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Improving personal budgets for older people: a review: phase one report
- Authors:
- ROUTLEDGE Martin, CARR Sarah
- Publisher:
- Think Local Act Personal
- Publication year:
- 2013
- Pagination:
- 21p.
- Place of publication:
- London
This project explores the challenges, identifies positive practice and makes recommendations for central and local government action with respect to improving personal budgets. Think Local Act Personal (TLAP) published, Personal Budgets: Taking Stock and Moving Forward (2011) which reviewed progress, challenges and possibilities with PBs and has initiated a National Self-Directed Support Forum. This brings together relevant groups and individuals to identify challenges and agree actions to achieve improvements. Approaches to making personal budgets work well for older people emerged as a high priority and TLAP has committed to do more work in this area. This report is the first stage. It draws on two key surveys: the ADASS personalisation survey (2012); and the TLAP National Personal Budgets Survey (2011). It reviews the literature and research on key challenges to successful implementation of personal budgets for older people, reviews data on numbers and outcomes including from ADASS and Personal Budgets Outcomes Evaluation Tool (POET) surveys. It also gives an initial overview of promising practice responding to the challenges from literature and the ADASS survey. Relatively strong average progress with numbers for people aged 65 and over is being made. The recent significant increase in numbers has been via more managed personal budgets with direct payment numbers steady but significantly lower for older people than for under 65s. There is very significant variation in direct payment numbers across councils and regions.
Can personalisation be a reality for older people?
- Author:
- SLASBERG Colin
- Journal article citation:
- Working with Older People, 14(3), September 2010, pp.15-22.
- Publisher:
- Emerald
The agenda to transform social care from its prevailing rigid and service-centred culture to one that is personalised is key in the government’s strategy to transform care and support services. The core driver used by the government to achieve personalisation is to give people ‘choice and control’ through the provision of personal budgets. This is the allocation of sums of money up-front to allow people to choose and commission their own support systems. The new coalition government has signalled its wish to not only endorse this approach, but to accelerate its implementation. However, there is growing evidence that while this will work very well for people and those around them with the will, the skills and the time to make a success of it, for most it will not result in real change. This is especially the case for older people. This article explores this issue, but carries the message that personalisation can and should be made a reality for all service users and all older people. However, it will require a commitment to a transformational change programme within councils that goes beyond simply achieving well against the former government's performance indicator of numbers with personal budgets.
Rural areas and personalisation
- Author:
- MANTHORPE Jill
- Journal article citation:
- Community Care, 23.10.08, 2008, p.34, 36.
- Publisher:
- Reed Business Information
Findings from a recent study to investigate how individual budgets have fared in country areas are summarised. The study sought the views of lead officers, mainly social service managers, from rural local authorities where individual budgets (IBs) were piloted. It also included the views of providers and service users in rural areas of England. The results highlight the importance of the local context of personalisation, and the need to consider specific rural issues.
Older people's services and individual budgets: good practice: examples and ideas
- Author:
- NICHOLLS Angela
- Publisher:
- Care Services Improvement Partnership
- Publication year:
- 2007
- Pagination:
- 19p.
- Place of publication:
- Leeds
The purpose of the paper is to identify and share ideas and examples of good practice currently being undertaken by the pilot sites working with older people’s services as part of their evaluation quota. The aim is to address, at least partially, some of the specific issues which have been raised in relation to the implementation of Individual Budgets for older people. Fourteen people from the eight sites have contributed their views for this paper, including Individual Budget project managers and service leads, and social workers and team managers working in adult and community services.
Improving personal budgets for older people: a research overview
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, CARR Sarah
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2013
- Pagination:
- 30p.
- Place of publication:
- London
This short report is an evidence overview of key pieces of UK research between 2007 and 2012, which focused on the implementation and uptake of personal budgets and direct payments for older people (including those with dementia) in England. It is not a systematic research review or an exhaustive examination of published research on the topic. Rather, it aims to give an overview of the main themes of research findings which help to identify the challenges and solutions to improving choice and control for older people (including those living with dementia) through the use of personal budgets and direct payments. Issues covered include: culture and system change; making choices and decisions; information and advice; direct payments and support services; understanding allowance and spend; budget management, monitoring and review; risk management and contingency planning; and older people living with dementia.
