Direct payments and personal budgets are a central part of the personalisation agenda to give people in need of care at home services full choice and control over their care and support. At HomeCareDirect we have over 10 years of experience in working in this area. Community Care has created an expert guide to direct payments, personal budgets and individual budgets which can be viewed here.

Direct Payment & Personal Budgets

It covers areas such as what are direct payments? What are personal budgets? What is the role of social care professionals?

In the guide there is also lots of information on how people are using personal budgets and direct payments. Showing that in March 2012 53% of people in need of community services in England were on a personal budget, this meant that over 400,000 people are using their personal budget funding to take control over their care at home services.

There are some areas of the country that have had a bigger take up in personal budgets than others. Councils in England were set a target of having 70% of people in need of community-based services and carers on personal budgets by April 2013 by the government. In July 2013, ministers concluded that councils had missed this target, but work is continuing to achieve personal budgets for all by 2015 however there have been warning that these targets have encouraged councils to move people on to council-managed personal budgets (also known as virtual budgets) without providing them with real choice and control over their services.

Direct payments have traditionally had a higher take-up among younger adults, people with learning or physical disabilities and the uptake by older people was slower, however this gap is closing and more and more people from all client groups are accessing self-directed support in general. However, it is still that case that older people are more likely to take their budget in council-managed (virtual) form, rather than as a direct payment.

The take-up of personal budgets has also traditionally been lower among people with mental health problems, there are concerns that not enough has been done to make personal budgets work for older people, people with mental health problems and those with the most complex needs; these issues have been raised in a number of reports, there are kinks to these available in the article. There are on-going efforts to boost take-up among people with mental health problems and older people and we at HomeCareDirect truly believes that anyone can benefit from having true choice and control over their care at home services with the right support in place from committed PA’s and organisations such as ourselves.

There is also information available about personal health budgets. In England, personal health budgets have been being tested to give people with mental health problems or long-term conditions control over resources spent on their health care. An evaluation report of the pilots in November 2012 found that personal health budgets were associated with significant improvements in quality of life and psychological well-being. Outcomes tended to be more positive where pilot sites gave patients more choice over how budgets were spent. After the success of the pilot the government plans to roll-out personal health budgets more widely from 2014, all people receiving NHS continuing health care will have the right to ask for a personal health budget. It has also passed regulations enabling health commissioners to provide direct payments to people to pay for health care, something that was previously outlawed. Health commissioners were already able to offer people personal budgets managed by the commissioner themselves or a third-party. HomeCareDirect have been involved in working with clients and commissioners in pilot and non-pilot areas and have some great experiences of how to make personal budgets a success for people, check out one such story here.

More information on personal health budgets is available from NHS England.

A number of studies have shown significant benefits for people who need care at home services from personal budgets and direct payments. For example, a 2010 report by charity In Control found that 68% of service users said that their lives had improved since they started using a personal budget.

The Think Local Act Personal (TLAP) 2013 National Personal Budget Survey which covered 3,400 service users and carers found at least half of people reported that personal budgets had made things better or a lot better in 9 of 14 aspects of their lives they were questioned about. However, significant minorities of people had found some aspects of the self-directed support process difficult or very difficult, including: making changes to support (22%), choosing from different services to find the right one for you (20%) and telling people what you think or complaining (20%).

The report found strong links between councils having simple processes that were easy for families to understand and positive outcomes. For example, older people were more than twice as likely to report positive outcomes in 11 out of 13 areas if they felt their council made it easy for them to have their needs assessed or to access information and advice on personal budgets.

Despite the links between less red tape processes and positive outcomes for people using services, personal budgets have been surrounded by excessive bureaucracy. 78% of social care professionals responding to Community Care’s 2013 personalisation survey said the implementation of personal budgets increased bureaucracy in their role. The sources of bureaucracy in the personal budgets process include long, multiple and complex assessment, resource allocation and support planning forms; resource allocation systems that generate indicative personal budgets that do not serve to meet people’s needs; and cumbersome panel processes for signing off personal budgets. These feelings have been echoed in feedback from people using services and providers such as ourselves. This has created calls for the processes involved in personal budgets to be simplified, which is one TLAP, which is looking to identify good practice among councils in cutting bureaucracy.

Although we at HomeCareDirect agree that there are on-going improvements to be made to the processes surrounding personal budgets and the cutting of some of the red tape involved within councils we do believe that they benefits that people receive from taking control of their care at home outweighs the frustrations that some people face.

We’d love to hear your thoughts and experiences of direct payments and personal budgets so please get in touch with us here.