The power of personal budgets

Image by Tristan Martin via Creative Commons

Image by Tristan Martin via Creative Commons

Described by supporters as having revolutionised the way the social care system in England is organised, personal budgets have developed to become the norm in social care commissioning in England.

One of the ideas underpinning personal budgets is the development of a new relationship between people who use care services and the organisations who provide them. The new approach was designed to move away from previous prescriptive services towards more bespoke, personalised models of care, where service users are directly involved in planning and deciding what care they receive, and how they receive it.

Within the personal budgets model an allocation of money is given to a specific person from their local authority, following an assessment of need. Money is allocated to the individual, who then works with a professional to work out the most appropriate support. The idea is based on the ideas of transparency, empowerment and personalisation of care.

There are 4 options for service delivery which recipients can chose from to best suit their care needs:

  1. Managed council budgets – where councils arrange the care that is needed following an assessment and an agreed set of outcomes to go alongside a pre-agreed care plan;
  2. Individual service funds – marketed as a more flexible option than local authority led management, this allows recipients to select an alternate organisation to manage an individual’s care budget, and deliver the required services;
  3. Direct payments – this option sees the money paid directly into the account of the person in need of support and allows them to buy care services from an agency or to employ their own carer, or a mixture of both;
  4. Mixed package – a combination of any of the options above, where recipients of support may give some of their budgets to a care provider (either a charity or local authority) but may get a portion of the budget paid directly to them so they can pay, for example, for additional carers to visit during the night.

Seniorin mit Pflegerin

Those in favour of personal budgets point out that the model promotes the personalisation agenda within health and social care in a way that no other policy does. It gives control of spending directly to the person in receipt of the support and has been heralded as a new age for transparency, increasing choice and control, reducing bureaucracy and cutting costs. Personal budgets have also become a key part of the health and social care integration agenda, as well as being highlighted within the recent reform of SEND (special educational needs and disability) care and provision.

Supporters also argue that one of the best and biggest changes between personal budgets and the original direct payment pilots are that personal budgets are designed to produce outcomes, not pay for a service. They are co-produced with the person in receipt of care, as well as professionals from a number of sectors, care providers and family, if appropriate, to ensure that care plans and agreed outcomes are established when the budget is allocated and that the payments achieve those outcomes.

pregnant carer giving pills and medication to her elderly pacient

However, studies have shown that there are big variations in service provision, choice can be limited and poor practice and processes can have a big impact on personal budget delivery and effectiveness. There has also been criticism of the high level of support within government for the model, despite the limited number of pilot roll outs and reviews into outcomes.

In 2016 a National Audit Office report was critical of the way that public services have monitored the impact of personalisation through personal budgets, as very little evaluation of their long term benefits and efficacy have been completed. The report stated that the Department of Health needed to “gain a better understanding of the different ways to commission personalised services for users and how these lead to improvements in user outcomes.” It is clear that there is a lack of evidence as monitoring does not allow service providers to understand how personal budgets improve outcomes.

Critics also argue that personal budgets are ineffective and cannot provide suitable care for everyone in need. They argue that there has never been, and never will be adequate funding to implement personal budgets properly. The principle is only effective, they argue, if there is an unlimited supply of both funds to pay for services and service providers delivering high quality service, which under current conditions of austerity there is not. Supporters counter however, that the concept of “self-directed support” is fundamentally a good one, but admit that poor delivery can deter some people.

Conclusion

Personal budgets can empower people in receipt of care, allowing them to take control of how their care is delivered. This recognition that care should be individualised is a big step forward for people who rely on care services on a daily basis.

However, reduced budgets, inconsistent service provision, and a lack of information for recipients has meant that some people have missed out on the benefits of personal budgets. In practice, services are patchy and evidence of actual benefits, in terms of improved outcomes, is lacking due to the limited number of research studies.

In order to fully realise the power of personal budgets for everyone in receipt of care, the provision, implementation and understanding of the model must be improved. Support for people to help them make the most informed decisions about planning their care packages should also be increased.

