Personal Budgets, Personalisation, Thoughts and Hopes


Yesterday Think Local Act Personal (TLAP) published the results of a National Personal Budget Survey.

The headline ‘results’ are of course overwhelmingly positive. Personal Budgets work. Direct Payments Are Good. Everyone is happy.
Questionnaire

jrambow@flickr

Is any of this a surprise though? We know that people who can and are able to manage (or have family members to help them to manage) personal budgets delivered through direct payments (where money is paid directly to users) prefer them to less flexible local authority provided care packages – particularly when the scope of local authority care packages is limited to agencies with block contract arrangements.

In Control – which publishes the survey – highlights the following ‘implications’ from the findings. The bold is a direct quote and the italics are mine.

Other implications that can be drawn from the survey results include:

  • Personal budgets work better for older people than you might expect and direct payments work just as well for older people as everyone else.

Who said we were not expecting personal budgets to work for older people? Does this make an ageist assumption and lump together all ‘older people’. Of COURSE they work as well for people who are 65 as they do for people who are 64 but what about people without capacity or who don’t have family or friends involved? What about a more subtle distinction between 65 year olds and 85 year olds rather than a blanket ‘old people’ response.

  • The processes used for delivering personal budgets are more difficult than they need to be and that impacts badly on carers and on personal budget recipients.

Did this seriously need a survey over three months to discover? You could have asked me three years ago and I wouldn’t have charged consultancy fees.

  • More work needs to be done to make direct payments more accessible generally but especially to older people.

This could have been written 6 years ago. We KNEW this from the roll-out of direct payments initially so why was NO WORK WHATSOEVER done around trying to work with more difficult to reach groups when personal budgets were being ‘piloted’. I really can say ‘I told you so’ as I begged our Personal Budgets roll-out team to allow us to pilot or be involved in the initial processes and they said our user group was ‘too complicated’. Heh.

  • There is a need to simplify and clarify the rules and regulations surrounding personal budgets.

So those are the ‘implications’ and forgive me my cynicism. I love the idea of personalisation. I want it to work. I want to work in more creative ways or outsource my work if necessary to other third sector organisations but this is not ‘different’. This is not ‘new’. I fail to see the value of reports and surveys that tell us exactly what we already know again, and again and again instead of actively trying to work with people who actually understand and know what is happening ‘at the sharp end’ to try and work out ways to improve outcomes for those who are not receiving direct payments currently.

So back to the report – which used a Personal Budget Outcomes Evaluation Tool (POET)

in total, 1,114 personal budget holders  completed the POET survey, including 832 returns from the 10 local authority demonstrator sites and returns from at least 76 other local authorities. 417 of these personal budget holders also wrote in a comment about their experience of personal budgets.
In total, 950 carers completed the POET survey,including 782 returns from carers in the 10 local authority demonstrator sites and returns from at least 66 other local authorities. 434 of these carers also wrote in a comment about the impact of personal budgets on their own lives

And

Almost half of people responding to the survey were aged 65 years or more (43%); the social care needs of working age adults (aged 16-64 years) were largely split between learning disabilities (17%), mental health needs (8%) and physical disabilities (25%).

I don’t want to play too many games with statistics but it would be interesting to know what proportion of people who meet the FACS criteria in total are over 65 and whether 43% is a proportionate figure in relation to total recipients of social care services. I think as well, to class ‘older adults’ as ‘over 65s’ is a little disingenuous although I know it is done because that is the basis on which statistics are given but it shows some of the ways that systems restrict and inhibit knowledge. It would be far more interesting to know the differences of take up of personal budgets between 65 year olds as opposed to 85 year olds for example.

And to some of the headline figures, that can catch the press attention – most people who receive personal budgets find there is a ‘positive effect’.

Looking through some of the figures, it seems that older people were much more likely to be receiving council managed budgets – you know, that ‘easy’ way of just switching around a bit of paperwork and making it look like there is now more ‘choice’ when in fact, the services and delivery is almost exactly as it was before the ‘change’.

As for the outcomes the report says

In terms of social care need groups, older adults tend to report less positive outcomes than other social care need groups in six out
of the 14 outcome domains

I find the report to be honest, a bit of a whitewash in itself. It is only accentuating the positives and like all discourse related to personalisation and personal budgets, seems to be going over all the same ground again and again.

People like choice, people like flexibility. Yes, and rabbits like to eat carrots. It doesn’t need a survey to tell me that. What action and money and research needs to be concentrated on is the HOW.

HOW is there going to be an improvement in service delivery to those who are marginalised in this process.

