money to all and sundry and had expected some kind of means test though had assumed that, being on Income Support, I would come under whatever threshold there was. No, apparently the way the calculations work out they can claim back up to all of the care component of my DLA and some of the severe disability premium as well. All in all, this means that I’d have to be assessed as requiring more than four hours support per week to get any financial assistance, presumably anyone in similar circumstances to myself would need as much as well.

    Now I’m not saying it’s deliberate however this is very convenient for Social Services, assessing a disabled person as requiring a few hours a week and claiming the money back costs very little and allows another box to be ticked, but it’s not very convenient for the individual involved, forced through another stressful process, disclosing often personal information to yet more people only to be left in exactly the same position as they were at the start. The ‘service user’, having gained nothing, then drops out of direct payments and, if they are anything like me, feels discouraged from dealing with social services ever again.

    Perhaps it is this combination of effects, failure to inform ‘service users’ of what is available and a system which seems tailored to the desires of council budgets not the real needs of people living in the community, that has led to such a low take up of individual budgets.

    One further point in defence of Paul Burstow; it is not only with individual budgets that there is a lack of communication with service users, my experience is that one is simply not told of what services are available, it is as if it is some big secret that should not be shared outside the department lest people should actually want to use access services, this certainly comes across as wanting to retain control.

  7. ‘I wish Mr Burstow would meet and talk with people who actually DO the job to understand the difficulties, rather than meeting and talking to people who manage people who do the job or people who write the policies or people who audit accounts.’
    I work for the British Association of Social Workers (BASW) and we have been trying to get Mr Burstow to meet with us so we can help him with our members’ knowledge of social work and social work issues since he came into post. We’ve been constantly fobbed off despite his comments about social work on communitycare.co.uk today. We’ll go on trying because he needs to know how we are committed to the principles of personalisation (which goes far wider than Direct Payments, Indiviudal Budgets, etc) and that we share service users’ frustrations about the way this is implemented in some places.

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  9. M – honestly, the Local Authorities have had a legal obligation to inform users about direct payments and individual budgets for years so I’m not sure where yours are up to but they are clearing failing there. and you are right, this is not ‘free money’ – it is means-tested and the amount of the payment is dependent on the local authority and their own charging policies so it can be something of a post card lottery.
    I’m sorry it has been so frustrating for you.

    Ruth – As a (somewhat dormant) member of BASW, I heartily approve of your (communal and personal!) efforts in this respect!

  10. Thanks for the response.

    An extra frustration is there appears to be no way to ascertain whether the Local Authority’s assessment of one’s needs is accurate, that is no independent service from which to seek a second opinion. It leaves the client very much at the mercy of individual departments.

    In a previous role I worked alongside social workers to provide services to young people and,having seen things from both sides of the fence the impression I am left with is that many problems stem from a lack of trust from on high; of professionals not being trusted to be professional and get on with their jobs, and of clients not being trusted to make judgements about what is best for them.

  11. M – that’s a fair point. Personally I think over-management and micro-management have destroyed a lot of the advocacy role which should be present in social work and may have reduced us, as far as care management/planning goes to automatons.
    The great hope that the personalisation agenda would be a beacon to showing how clients can be trusted and should be trusted to plan and organise their own care is, has, in practice become another smoke-screen to cut costs but because the language remains forward-thinking, it is hard to criticise without being accused of wanting to ‘retain control’ as a professional.

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