Co-production in social care … a need for systems change

meeting

By Rebecca Jackson

One of our most popular member briefings has been our 2014 introduction to co-production in public services. In fact, it was so popular that we made it freely available to download from our website. For those who don’t know, co-production is an approach to improving or developing services by working collaboratively with the people who use those services. It has become increasingly popular within many types of public services in the UK, but especially in health and social care.

The components of co-production

But what does co-production actually mean in practice? Although every case is different, generally it can be broken down into several processes:

  • Co-design – the planning of services
  • Co-decision making – with regards to the distribution of resources and the allocation of services
  • Co-delivery (of services) – including outlining the role of volunteers and the third sector, and including them in the process if necessary
  • Co-evaluation (of services) – assessment of the outcomes and whether they have been successful for all parties involved.

Legislation and implementation

The 2014 Care Act was one of the first pieces of UK legislation to include co-production as a concept in its statutory guidance, stating that:

‘Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.’

Co-production is now a key part of the implementation of health and social care strategy across the UK. It provides service users with an input on which elements of services are of most use, and which could be altered to make them more effective – particularly important at a time when local authorities are under pressure to deliver more efficient and cost-effective services.

Co-production relates to other strategic priorities such as prevention, wellbeing, a focus on outcomes and the personalisation agenda. It allows people who use services to have a direct input into the design of care services and care plans, so as to create more effective programmes of care.

Implementing co-production can be a difficult transition and requires a whole system approach to change. This means that organisations, such as local authorities, must adopt change at every level to encourage meaningful participation and to embed co-production in day-to-day practices.

Managing change

The SCIE co-production guidance uses a jigsaw model for management of change which may be a helpful way to identify the elements of an organisation which must be altered to effectively incorporate co production.

jigsaw 3The guidance provided by the Social Care Institute for Excellence (SCIE) recommends that:

  • organisations must change at every level, from senior management to front-line staff,  if they want to achieve meaningful participation
  • participation should become part of daily practice – and not be a one-off activity
  • participation operates at different levels, as there are many ways to involve people who use services in different types of decisions

Social care co-production in practice

  • The project PRESENT is a joint initiative between East Dunbartonshire Council, the local Dementia Network, the Joint Improvement Team and Governance International, which uses co-production to engage people with dementia and enable dementia sufferers to make a positive contribution to their communities.
  • Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and has impact. The council worked with people who use services and carers to produce the Framework. Local statutory and voluntary sector organisations, including the Making it Real Experts by Experience and Project Team, and Healthwatch Islington, were also involved.
  • A report produced in 2013 by the Scottish Co-production Network, Governance International, the Scottish Joint Improvement Team and the Social Care Alliance,  also provided comparisons between the approaches to co-production in social care between Scotland and Sweden.

These are just a few examples of innovative practice, more of which can be found on the SCIE website.

The potential of co-production

Co-production has the potential to transform the way social care is delivered in the UK. However, implementing co-production approaches into existing organisations, with their own culture, structures and operating procedures, as well as their own expectations about services and how they should be created and delivered, remains a challenge for commissioners, the third and private sectors, politicians and the public.

In order to be successful and to produce sustainable and effective relationships, total change will be required and it will take a huge commitment and long term vision to ensure its success. Once implemented, though, it is clear that co-production has the potential to contribute greatly to prevention, personalisation and outcomes-focused service delivery – which are all key agendas in the current health and social care policy climate.


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Co-production in the criminal justice system

Community concept word cloud background

By Rebecca Jackson

Co-production in criminal justice was the core theme of a conference held last Wednesday by the Scottish Co-Production Network.

The speakers were invited to showcase their organisations as three examples of best practice. All the organisations have integrating partnerships and co-production at the heart of their values, and they spoke of the benefits and challenges they had faced, as three very different organisations, all looking to use co-production in the context of criminal justice.

Startup Stock Photos

Startup Stock Photos

Supporting vulnerable women

Tomorrow’s Women Glasgow, is part of a national pilot which aims to develop community- based justice options for people who are offenders. This specific pilot focuses on vulnerable women with complex needs who are in, or have recently been involved in, the criminal justice system.