HOW are we going to wriggle out of the sham that is council-managed budgets while allowing those who need to have others to manage their budget and support their care to have the same access to quality care and personal assistants that those who are able to choose and decide have.

I’m rapidly coming round to the view that personal budget support planning needs to be moved out of the hands of local authorities who currently have no interest in the process except for meeting the government targets. Where is the innovation within local government for change? Sure there are people, and I hope to be able to count myself among them, who want to do a better job and provide a better service but the constraints of the type of job I am doing means that I can’t devote the time necessary to truly inclusive and supportive care planning so Mr G whose support plan I am writing up (he doesn’t want to be involved in the process as he ‘doesn’t like forms’ and can generally only tolerate conversations with people for between 5-10 mins maximum and that’s only if he’s known you for at least a year) does get a rushed service because I have to carry out Best Interests Assessments, do Mental Health Act Assessments,  complete reviews and CPAs, liaise with other professionals, arrange discharges from hospital for other people. Yes, it’s a little bit of wallowing in self-pity and I wholly accept that. We are all busy but local authorities have no idea if they want a quality support plan without changing the ways of working in any other respect. Where is the time to devote to Mr G’s creative support plan? Oh, well, we’ll just do a regular care plan and a managed budget. Should it be that way? How has the march towards personalisation helped people like Mr G? Mr G wouldn’t complete a survey about a personal budget even if he did get a letter. Letters worry him and he doesn’t have a phone. I don’t want the Mr G’s that I work with to be forgotten in the rush towards direct payments.

When I first attended training we were told that any additional time we might be spending in our day to day work on these awful process-driven systems would be made up by the amount of time we would save by people completing their own support plans and assessments without any assistance. That may work for some people and I hope it does but for most of the people in the team in which I work it is unfeasible due to the amount of people I work with who have high support needs and who don’t have the capacity to make decisions about their own care needs.

The survey angered me, in a way that is probably irrational. Partly because it seemed to have taught us nothing at all. And partly because again, I see no new thoughts and ideas about developing systems that will be truly inclusive.

HOW can social care improve for everyone. That’s everyone. Even those who don’t want direct payments. Even those who don’t have advocates. Even those who are self-funding their own care packages as the criteria for receiving government support rise higher.

Those are the questions I want Think Local Act Personal to answer.

I have my own ideas. I think there will be a movement to roles for professional ‘support plan advisors’ who aren’t necessarily based in the local authority – perhaps individual social work consultancies but there has to be a separation between planning and delivery and the cost of these services shouldn’t need to be met out of the personal budget itself.

First and above all, there has to be a consistency and a transparency in the way resources are allocated and if necessary a weighting towards people who need assistance to access the same kinds of services who have been excluded from the process and the benefits in the past.

A survey of the skills-base of professionals who do implement support plans needs to be undertaken to establish what is needed and what is important to have.

Maybe it is a professional type qualification or maybe not. There is not much discussion about what the role of the social worker should be in the process. Should we be the ones support planning? I think there’s a argument that a social worker is well-placed to look at building plans together in conjunction with a user and family member if necessary and setting up things like trust funds or managed local authority budgets but only if the social worker is removed from the local authority talons.  Maybe some kind of team of people with different kinds of experience and expertise working together with some background and training in non-directive advocacy for people who do lack the capacity to organise their own support plans. Perhaps the social worker or support worker in these new roles could have longer term relationships with the users and carers and wouldn’t feel so pressured by management if freed from the local authority reins.

But who is going to suggest and discuss the new ideas? Where do they go? Who will collate them?

While I see lots of discussions around me about personalisation, I see little that says anything other than it HAS to work because it is best for ‘people’.

I genuinely believe that is has potential to deliver a much better system but and this is a big but, there has to be more creativity and different kind of research that looks at new models and methods of delivery and consults people – yes, like me – who while being critical really really do want things to work better.

My criticism isn’t because I want to bury my head in the sand and ‘retain the reins of control’. I really don’t. I want to relinquish control but I want more than anything an equitable system that doesn’t fob off ‘more difficult’ service users with a second class service.

