Personal Budgets in Adult Social Care: Same Resources, Better Outcomes?

flow chartTheoretically, personal budgets are an outcomes boosting, resources light means of delivering adult social care. The arguments for personal budgets are simple. On an individual level personal budgets are seen to offer more choice and control to adult social care service users and help them maintain their independence[i][ii]. From an economics perspective personal budgets are promoted as more efficient. They can offer a reduction in duplication of assessments and administration, encourage integrated, cross-service support and produce better quality of life outcomes for service users without additional costs[iii].

There are two main methods of delivering personal budgets in the UK; direct payments and those generally referred to as personal or individual budgets[iv]. Direct payments involve eligible citizens receiving a sum of money, instead of centrally commissioned services, to purchase services they or their primary carer feel best suit their needs (subject to an assessment by and agreement from their local authority)[v]. Individual/personal budgets, such as Individual Service Funds, involve money being paid to a provider who is then responsible for providing services on an individual by individual basis, as chosen by the service user in question[vi].

Personal budgets are largely seen as a very good thing. However, whilst direct payments have been linked to improved outcomes (if also to slightly higher costs per user than estimates of traditional services)[vii], the evidence in favour of personal/individual budgets has been contested. With Government targets aimed at getting 70% of all eligible social services service users onto personal budgets by April this year[viii], ensuring that any systematic shortcomings are understood and exposed is essential.

The major issue amongst academics and campaigning organisations is not the theory behind personal/individual budgets but the implementation and administration of the system. Personal/individual budgets are largely assigned via Resource Allocation Systems (RAS) and Support Plans. RAS are formulae through which a service user’s needs are assessed and an estimation of their budget produced, largely based on an estimate of what meeting these needs would cost via traditionally procured services[ix]. They are then aided in creating and submitting a Support Plan detailing how the funding will be spent to meet their needs and desired outcomes[x]. The Support Plan is then queried or signed off accordingly and a final budget allocated.

In practice, however, what is intended to be a system that empowers service users and reduces costs for providers is now viewed by some as having spawned a whole host of unnecessary bureaucracy and administrative burdens.  Key among these are overly complex RAS, unnecessary support staff dedicated to co-creating support plans and the over rigorous enforcement of support plans[xi]. Some research suggests that administration of personal/individual budgets, rather than being more efficient, actually leads to a marked decrease in productivity amongst public sector staff tasked with their implementation[xii] without significantly improved outcomes[xiii]. One  study found that the vast majority of respondents receiving personal/individual budgets commented negatively on the personal budget process[xiv]. In short evidence that personal/individual budgets improve outcomes without increasing costs is, at best, questionable. Such are the issues with the administration of the system that one high profile campaigner has even apologised for his role in the creation of it[xv].

So what can be done? Suggestions range from increasing trust in service users[xvi] to manage their budgets without unnecessary interventions to realigning service providers’ focus from outputs to outcomes[xvii]. But what is also clear is that, if personal budgets are going to live up to the hype and offer improved outcomes without increased costs, public sector managers need to keep a close eye on their administrative systems. They need to rein in any unnecessary processes and ensure that overzealous efforts to minimize risk are not gaining precedence over the needs of service users.


[i] p.267, Carr. S. (2007) User Participation in the Social Care System of England and Wales, Participation, Power, Conflict and Change: Theorizing Dynamics of Service, Critical Social Policy, 27(2): 266-276

[ii] p.233, Moran, N., Glendinning, C., Stevens, M., Manthorpe, J., Jacobs, S., Wilberforce, M., Knapp, M., Challis, D., Fernandez, J., Jones, K., and Netten, A. (2011) Joining Up Government by Integrating

Funding Streams? The Experiences of the Individual Budget Pilot Projects for Older and Disabled People in England, International Journal of Public Administration, 34(4): 232-243

[iii] P.240, ibid

[iv] P.807, Alakeson, V. (2008) Let Patients Control the Purse Strings, British Medical Journal, 336(7648): 807–809

[v] NHS Choices, Direct Payments, [Online] Available from: http://www.nhs.uk/CarersDirect/guide/practicalsupport/Pages/Directpayments.aspx [Accessed 30 March 2013]

[vi] Support Planning, From a Support Plan to an Individual Service Fund, [Online] Available From: http://www.supportplanning.org/IndividualSF/ [Accessed 30 March 2013]