The women-only centre offers a safe space for women to come and spend time and to work with mentors to address the barriers and issues which prevent them from leading positive, healthy lives. In addition to this, the women are invited to contribute ideas towards the running of the centre, planning activities, contributing to a newsletter and hosting open days.

“The scheme gives vulnerable women a choice, a voice, a direction and opportunities”

The project is run in association with the social enterprise Outside the Box. There are some examples of Outside the Box’s other projects here.

woman hands isolated on sky background

Improving transitions from prison

Pete from Positive Prison? Positive Futures… delivered an inspiring and thought-provoking presentation about his experiences as a person with a conviction who had served time in prison and how that drove him to help others upon their release from prison. He helped to set up the organisation Positive Prison? Positive Futures… (PP?PF) which seeks to “improve the effectiveness of Scotland’s criminal justice system so as to reduce the harms caused by crime and to support the reintegration of those who are or have been subject to punishment”.

He was keen to stress that the charity is not a service provider; rather it is an initial point of contact to help direct people with convictions to the available and relevant services which already exist.

“We’re kind of like in space when you use the gravitational pull of an object to slingshot you in the right direction (Apollo 13 reference anyone?!). People are coming to us going one way, we come into contact with them, build their speed and send them in another, safer, hopefully better direction!”

In addition to this, the charity engages regularly with the Scottish Government as part of committees looking into reform of the prison service, the redesign of community justice and have, among other things, influenced policy decisions around the release of individuals from prison including transitional care.

The charity works with recently released, or soon to be released people with convictions, looking at building relationships during the vulnerable first few weeks ‘on the outside’ where re-offending and suicide rates are high. They also offer mentoring to help prepare people for the transition from prison life.

Two adult education students studying together in class.

Co-production and young people

Space Unlimited is a social enterprise based in Glasgow, which offers a creative space for young people to become involved in the planning and review of the criminal youth justice system. It encourages young people from vulnerable backgrounds, as well as young people who have served time in prison, to use their experiences to change how offending and criminal justice is viewed by young people.

The scheme aims to provide a space to show how young people can use their views to influence how the system can work best for them, to avoid re-offending and help integrate them back into society. The young people interact with adult stakeholders from across the local authority and criminal justice sector, as well as charities and third sector organisations.

“We promote and encourage children and young people to view themselves as experts in their own right, using their own experiences to promote positive change in the youth criminal justice system”

Category Picture Community Development

Creating new spaces for dialogue

What all of the case studies sought to highlight were the key elements of co-production:

      • Assets
      • Capacity
      • Mutuality
      • Networks
      • Shared roles
      • Catalysts

The speakers discussed their learning and experiences, as well as the challenges they face, but all highlighted the fundamental belief underpinning co-production – that service users and service providers can learn from one another. We create better services by engaging service users – creating services with people, not for them.

Co-production is an approach which is widely spoken about in health and social care, but as the conference and its speakers highlighted, the application and remit of co-production could be rolled out over other areas of policy too. It is all about finding groups of people willing to engage and to listen – creating a space for an exchange of dialogue, knowledge and learning. And the results could potentially be hugely beneficial for both service users and service providers. This video from the New Economics Foundation (NEF) highlights some of the benefits of co-production in practice.


Co-producing Positive Futures learning event: how co-production, learning and partnership building can improve community experiences and engage people in the criminal justice system. Scottish Co-production Network, Glasgow, 28 October 2015.

Giving service users a say: how self-directed support is shaking up social care service delivery in Scotland

Image courtesy of Time To Change campaign

Image courtesy of Time To Change campaign

by Laura Dobie

Back in 2010, the Scottish Government and the Convention of Scottish Local Authorities (COSLA) published a ten year self-directed support (SDS) strategy, with proposals to give individuals real choice and control in the health and social care services that they receive. The strategy is part of a broader reform agenda, and supports current health and social care policy to deliver improved outcomes for individuals and communities.

Halfway through the ten-year strategy period, it seems timely to consider the impact that implementing this transformation in service delivery is having on local authorities in Scotland.

What is self-directed support?

