The Financial Management of Personal Budgets


The soon-to-be defunct Audit Commission published ‘The Financial Management of Personal Budgets’ today.  Community Care have a good run down on the basic points but I thought I’d read through it myself, just because I’m actually genuinely interested in the issues.

This report was based on research taken in eight different councils.

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As the report states in its opening words it is

‘Intended for finance staff and staff in adult social care departments with an interest in personal budgets.. ‘

I have to wonder if that is in order of importance. It probably is as far as the councils are concerned.

I had a brief glance over at the report this morning.

What did I learn?

Well, to be frank – nothing in there surprises me,  but then, I’ve probably got more experience of the working of personal budgets than most people.

As I read through the report, I’m just highlighting a few of the issues that I come across as well as my thoughts and responses.

– People with mental health problems are less likely to have access to personal budgets than other service user groups

The report highlights some of the issues of disentangling health and social care budgets being a particular issue for mental health. I’d add that in the ‘mental health’ sphere you have the people such as those that I work with who have dementia and the roll out of personal budgets for people who lack the capacity to manage them has been woeful because none of the training I have attended, and none of the ‘piloting’ was done with the group of service users who need more assistance to manage budgets due to capacity issues and who might not be able to have the imagined ‘choice’ simply because the choice is being made outside their sphere of control in any case. These people don’t make the ‘perfect case study’ examples that the policy drivers want to promote.

Personal budgets are unlikely to result in significant cost savings for councils.

This is a massive issue. We were always told that theoretically the change should be ‘zero cost’ but the hopeless inadequacy of the resource allocation system (that I have been party to, at any rate) and the growing realisation among service users and professionals that actually care might be being cut ‘stealthily’ or re-classified has made it a less than attractive proposition to push.

In fact, another point that the report makes is that the savings which  might be made by achieving better outcomes for users would actually be made by the NHS rather than the local authority. This highlights the problems with the differentiation between the budgets. Would a local authority pay out when it is saving the NHS money? Hopefully after all,  it it is the right and moral thing to do but with eligibility baselines rising and the government constantly harping on about the ‘protected’ NHS budget, I can see a massive timebomb about to explode in the NHS funding.

‘Method for allocating funding to individuals – the Resource Allocation System (RAS) – needs to be affordable, transparent and equitable for all care groups’.

Well, thanks Audit Commission for making me splutter my tea all over the keyboard as I chortle merrily at the utter dog’s ear that has been made of this process so far

(I know, I wouldn’t be able to do better myself so I shouldn’t criticise quite so heartily but I criticise because I find the system quite oppressive and I hate diluting needs into ‘figures’ it seems to depersonalise the human being behind the assessment and quantify needs but maybe I’m just a bit too fluffy and old-fashioned like that ).

Perhaps it is a reason for the lack of take up in mental health services but the RAS seems to work in a world of its own – based heavily on physical needs.  Note the ‘equitable’ not ‘equal’ or ‘equivalent’.

The report extensively focuses on the RAS systems and some of the inefficiencies that exist in the current formats. There are some examples offered of ways that the systems can be made more transparent and simplified. I hope the team in my borough read the report extensively, is all I’ll say.

Reduction of in-house services/block contracts

One of the things that the report highlights is the way that in-house provided services are increasingly expensive to provide and can’t meet the needs of those who wish to use personal budgets. I refer to my posting about the privatisation and outsourcing of care. Where I work, the in-house care service (which has been dramatically reduced) really is the gold standard of care among a heap of agencies that battle to drive costs down. This is what we are being told to give up for the sake of increasing choice. Quality v choice? It shouldn’t have to be an ‘either/or’.

As for block contracts disappearing? Well, they limited choice in any way – restricting the agencies that could deliver services in particular area – but, the lowered costs without doubt so that may be a further potential strain on the ‘systems’.

Figures

The report states that between 13% and 59% of older adults (34% nationally) have personal budgets – we can see the problem with looking at the average figure here –  whereas, on average 50% of adults with physical disabilities (nationally) have personal budgets and one council is reported to have a 94% take up rate for adults with learning disabilities.

