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OPM Public Interest Seminar: The Future of

Personal Budgets
Policy context
The new Conservative/ Liberal Democrat government has confirmed its commitment to the
personalisation of health and social care. The coalition deal, published 20 May 2010,
promises to break down barriers between health and social care and extends the roll-out of
personal budgets to give people and their carers more control and purchasing power1.
The policy context for personal budgets has evolved over the past few years. The previous
government’s 2006 White Paper Our Health, Our Care, Our Say set a new direction for the
whole health and social care system. It confirmed a radical shift in the way services are
delivered, with an emphasis on ensuring they are more personalised, giving people a
stronger voice so they can act as the major driver of service improvement.
In December 2007, the former Government’s vision was set out further in the Putting People
First concordant, where central and local Government, health professional and voluntary
bodies agreed the need for ‘a system focused on prevention, early intervention, re-ablement
and tailored on-going support services’. With the exception of emergency situations, it
requires all local authorities with social services responsibilities to make personal budgets
available to those who are eligible for social care support.
In March this year, following a period of public consultation, the then government launched
the White Paper, Building the National Care Service, which set out proposals to build a
comprehensive National Care Service for all adults in England including personalised care
and support through a personal budget. It was underpinned by six founding principles, one of
which was to ensure choice and control: respecting individual human rights, personal to
every individual's needs, and putting people in charge of their own lives.

What personal budgets can achieve

Over the last three years, the take-up of personal budgets has continued to spread across
England. Over 30,000 people across 75 local authorities are now reported as having a
personal budget.
Research and evaluation studies looking at the impact of personal budgets have shown that
when people take more responsibility for organising their own support, not only do they feel
more in control of their lives, they also report higher levels of satisfaction with the quality of
care they receive. Other outcomes reported by service users include improved quality of life,
for example through spending more time with people they want to, taking a more active role
in their community, and feeling they are supported with greater dignity.
Personal budgets are now enabling many service users to make decisions about the support
they feel will best meet their needs, for example choosing individual care providers with
particular skills or interests, or those which offer them greater flexibility so they can live more
spontaneously with less rigid routines. Through personal budgets, some people are also
accessing completely different services to those traditionally commissioned by local


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OPM Public Interest Seminar: The Future of Personal Budgets

authorities, enabling them to purchase services which reflect who they are as an individual.
For others, personal budgets simply give them a greater sense of leverage and control to act
if they feel the services they receive are not delivering what they have promised.
There is also some evidence of wider impact on carers and families, in particular that being
able to choose providers and to change them if there is a problem gives them greater peace
of mind.

The role of frontline workers

Evidence to date highlights a number of factors which are crucial to ensuring not only the
continued take-up of personal budgets, but their effective use in order to achieve desired
outcomes. It is clear that strong leadership, effective commissioning, a functioning market,
appropriate systems, the third sector and social capital all contribute to the success of
personal budgets. However, experience so far also demonstrates the important role which
frontline staff can play in either opening up - or closing off - space for service users to think
creatively about ways to use their budgets and maximise positive outcomes for themselves
and their families.
Local authorities have invested time and resources in targeted training and support to those
working at the frontline so they can develop the required knowledge and skills. Yet many
frontline staff, for example some social workers, still express feelings of frustration, low
morale and anxiety about the changes taking place, including – in some cases - the
perceived loss of their specialist skills. While there are a number of practical issues to focus
on, for example clarity around accountability structures, the changes also requires a
significant degree of cultural change, in terms of attitudes and behaviours at the frontline as
well as organisation-wide. One of the challenges, for example, is the amount of direct contact
frontline staff are expected - and encouraged – to spend with service users.
Frontline staff are in an important position to explain the ‘rules of the game’ to service users,
for example describing the parameters of how personal budgets can be spent. Perceptions of
risk and vulnerability can impact on the confidence of frontline staff in recognising the
potential of personal budgets to have a positive impact on service users’ lives. Uncertainty
among frontline workers about the nuts and bolts of the process of arranging personal
budgets - and the rules governing it - can translate into a heightened sense of risk, which can
then be passed on to service users. To some extent, this is an issue of communicating
information and clarifying processes to frontline staff. However, it also has a ‘hearts and
minds’ aspect, and relates to attitudes among frontline staff and interpretations about what
‘choice and control’ means at a practical level. These attitudes and beliefs can then be
passed on to service users, impacting on the level of freedom they have to assess their own
needs and identify the most effective ways they feel they can be met.

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