SDS allows individuals to choose the way in which their support is provided, and allows them as much control as they would like over their individual budget. It is not the same as personalisation or direct payments. SDS is a means of delivering personalisation, while direct payments are one of four options for delivering SDS:

  • Local authorities make direct payments to individuals which they can use to arrange their own support;
  • The local authority allocates funding to the provider of the individual’s choosing;
  • The local authority arranges a service for the individual; or
  • A combination of all three.

The benefits

An advantage of SDS is that it gives individuals the freedom to purchase the support that is best suited to their requirements. Some of the benefits highlighted in a review of self-directed support in Scotland are:

  • Flexibility, control, choice and independence;
  • The sustained delivery of personalised, quality, hands-on care;
  • Enabling clients to continue living their lives as they wished, such as by remaining in work or keeping up long-established activities, instead of conforming to rigid routines of care;
  • Helping families to stay together and family carers to continue in their caring role.

Implementation and impact on councils

SDS has required considerable change from service providers, who have had to alter the way in which they design, deliver and market services. Challenges in the implementation of SDS include training for social workers, dealing with the loss of economies of scale associated with personalisation, and achieving a greater degree of consistency in the approach employed by local authorities. There have also been concerns about costs and administration.

An Audit Scotland report last year, which reviewed local authorities’ progress in implementing SDS, has noted that SDS will have a considerable impact on social care at a time of growing demand and financial pressures. Professional staff are required to work in partnership with service users and their families, where appropriate, to identify services that will meet their needs. This approach is sometimes called co-production. The report found that council staff meet regularly with users, carers and organisations providing care, but have not always worked together with them in planning SDS.

The SDS strategy is a ten-year strategy running from 2010 to 2020, and it is not anticipated that councils will change the way in which they plan and deliver social care immediately. The Audit Scotland report found that councils have started to make substantial changes to social care, although progress has been slower in some areas.

Its case study councils expect to take between one and three years to offer the SDS options to all eligible individuals. They expect that fewer people will opt for day care centres and respite care but it will be challenging to shift away from this form of service provision – some people will want to continue to receive this form of support, however lower uptake may threaten the financial viability of these services.

The Audit Scotland report also found that some councils have underestimated the extent of cultural change required and the need for effective leadership. SDS is also changing the way in which councils are managing their social care budgets, and it is necessary for them to manage financial risks when implementing SDS.

Achieving successful co-design

The Institute for Research and Innovation in Social Services (IRISS) Pilotlight project has explored effective pathways to self-directed support (SDS) and ways of achieving successful co-design. The project website launched in May and contains useful SDS resources, lessons learned and a toolbox for successful co-design.

One of the project’s objectives was to explore how services can be delivered differently, in particular by engaging goups of service users and their families who can be excluded from participation. These groups could include people with mental health problems, vulnerable adults, disabled people of working age, and young people with additional support needs.

The project found that co-design could help councils develop more effective pathways to self-directed support for people who previously faced barriers. In a case study of the project, one service manager reported:

“Seeing the service users who have been involved in the process, I have known a lot of them for a long time and to see them take control and flourish and for their ideas to be taken on board has been a great success.”

Looking to the future

It is clear that self-directed support has required councils to make significant changes to the ways in which they work and deliver services, and that this transformation has occurred at a time when social care services are facing challenges related to demand and budget pressures.

Projects such as Pilotlight offer lessons and resources which can help councils and providers to plan and deliver support in conjunction with service users.

In June, the Scottish Government announced the award of funding to continue building the capacity of provider organisations to provide self-directed support, help develop the workforce and to ensure that support and information is available to individuals throughout Scotland to assist them in making informed choices. This three-year funding programme should help continue the major culture shift in the way health and social care services are delivered.


The Idox Information Service can give you access to a wealth of further information on social care services – to find out more on how to become a member, contact us.

Further reading

Self-directed support, Audit Scotland (2014)

Self-directed support: preparing for delivery, IRISS (2012)

Self-directed support: a review of the barriers and facilitators, Scottish Government (2011)

 

Social labs … tackling social problems through collaboration and design

Crossing out problems and writing solutions on a blackboard.

by Laura Dobie

Nesta’s LabWorks 2015 global lab gathering kicks off today in London, bringing together innovation labs, units, offices and teams working within and with government to address social challenges.

