Tag Archives: self-directed support

The power of personal budgets

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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.

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

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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)