9 thoughts on “Personal Budgets, Personalisation, Thoughts and Hopes

  1. Totally agree with everything you say. I wont read the report as I know it will make me furious, knowing I could have written it myself three years ago.
    If the government of the time had remembered to adjust/change legislation to fit “personalisation” that would have helped. The legislation and attempts to cover up cuts have now lead to senior folk devising ever more complicated means of making budgets difficult to get and tying social workers up in knots so no time to spend with people. What is it with those that get to the “top” in S/W, ? they seem to really enjoy being the spiders at the centre of huge complicated webs.
    In my authority support planning is already being outsourced. Good in that S/Ws no longer have time for planning, and have reverted back, after a brief respite to being “agents of the department”
    Bad, because many S/Ws are a good and a safe pair of hands to work on planning, it is very easy to do bad planning. Planning should be taken on by different people including S/Ws.
    Of course it is cheaper for non-S/Ws to do the work…..which is really the main motivation.
    Personalisation was sold to the government by “in control” as a way of saving money, whilst at the same time offering a much much better deal to those needing support. I think they then hoped the saved money would go back into peoples budgets. Mmmm. a certain innocence there then from In Control.
    Personalisation is now about saving money, and that will be its ruin. Of course some will benefit, but as you say those who need most help/support are the most likely to loose out.
    Also, dont forget some still need and want different types of building based support. We have those that started well, but in attempts to get business promise the world which they cant deliver without a reasonable amount of money, and the money is less and less forthcoming. P/As seem to be expected to offer very high levels of support for less and less money. As P/As dont need less money than the rest of us to live not sure how that will all pan out!

  2. Cb you are like a breath of fresh air. Your blogs are honest and truthful and how I wish my son had a social worker like you.

  3. I wonder how representative it was to have the ‘demonstrator sites’ so heavily featured in the research responses. Surely it could be argued that they were already the authorities who were more motivated, further down the road, who had more at stake in making pzn work etc etc?

    As for who should do support planning – I think there is a sting in the tail for service users if support planners are not social workers. This is that support planners don’t have the ‘clout’ that social workers have to complain if someone’s personal budget is not enough. I’m sure lots of social workers feel that they have no clout whatsoever, but if a whole team of them is moaning directly to a service manager then they will be harder to ignore than random support planners. Plus if you haven’t done the assessment, it is surely harder to argue about the paucity of the allocated budget to meet a persons needs. you can’t dig your heels in and say ‘but I assessed Mr X as needing whatever, and that was my professional judgement, and his personal budget simply won’t meet it’. Support planners are dislocated from that part of advocating for service users best interests surely?

  4. In reply to Bert, as a S/W you can try complaining about level of budget to your Manager, but wont be “allowed” to complain any higher then that! We work in a very rigid structure.
    People can ask for assessments to be looked at again if they think their needs are not correct, but the amount each section allocates is set, no room for discussion.
    I honestly dont think Support Planners are at any disadvantage and hopefully will be fresher and less dragged down by paperwork than S/Ws, so could offer a better deal in many ways.
    The sad thing for S/Ws is that the planning is the best bit, and a possible source of much needed job satisfaction. Also believe many S/Ws could do a very good job of planning, given the time, opportunity.

  5. Thanks all for your comments and I’m sorry not to have come back for them sooner. Mary – you replied better than I could have so thanks for that.

  6. Personalised budgets are not right for everyone. Our son had a good package of care (fought hard for over many years before personalization ‘came in’.) We are now being forced to take part of his care as a personal budget against our wishes. This is being forced by the non provision of part of his care (too difficult and not fitting new guidelines) so only we are ‘allowed’ to provide it. It’s effectively being used as a cuts vehicle.
    We had a care package that worked – now it doesn’t. personal budgets are good for some but shouldn’t be used to cut services and shouldn’t be forced on people where the package of care works.

  7. hi – first of all id like to say how great it is to read the thoughts of a social worker who cares so much – the media would have us beleive that your profession is made up of sloppy, burnt out individuals who put those they work with at risk…
    I am being trained, as we speak, as a support planner. Its a three month secondment to the local council. my actual place of work is a mental health charity. we liaise closely with the social workers whose clients we are working with, and its my first, first-hand experience of social workers and what they actually do. I am in awe of the number of cases each one has to work and of the care and attention they somehow still find the time to give to each one – it shatters the tabloid stereotype.
    Like you, I really want personalisation to work – like you, I am so aware its a flawed process. The team i am training with really care about helping our clients be creative with their support plans so they come through the transition with an improved quality of life.
    I agree with you that personal budgets/personalisation is flawed and, dear god, I really hope mine, and others, work as support planners helps minimize the number of people who get stuck with inppropriate packages and insufficient support for their needs etc
    i have really enjoyed your writings and learnt a lot from them

  8. hi again – just to say that i have started a blog -AfterAlice.wordpress.com
    the idea of it is for support planners to share their experiences and share ideas about how to best work with and for our clients – do check it out

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