Rich Watts – Director of Policy & Development at user-led disability charity ecdp, guest writes a blog looking at how Personal Budgets can be made to work in health care
Personalisation – and Personal Budgets in particular – are making a positive difference in the lives of lots of different people of different ages and impairment groups.
This finding comes from 3 years of work ecdp, OPM and Essex County Council have done in Essex, following 29 people on Personal Budgets, the first “longitudinal” study of its kind.
Older people, people with learning disabilities and people with physical and/or sensory impairments have all reported positive outcomes from using a Personal Budget, such as:
- Improved quality of care through increased choice and control. This included more choice and control over the providers used to deliver services, and more consistent, flexible or personalised care
- Improved wellbeing and the ability to live a fuller life
- Increased independence and dignity for service users
- Increased confidence, self-esteem and sense of empowerment.
Of course the road to successful outcomes through personalisation and Personal Budgets has not always been smooth. But in recording the lessons learnt – including the occasions when things didn’t quite work and key recommendations for making these processes run more smoothly – the final report tells us how to continue to make personalisation and Personal Budgets as good as they can be.
The challenge of personalisation and Personal Budgets in social care has been considerable. It will be even more of a challenge to introduce Personal Health Budgets in the health service. It’s a challenge I have every confidence will be met though, and that will therefore make a considerable difference in the choice and control people have over their healthcare.
To help things along, here are the 7 very practical suggestions taken from the 3-year study that it would be worth those working on Personal Health Budgets keeping in mind.
- It’s very unlikely someone will choose to have a Personal Health Budget if they don’t know about their existence. Make sure you let them know.
- It is not possible to exercise choice and control if someone doesn’t know what options they have with their Personal Health Budget. Make sure you let them know their options.
- It is entirely possible to forget to tell someone how much money they have available in their Personal Health Budget. Don’t forget to tell them.
- It is entirely possible that someone can get good advice and guidance about Personal Health Budgets from health professionals. But it’s just as possible they can get that advice and guidance from someone independent. Make sure they have this option if they want it.
- It is possible you’ll think a website will provide someone with all the information they need about Personal Health Budgets. It really, really, really won’t. Face-to-face contact, peer support, sources of information in the local community (such as voluntary sector organisations): these should all also be part of the information mix.
- It is possible that holding a budget to meet healthcare needs is second nature to some people. But most likely, for the majority, it won’t be, particularly if they consider employing their own staff. Ensure support options for managing money and employing people are in place.
- Finally, it is inevitable that assessing someone’s needs, establishing the level of financial resources this correlates to, describing the options they have available, planning and summarising how to meet these needs, signing it all off and putting the new system into place – is a complex process with many, many complicating factors. If people know it’s going to be a complex process, they’ll probably understand. Manage people’s expectations about how long the process will take, be honest about some of the common pitfalls and reassure them it will be worth it in the end (because, as we’ve seen, it most likely will be).
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Rich – I would be interested to know your view about how personal budgets have added to or changed what was already available under Direct Payments which, of course, have been available since the mid 1990′s.
Thanks for your comment, Colin.
As you know, much has been written on this topic. The key thing I’d personally highlight is that PBs offer a range of options to people that enable choice and control, only one of which is taking the money.
More generally, we should never forget that DPs, PBs etc. are (a) a means to the end of personalisation, and (b) only one part of the whole personalisation agenda.
The full report has just been published, and what I think you’ll see in there is the tremendous amount of outcomes achieved both because of, and through, the Personal Budget, within the context of a personalised system.
Thanks for the reply Rich. But I think you’d have to agree that you havent actually answered the question.
I think it is wrong to group DP’s and IB’s into one as if it doesnt really matter. I think the dictinction does matter, if only becuase they carry with them very different machinery to deliver. For PB’s,the key innovation is the up front allocation of resource. A very large amount of bureaucracy has gone’ into making it work, not least becuase it is the sole test of each council’s delivery of personalisation. But has it worked? For how many of the 29 service users in the study was the up front calculation a key factor in determining either the outcomes they achieved or, indeed, the actual level of their resource?
Thanks Colin. I don’t think I do group them into one – I wouldn’t, because they’re different things! I also don’t mention IBs, which are another thing altogether!
Your impassioned article in Community Care after the second round of the report was published is something I often read back, to see how personalisation might be progressing.
To pick up the implicit point of your final question above, much of the commentary around personalisation has conflated the different issues of the overall amount of resource available in the system with the choice and control previously and currently available in the system.
Though I understand why people might do this, I am a keen supporter of personalisation. I don’t share the view that choice and control is dependent upon the level of resource someone has, and my personal feeling is that the longitudinal study – in the words and experiences of people themselves – shows this.
This isn’t to say there aren’t still challenges about the process, and these are highlighted in the report. But it is to say that personalisation works, even within the resources currently available.
Rich
I am sure there is much we agree about (and apologies for the slip of the finger, I didnt mean to type IB’s, I meant PB’s).
But I do think its terribly important to unpack the different elements of what is going on to know what is making the difference and what is not. I agree completely that personalisation does not depend on resources – however little is available – if personalisation means that resources are designed around the person. I also think personalisation gets the best value from resources. But what does depend on level of resource is the ambition of outcomes that can be achieved. I know there are people in the PB lobby who dispute this – but to do simply flies in the face of common opinion and common sense and, crucially, the evidence. Nationally, people with a DP (who are the only ones to have better outcomes) have much more resource than the rest. In Essex, the gap is even greater than the national average. Can this really not a factor in the better outcomes achieved by these service users? I think it is a grave dis-service to the majority to say that the struggles they have with life given the meagre support they have is nothing to do with needing more resource. Politicians love to hear it, of course they do. It lets them off the hook as they say the great success of the minority is all about process and practice, and nothing to do with resoures.
So I think it is crucial we unpack all that is going and really get to grips with the realities of what makes a difference and what doesnt.