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Choice and control for older people using home care services: how far have council-managed personal budgets helped?
- Authors:
- RABIEE Parvaneh, GLENDINNING Caroline
- Journal article citation:
- Quality in Ageing and Older Adults, 15(4), 2014, pp.210-219.
- Publisher:
- Emerald
Purpose: This paper reports the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise. Design/methodology/approach: Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face. Findings: Areas discussed include choice and flexibility over care agency, care workers, tasks, and timing and duration of visits. Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the 'ideal' of user choice and the 'reality of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to 'exit' from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs. Originality/value: The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider. (Edited publisher abstract)
Managed personal budgets for older people: what are English local authorities doing to facilitate personalized and flexible care?
- Authors:
- BAXTER Kate, RABIEE Parvaneh, GLENDINNING Caroline
- Journal article citation:
- Public Money and Management, 33(6), 2013, pp.399-406.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper explores how three local authorities in England have tried to facilitate personalized home care for older people through changes in commissioning and market development activities; and how these changes have been experienced by support planners and home care agency managers. Two borough council and one county council were selected. One council offered Individual Service Funds (IFS) and one offered 'virtual budgets'. Overall, it appears that changes are well intended, but the practicalities of implementing them raise some challenges that mean desired objectives may not always be achieved. (Edited publisher abstract)
Individual budgets: lessons from early users' experiences
- Authors:
- RABIEE Rarvaneh, MORAN Nicola, GLENDINNING Caroline
- Journal article citation:
- British Journal of Social Work, 39(5), July 2009, pp.918-935.
- Publisher:
- Oxford University Press
Within the context of modernization, there has been a trend towards ‘cash-for-care’ schemes designed to bring choice and control closer to the service user. In England, Individual Budgets (IBs) are being piloted, with the aim of promoting personalized support for disabled people and other users of social care services. This paper reports on the experiences and outcomes of early IB users two to three months after first being offered an IB. The users included adults with physical/sensory impairments, learning difficulties, mental health problems and older people. Semi-structured interviews were carried out with nine service users and five proxies. The findings suggest that IBs have the potential to be innovative and life-enhancing. However, achieving this potential in practice depends on a range of other factors, including changes in the routine practices and organizational culture of adult social care services and ensuring users have access to appropriate documentation and support. Any conclusions drawn from the experiences of these early IB users must be treated with caution. The findings nevertheless indicate some of the issues that will need to be addressed as IBs are implemented more widely to replace conventional forms of adult social care provision.
Increasing choice and control for older and disabled people: a critical review of new developments in England
- Author:
- GLENDINNING Caroline
- Journal article citation:
- Social Policy and Administration, 42(5), October 2008, pp.451-469.
- Publisher:
- Wiley
This paper critically examines new policies currently being implemented in England aimed at increasing the choice and control that disabled and older people can exercise over the social care support and services they receive. The development of these policies, and their elaboration in three policy documents published during 2005, are summarized. The paper then discusses two issues underpinning these proposals: the role of quasi-markets within publicly funded social care services; and the political and policy discourses of consumerism and choice within the welfare state. Despite powerful critiques of welfare consumerism, the paper argues that there are nevertheless very important reasons for taking choice seriously when considering how best to organize and deliver support and other services for disabled and older people. A policy discourse on consumerism, however, combined with the use of market mechanisms for implementing this, may be highly problematic as the means of creating opportunities for increased choice and, on its own, risks introducing new forms of disadvantage and social exclusion.
Supporting choice: Support planning, older people and managed personal budgets
- Authors:
- BAXTER Kate, GLENDINNING Caroline
- Journal article citation:
- Journal of Social Work, 16(4), 2016, pp.453-469.
- Publisher:
- Sage
Summary: English policy emphasises personalised and flexible social care support using ‘Personal Budgets’ (PB) – preferably as cash direct payments. However, most older people opt for their council to manage personal budgets on their behalf. It is not clear what benefits of personalisation are available to this group of older people. This article reports research into the choices available to older people using managed personal budgets to fund home care services in three councils. It focuses on the roles of support planners, in councils and service provider agencies, who are central to supporting choice on the part of service users. Data were collected from three focus groups with 19 council support planning practitioners and interviews with 15 managers of home care agencies. Findings: The study suggests that new commissioning and brokerage arrangements have the potential to give older people using managed personal budgets greater choice and control over their support. However, new communication barriers have also been introduced and some staff report receiving inadequate training for their new roles. Above all, resource constraints were reported to impede council support planners in encouraging users to plan creatively how to use personal budgets. Resource constraints also meant councils placed constraints on how flexibly home care agencies could respond to changing needs and preferences of older users. Applications@ The paper concludes by highlighting the implications of new arrangements for social work practice and some of the barriers that need to be addressed if the potential benefits of personalisation for older people holding managed personal budgets are to be achieved. (Publisher abstract)
Carers' roles in personal budgets: tensions and dilemmas in front line practice
- Authors:
- MITCHELL Wendy, BROOKS Jenni, GLENDINNING Caroline
- Journal article citation:
- British Journal of Social Work, 45(5), 2015, pp.1433-1450.
- Publisher:
- Oxford University Press
Adult social care in England emphasises the service and support preferences of disabled and older people. Personal budgets play a central role in this development. Carers in England have also secured rights to assessment and support in their care-giving roles. However, these policies have developed largely separately, with little consideration of the interdependencies between disabled and older people and their carers. There is limited evidence detailing current practice. This paper explores current practice, particularly how far social care practitioners recognise and balance the needs and interests of service users and carers, especially those with cognitive and/or communication impairments. The paper reports findings from nine qualitative focus groups (forty-seven participants) conducted in 2012 with practitioners involved in service user personalisation and carer assessments from older people and learning disability teams across three English authorities. Findings indicate inconsistencies in practice. Although practitioners felt they sought to involve carers, practices varied between authorities, teams and colleagues in the same team. Clear and timely links between processes for service users and carers were absent. Practice was discussed most frequently around service user assessments; other stages of personalisation appeared ad hoc. Areas of confusion and tension are identified. Future policy and practice developments and challenges are also considered. (Publisher abstract)
Personalisation and partnership: competing objectives in English adult social care? The individual budget pilot projects and the NHS
- Authors:
- GLENDINNING Caroline, et al
- Journal article citation:
- Social Policy and Society, 10(2), April 2011, pp.151-162.
- Publisher:
- Cambridge University Press
This paper discusses inter-sectoral and service partnerships alongside personalised approaches in delivering health and social care in England, where improving collaboration between care services is a long-established objective of social policy. A recent example has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. This article examines interviews with lead officers responsible for implementing individual budgets (IBs). It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. In conclusion, the authors suggest that these will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation do not weaken other collaborative accomplishments.
Reforming long-term care: recent lessons from other countries
- Authors:
- GLENDINNING Caroline, MORAN Nicola
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2009
- Pagination:
- 51p., bibliog.
- Place of publication:
- York
This paper reports on a review that explored the experiences of a number of countries in reforming their arrangements for funding and delivering long term care. It aimed to: describe the key features of social care funding and service delivery in a number of countries; examine the current debates and reforms in arrangements for funding and delivery in these countries; discuss the implications and lessons for reform in England. In doing so, three issues were of particular interest: the promotion of choice through individual budgets; sustainability of current arrangements; the extent to which funding and delivery arrangements apply equally to older and younger people with care and support needs. The paper concludes with a number of lessons for the reform of care and support in England.