Today on the blog we look at social labs, their potential to improve public services and a couple of social labs who are carrying out innovative work in public services.

What are social labs?

Social labs are platforms for tackling complex social challenges.

Zaid Hassan highlights the following key characteristics of social labs:

  • They are social, facilitating participation by a broad range of stakeholders
  • They are experimental, taking an iterative approach to problem-solving
  • They are systemic, seeking to address the root cause of a problem, and not just its symptoms (Hassan, 2014, p.3)

Social labs draw inspiration from design thinking, which is centred on the following principles of design which were promoted by design firm IDEO:

  • A user-centred approach to problem solving
  • Using direct observation as a main source of learning
  • Moving quickly to creating prototypes as a means of generating additional knowledge
  • Learning from failures to refine and redevelop

Social labs in the public sector

The public sector is making increasing use of design, policy or social labs as a means of complementing and reinforcing skills in public policy, programme and service design. They contribute a different perspective to challenges and use a range of research methods and facilitation techniques to foster ideas and insights that attempt to incorporate many different points of view.

Recent Canadian research on a What Works Lab, which was established to develop approaches to increase employer engagement in workplace training, found that using lab methodology enhances the ability to generate insights into potential policy responses, and that lab techniques can also substantially reduce the transmission cycle between research, policy and service delivery. The research also highlighted how experimentation in a lab setting can be used to de-risk an initiative before wider implementation, and demonstrated that labs are an effective means of generating high-quality policy work.

Social Innovation Lab Kent (SILK)

SILK is a small team based within Kent County Council established in 2007 to ‘do policy differently’. They consider that the best solutions come from people who are at the heart of an issue, those with lived experience, families, friends, volunteers, and front line workers, and they ensure that these groups are involved at all stages their projects.

Projects are broken down into the following phases:

  • Initiate. Involve the right people, create a project plan collectively and decide who needs to be informed about the project.
  • Create. Collect as many insights as possible, involve a broad range of stakeholders and generate ideas for testing in the next phase.
  • Test. Test the ideas which were proposed during the create phase, and continue testing until a model that woks is identified. Trial runs, prototypes or ‘mock ups’ can be a part of this process.
  • Define. A model which has been tested and known to work is defined and consolidated.

SILK has delivered a variety of projects across the themes of future services, service (re)design and sustainable services, and tackled a range of social issues, including accessible and affordable food, the resettlement of offenders and creating a dementia-friendly community.

MindLab

Based in Danish central government, MindLab employs a human-centred design approach to address public sector challenges. Its board sets its strategic direction and approves its portfolio of projects, ensuring that their work is aligned with their sponsors’ priorities. Its emphasis on human-centred design helps to forge links between the perspectives of end users and government decision making.

MindLab’s team has a variety of skills which are indicative of its ethos and method, including social research, design, public administration, project management, organisational development and creative facilitation.

In one project MindLab worked with National Board of Industrial Injuries (ASK) to increase the number of people who remain in employment after suffering an injury at work. MindLab highlighted the potential in strategic working across working across public, private and non-governmental organisations and a change in attitude in helping these people return to the labour market.

MindLab interviewed people who had suffered industrial injuries and put together service journeys, which mapped the different stakeholders involved in a work injury case from a citizen’s perspective. They demonstrated through a case study how cooperation between the municipality, the insurance company and ASK improved an injured person’s employment prospects. MindLab also conducted internal workshops with ASK management to support a change in strategic focus from case resolution to employment outcomes for injured people.

It is clear that social labs are taking a different approach to policy and service delivery, focusing on the experiences and needs of service users to devise innovative solutions to a range of social challenges.


The Idox Information Service can give you access to a wealth of information on economic and social policy and public service delivery. To find out more on how to become a member, contact us.

Further reading

Hassan, Zaid (2014). The social revolution: a new approach to solving out most complex challenges. San Francisco: Berrett-Koehler Publishers, Inc. (Available for loan from the Idox Information Service Library)

The What Works Lab process: report for the Skills and Employment Branch, Employment and Social Development Canada