Progress on personalisation?

Last week’s Audit Commission publication of Financial management of personal budgets: challenges and opportunities for councils shows that there is still progress to be made in rolling out personal budgets across the board, and especially amongst older people. Only six councils have met the target of 30% of those eligible for social care to receive a personal budget (and a smaller proportion still receive this money as a cash payment). There is huge progress to be made before April 2011.

The report makes the valid point that personal budgets are not cost-saving in comparison to traditional services, and luckily councils involved in the research seem to have taken on the message.

There are some challenges for councils, not least to ensure their internal procedures and processes are capable of dealing with the requirements of a person-centred approach to care. The report also highlights that councils should be prepared to be flexible in the use of their Resource Allocation Systems which work out how much money can be used to meet someone’s needs. Councils should be prepared to increase the budget, using the Resource Allocation System suggested figure as a good initial ball-park. Coventry’s outcomes-based model of assessing what support someone needs is the way forward, but I wonder whether many other councils will take this on? It involves a reversal of the traditional ways of assessing someone.

However, what the report doesn’t mention is what councils have been doing to persuade those who need care and support that these budgets are a good idea. Mention is made of the attitude of staff being paramount, but this idea is not explored to see whether this might be the root of the lack of take up.

There is also very little mention of people’s rights and entitlements in social care. Unfashionable in today’s choice-and-DIY-social-care landscape, but nonetheless, a statutory responsibility that can’t be wriggled out of if councils provide services. The report talks about brokerage and care management as though the two are the same. This is a fundamental distinction, as care management is part of the statutory duty of the council, brokerage could be a charged-for service. It makes you wonder whether people are being charged incorrectly for care management?

Back to the 30% target. A bit of me can’t help wonder if personal budgets are not the rip-roaring success for older people that they were branded to be simply because for many people they do not work? There’s a world of difference between a younger physically disabled person using a personal budget for their stable and predictable needs and an older person learning to cope with a new disability which they’re not used to. It’s not impossible for this to be achieved by older people, but it needs careful thought and a great deal of support from the council providing the budget or the care and support to the budget holder.

We expect the coalition government will push personal budgets even harder. Some councils are clearly well on the way to broad provision of care in this way but they are few and far between, the majority need to up their game.

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