Understanding resource allocation processes in social care for frail older people: lessons from a national survey
- Authors:
- STEWART Karen, et al
- Journal article citation:
- Journal of Long-Term Care, February 2021, pp.43-57. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: Traditionally local authorities in England allocated resources in social care following a professional assessment of need and a costed care plan. With the introduction of personal budgets, resource allocation tools have been used to provide service users with an initial indicative budget for their care. This is promoted as being more transparent, equitable and giving people greater control over decisions about their care. Objective: This study examined the different approaches to resource allocation and the content of resource allocation tools used for social care in England. Methods: Information was obtained from local authorities about their resource allocation systems. An analytic framework was developed and applied to the tools to explore: who identified needs; whether informal and formal support were recorded; and whether 17 need indicators covering functional status, mental health, and health and wellbeing were present and in what detail. Findings: Ninety-one per cent of 152 authorities responded and 61 per cent of authorities’ tools were analysed. Three approaches were identified: points-based self-assessment tools; standardised assessment data (FACE); and non-points-based/ready reckoner tools. Most authorities used a points-based self-assessment tool. All tools included the service user’s views and a high proportion included a professional’s view, while fewer covered the carer’s view on need. Coverage and presence of detail for the 17 need indicators showed high variation and was least on points-based self-assessment tools. Limitations: The study is the first to examine a large sample of resource allocation tools and provides a valuable baseline for future work. However, non-points-based/ready reckoner tools were under-represented in the sample. Implications: Further research could build upon this study to examine key properties of the tools used such as reliability, validity, sensitivity and specificity; and explore their impact upon service users and staff in terms of time use, cost, utility and equity. (Edited publisher abstract)
Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have a managed personal budget or a direct payment
- Authors:
- WOOLHAM John, et al
- Journal article citation:
- Ageing and Society, 37(5), 2017, pp.961-984.
- Publisher:
- Cambridge University Press
Direct payments - cash for people eligible for adult social care and spent by them on care and support - are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in 2012–13. Included in the study were 1,341 budget users aged 75+, living in ordinary community settings. The overall response rate was 27.1 per cent (339 respondents). Three validated scales measured outcomes: EQ-5D-3L (health status), the Sheldon–Cohen Perceived Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related quality of life). The study found that direct payment users appreciated the control conferred by budget ownership, but in practice, for many it did not ‘translate’ into improved living arrangements. It also found no statistically significant difference in outcomes between direct payment and managed personal budget users. The paper argues that despite policy and other guidance and research evidence about effective implementation of direct payments for older people, the absence of evidence for better outcomes may at least in part be attributable to values underpinning policies relating to personalisation and personal budgets. (Publisher abstract)
Older people's experiences of cash-for-care schemes: evidence from the English Individual Budget pilot projects
- Authors:
- MORAN Nicola, et al
- Journal article citation:
- Ageing and Society, 33(5), 2013, pp.826-851.
- Publisher:
- Cambridge University Press
Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (2005–07). It presents quantitative data on outcome measures from structured interviews with 263 older people who took part in a randomised controlled trial and findings from semi-structured interviews with 40 older people in receipt of IBs and with IB project leads in each of the 13 pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget. (Publisher abstract)
Personal budgets for people with dementia: a report on the challenges and solutions to implementation based on interviews with eight local authorities in England
- Author:
- GOODCHILD Clare
- Publisher:
- Mental Health Foundation
- Publication year:
- 2011
- Pagination:
- 22p.
- Place of publication:
- London
Regulations made in November 2009 paved the way for people with dementia to receive a personal budget. This report explores the challenges and solutions to delivering personal budgets to people with dementia. It is based upon a review of the literature and on interviews with personalisation leads and dementia service leads in local authorities. A total of 9 in-depth telephone interviews were carried out with staff at 8 local authorities. Drawing on the findings, the report outlines 4 levels at which the success of delivering personal budgets to people with dementia is determined: the culture of local authorities and local whole systems; strategic leadership; organisational capability; and operational practice. It demonstrates that systems to support personal budgets for people with dementia are not well developed. The reasons for slow implementation are complex and multi-layered across the local authority culture, strategic planning, organisational infrastructure, and operational systems. There are examples of good practice but they remain in pockets rather than being spread throughout the whole system. One problem is the reticence on the part of older people and families to seek a personal budget. The report concludes by summarising the challenges in delivering personal budgets to people living with dementia and suggesting potential solutions.
Self-styled success
- Authors:
- HENWOOD Melanie, DAVIS Rowenna
- Journal article citation:
- Community Care, 24.04.08, 2008, pp.16-18.
- Publisher:
- Reed Business Information
Putting People First made clear that self-directed support is to become mainstream In this article, the first author describes what self-directed care entails. The second author then describes the work of four teams given awards for innovative and impressive practice in Community Care's Excellence programme.