[vii] P. 1031 Slasberg, C., Beresford, P. and Schofield, P (2012): Can personal

budgets really deliver better outcome for all at no cost? Reviewing the evidence, costs and quality,

Disability and Society, 27(7): 1029-1034

[viii] Brindle, D (2012) Councils no longer required to give all social services users a personal budget, The Guardian, Friday 26 October 2012, [Online] Available from:

http://www.guardian.co.uk/society/2012/oct/26/councils-social-services-personal-budget [Accessed 30 March 2013]

[ix] p.162, Slasberg, C., Beresford, P. Schofield, P. (2012) How self-directed support is failing to deliver personal budgets and personalisation, Research, Policy and Planning, 29(3):161-177

[x] p.920, Rabiee, P., Moran, N. and Glendinning, C. (2009) Individual Budgets: Lessons from Early

Users’ Experiences, British Journal of Social Work 39(5): 918–935

[xi] Duffy, S (2012) An Apology, Centre for Welfare Reform, [Online] Available From: http://www.centreforwelfarereform.org/library/by-date/an-apology.html [Accessed 30 March 2013]

[xii] P.171, Slasberg, C., Beresford, P. Schofield, P. (2012) How self-directed support is failing to deliver personal budgets and personalisation, Research, Policy and Planning, 29(3):161-177

[xiii] P. 1031 Slasberg, C., Beresford, P. and Schofield, P (2012): Can personal

budgets really deliver better outcome for all at no cost? Reviewing the evidence, costs and quality,

Disability and Society, 27(7): 1029-1034

[xiv] P.19, Hatton, C, and Waters, J. (2011) The National Personal Budget Survey: June 2011, [Online] Available from:

http://www.thinklocalactpersonal.org.uk/_library/Resources/Personalisation/Personalisation_advice/2011/POET_surveys_June_2011_-_EMBARGOED.pdf [Accessed 30 March 2013]

[xv] Duffy, S (2012) An Apology, Centre for Welfare Reform, [Online] Available From: http://www.centreforwelfarereform.org/library/by-date/an-apology.html [Accessed 30 March 2013]

[xvi] ibid

[xvii] P.174, , Slasberg, C., Beresford, P. Schofield, P. (2012) How self-directed support is failing to deliver personal budgets and personalisation, Research, Policy and Planning, 29(3):161-177

 

6 responses to “Personal Budgets in Adult Social Care: Same Resources, Better Outcomes?

  1. You allude to the issue of placing more trust in service users, which is surely an issue, but it seems to me that the bigger trust issue which Simon Duffy addresses in his apology is one of managers not trusting social workers. This seems to be a bizarre and all pervasive problem in local government. Hugely cumbersome systems are put in place in an attempt to make absolutely sure that professionals who have spent years learning their profession continue to do it properly. I’ve been there myself, albeit in an area with far less impact on people’s lives. We realised that the manager whose job it was to sign off my decisions on particular applications, and who knows nothing about the subject, had never actually altered or objected to anything I’d done. Shifting the delegated powers to me knocked nearly 30% off the time it took to process them.

    There seems to me to massive scope to trust and empower public sector workers. There still needs to a balance struck with accountability—there will always need to be some checks and balances—but at the moment the balance is far too heavily towards control and risk aversion.

  2. Pingback: Personal Budgets in Adult Social Care: Same Resources, Better ... | Disability Issues | Scoop.it·

  3. Pingback: Personal Budgets in Adult Social Care: Same Resources, Better Outcomes? | Welfare, Disability, Politics and People's Right's | Scoop.it·

  4. Pingback: Personal Budgets in Adult Social Care: Same Resources, Better ... | Public Sector of the Future | Scoop.it·

  5. Henrietta, i will take this blog to work on Tuesday and share it with the Lead professionals currently assessing and then developing a RAS and following that with then commissioning the services for disbaled children. I have been struggling with the level of bureaucracy and administration involved, this research gives clear direction in ensurung that we dont create an alternative complex system for complex issues

  6. This blog post clearly outlines the issues that are associated with personal budgets, which I think you have explored really well. Personal budgets, if correctly implemented, seem to be a great way to deliver adult social care. It means that service users will become more involved and so will help to co-produce the services that they receive. I agree that the issue of excessive bureaucracy needs to be dealt with to allow for greater co-production as this will lead to a more efficient delivery of adult social care.

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