Getting up Close with Personal Budgets

Yesterday I spoke at an event put on by third sector CEOs body ACEVO about the challenges and opportunities presented by personal budgets (PBs) for social care.

The line up was intereting. First up was David Challis of the University of Manchester who was one of the leaders of the IBSEN government sponsored research into PBs.

In essence his research showed that, over the whole sample, having a PB had a very small impact on personal well-being, compared to those in the control group.
However, there were differences within the sample. Young people, for example, fared a lot better, as did people with learning disabilities and mental health problems. But for older people - the vast bulk of potential PB users, outcomes were actuallý overall marginally poorer.

Now this could have been an 'old versus new' effect which would erode over time but the big take out from David's work was that it cannot be proven yet that PBs improve outcomes as a matter of course.

What he did say, however, was that the changes that did happen for people who
altered their provision slightly were often reported very positively. The meal you pay the pub to deliver rather than having meals on wheels. Being put to bed by your neighbour rather than a paid carer who might appear long beforeor after your preferred bedtime.

David's message to the third sectorwas that this policy could be a massive opportunity to increase their role, ashe has seen happen in Australia and Japan, where TSOs now do many of the roles currently delivered by local authorities such as assessment of needs and allocation of resources. In parts of Australia, for example, it is quite normal for a charity to be assigned the whole responsibility for social care needs within a particular geographic area.To this end they set up brokerage services, as well as provision.

My worry, and one shared with many of the audience is that in most parts of the UK,local authorities are defending this role and ensuring that, long term, it is they, not TSOs or anybody else have this central role. It is they who have the funded brokerage services running already and so forth. In essence, yet another uncontested service delivery contract won to the only candidate allowed into the process.

Next up was Caroline Glendinning, another of the IBSEN researchers. Her presentation focused moreon the logistics and challenges to the social care provider market when you disaggregate demand in the way PBs do. There are unintended outcomes, losses of efficiency in contracting and all sorts of tricksy problems around who ensures carers are checked-out,trained and doing what they should be doing etc. Hers was aless compelling presentation thn Challis' but the take away, for me, is that every major policy shift has unintended consequences that can actually challenge the whole model.

I spoke about our experience of attempting to get a new support service to people using PBs off the ground in Cambridgeshire, something which we started thinking about in 2007.

For me the experience has been frustrating. The LA seem to be investing most of the Social Care Reform Grant into their own initiatives and , so far, there has been little tangible support. I am not actually convinced that LAs want to see TSOs in this space. As providers yes, they ok with that. But working closely with users to shape their budgets, no I remain unconvinced of their will to fund this happening outside of the LA. I hope I am proven wrong.

Final speaker was Stephen Rose of Choices Support, a 35 million pound charity which he has grown from an acorn. Stephen is the opposite of the self-centred, bucaeering social entrepreneur. His low key, modest approach seems almost unbeting of a person of such achievement. His key point was that TSOs themselves can, as providers of services, get involved in helping to broker change for individuals they support. Choices has, he told us, broken its 35 million budget into 6000 individual accounts and they now offer brokerage for free.

Did the session change my views of PBs? I think I now appreciate more fully the role that service providers will play in acting as brokers, despite a degre of conflict of interest. I also now think that any solution we develop may need to have a provision-option built into it. The session also brought to mind that in order to really get momentum into what we are doing - and our process has been relatively slow - we need to obtain development capital quite soon. One way to do this is to partner with a large provider and this is something to which I think we now need to give proper consideration.

Overall I believe that by 2019, PBs will be the norm for most people whether these are held as a cash payment or, at the other end of the scale, within the Local authority. The third sector will be providing more than it does now though I somhow doubt we will see an Australian-style handing over of responsibility from LAs. Nice though that is to envisage, I suspect that is to hope for too much.