The audit commission is being a bit mealy-mouthed with figures here using three different kinds in the same paragraph to show a point. I wonder what the figures were for adults with physical disabilities in the particular councils where 13% of older adults have personal budgets and we have no idea what the spread of take up is for adults with learning disabilities – just that one council is doing particularly well.

The other interesting figure hiding in the report is that most councils manage the personal budgets for service users but up to 36% and 50% in one council are provided by direct payments. I’d love to know what the breakdown of take up of direct payments is across the different service groups but I think I can guess. Higher with adults with physical disabilities and learning disabilities – low with older adults and mental health.

Auditing, Risk and Choice

The latter part of the report that I’ve been skimming through relates to processes for auditing the use of payments and preventing misuse of funds as well as an explicit statement that choice includes the choice to accept risk to ones self. This has been highlighted as one of the problem professionally with personal budgets getting things off the ground for adults with mental  health needs. I expect that is a bit of a smokescreen put up by people who don’t work in mental health services responding to some risk aversion but it is an attitude which I hope will be challenged.

Conclusion

The headlines highlight the slow progress in personal budgets roll-out in the UK.  I think the news organisations, unsurprisingly, find this the easiest point to pick up but as was stated on Breakfast News this morning, the take up is likely increasingly rapidly on a day by day basis  even since the report was completed but it is important to remember this is a ‘snapshot’ piece of research.

None of the findings are even remotely surprising to me. The more important things to take from this report in my opinion are:-

The massive disparities between the take up in different service user groups

The need for much better working between the NHS and social care to allow for even greater flexibility and to work particularly in mental health to promote a cohesive system of care provision

The risk to good quality in-house services.

The increased pressures on informal carers are criteria rise and the expectations made of informal carers rise. That is, I fear, the main way that costs will be saved.

In my mind, there scope for some really strong research in this area and some new ideas. At the moment, there is a reliance on the model used for direct payments and ILF monies. It is all very well telling people to be more flexible – it works amazingly for those people – but there needs to be more support within the local authorities for staff to better understand the processes and for staff to be more aware of their need to promote advocacy and creativity in care planning.

The desire to push self-directed support is absolutely the right way to be moving. I 100% back up the policy aims but the systems and the will has to be there within the services. The grant money is due to run out in 2011 and there will not be any more money to push this agenda. That’s where I feel the real failing will come. This needs to work for EVERYONE and not just those able to articulate and fight for their own corner.

I know I am a bit like a broken record on this but I won’t stop until I see the point being taken up!

4 thoughts on “The Financial Management of Personal Budgets

  1. “The increased pressures on informal carers are criteria rise and the expectations made of informal carers rise. That is, I fear, the main way that costs will be saved”

    Its always been assumed that what are actually full time experienced Carers will work for next to nothing. That has to stop. Parity with Foster Carers would be a good starting point. Its quite possible that “unpaid Carers” will become employees with the take up of Direct Payments increasing and with that it will be more likely that they may join unions like Unison who may well decide to take up test cases to make sure they are paid adequately in the future.

    Wouldn’t that surprise the coalition? A whole new budget running into billions!

  2. I’m with you when it comes to having a concern for the fate of in-house agencies. In my area too the in-house agency tended to perform better than the private sector and really did benefit from a close working relationship with the rest of the organisation.

    On the subject of block contracts. It’s a worry for me in terms of equality of care. Block contracts for their faults did provide many people with access to a reasonable level of care for a reasonable price. When this system goes we will se a care market much more vulnerable to market distortions.

  3. Casdok, ians12, neil80 – thanks for the comments. I am concerned about additional pressure on informal carers and I fear that the narrowing criteria will have a worse impact. The councils have always worried about paying informal carers for work that they would otherwise have done without ‘payment’ and I think this will be an increasing strain although it goes against the policies of supporting carers more.
    I agree about the block contracts – they did drive costs down but restricted choice. It’ll be interesting to see if anything pops up in their place.

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