OPM Public Interest Seminars

Self-directed support and personal budgets will be the norm in 5 years time: a debate
3rd November 2011
Our recent public interest seminar was a debate on personalisation and whether personal budgets would be the norm in five years time. The debate format involved four speakers, two presenting arguments in favour of the assertion, and two speaking against it. The speakers were: Aileen Buckton, Executive Director of Community Services, Lewisham Council Bill Mumford, Chief Executive, MacIntyre, Chairman, Voluntary Organisations Disability Group and board member of the Think Local Act Personal partnership Su Sayer, OBE, Chief Executive, United Response and Vice-Chairman, The Prostate Cancer Charity Vidhya Alakeson, Research and Strategy Director, The Resolution Foundation

The debate was introduced and chaired by Clive Miller, OPM Principal and lead on personalisation. Attendees were from a range of organisations including senior managers, policy-makers and practitioners from OPM's extensive public service network.

Key points from the speakers in agreement with the proposition

Those speakers that argued self-directed support and personal budgets would soon be the norm presented several arguments with an emphasis on the benefits of personalisation and the power of consumer choice in enabling the transition for providers and professionals. According to a recent SCIE report, the main obstacles to the expansion of self-directed support and personal budgets are the attitudes and risk-averse behaviours of health and social care professionals. Culturally and professionally, the transition to personalised care represents a significant shift in power: one speaker compared it to Copernicus revelation that the earth revolves around the sun because it places the service user at the centre of provision instead of the professional. So what is the main driving force needed to overcome this challenge? With Copernicus, it was 250 years later when Sir Isaac Newton proved the existence of gravity that people fully accepted the shift in thinking. With the move towards personalisation in health and social care, a force on a similar scale is needed: and this force is consumer society, delivered through money and choice. Placing funding directly into the hands of service users will force providers to adapt behaviours and change service provision in order to secure their viability. Experience also shows that personal budgets have the power to change what professionals do to make services more responsive and tailored to individual need. As the number of service users receiving self-directed support and personal budgets increases, the spirit of consumer power will increase, leading to a shift in power towards users and away from top-down provision. The progress that has already been made will add to personalisations future success because once service users have been given control they

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will be reluctant to give it up this will make it very hard to undo what has already been achieved. The government has already made the commitment to personalisation, with 98% of councils making progress and structural changes in order to be able to offer all eligible people a personal budget by 2013. Recent figures from ADASS (Association of Directors of Adult Social Services) show that the numbers of users already receiving personal budgets is increasing rapidly, and that a third of those people eligible for social care support (338,000) are receiving personal budgets. It is therefore only a matter of time before this shift is complete, and personalisation becomes the norm. This increase in the allocation of personal budgets is also being driven by the current economic climate: personal budgets are cost neutral and can be better value for money compared to universal provision. Furthermore within the health sector the pressure of chronic health conditions on the NHS are making the move towards personal budgets inevitable. At present, approximately 70% of the NHS budget is spent on managing long-term conditions. Personal budgets can be used by service users in a holistic way to address wider needs that impact on these conditions and on users quality of life, therefore resulting in efficiency savings. Finally, speakers cited the continuous progress towards personal budgets as evidence that the transition will soon be complete In the 3.5 years since the agenda fully took off there has been no show stopper or killer issue rendering the agenda obsolete or unachievable. All of the challenges are issues that can be, and will be, overcome. This reflects the strength of the values underlying personalisation, as well as the undeniable benefits that it can have for service users.

Key points from the speakers arguing against the proposition

Whilst all of the speakers at the debate were positive about the move towards self-directed support and personal budgets in health and social care, those speaking against the proposition presented arguments illustrating the barriers that still need to be overcome within both sectors in order to make personalisation the norm in five years time. The pace of change within the personalisation agenda to date shows that it is a slow, difficult process with many challenges. It has been 15 years since the law allowing Direct Payments was first passed, and yet a relatively small number of people are receiving personal budgets in comparison to the overall numbers receiving social care (one third). Furthermore there are issues concerning the type of personal budget reflected in these figures because even though the overall number has increased in the past year, the number of people receiving direct payments has decreased. This reflects the lack of consistency across different local areas in relation to the allocation of self-directed support and personal budgets. Whilst in some areas clear progress has been made, there are huge differences in the types of personal budgets being delivered (e.g. managed budgets rather than self-directed support), which makes progress even harder to measure and could result in a postcode lottery for service users. The potential confusion resulting from these differences means that many families and individual service users are too afraid to take on the responsibility of managing their own budgets, especially vulnerable people such as those with mental health problems. The quality of information-giving and advice associated with personal budgets is variable and in many cases the needs of service users are not accommodated. Evidence from Think Local,

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Act Personal reflects this: in the National Personal Budget Survey, only half of those users receiving a personal budget felt that the council had made the process easy. This is a major obstacle to address: we need to skill people up to understand and make an informed decision about personal budgets because at the moment this support is lacking. Another significant obstacle to the personalisation agenda is the current economic climate: as budgets are being cut, eligibility criteria are being tightened; and there is evidence that these restrictions will continue for at least the next three years. Local Authorities do not have the resources to implement whole systems change, and the current climate means that organisations are entrenched and do not have the mentality necessary to establish personal budgets and self-directed support as the norm within 5 years. To overcome these barriers it is important to take stock of what the issues are and how to overcome them: with professional attitudes and risk-averse behaviours it is important to look at why they may be reluctant. Health and social care professionals working on the ground have a clear understanding of what is achievable, they want to deliver a quality service and they do care about service users. If they are putting up barriers it may be because there are issues that need to be resolved and we need to listen to that. Similarly when Local Authorities are accused of introducing bureaucracy to slow the pace of change we need to consider why that is. It can be hard for service users to agree, but systems and processes are there for stability and to protect public money. It is better to introduce personal budgets in a sustainable and proper way than to rush through and risk reducing the quality of provision. Finally, we should not forget that personal budgets were never intended to replace universal services, rather they are designed to complement them, acting as a complete package of care. We need to take a step back and look at how personal budgets can become the norm because rushing into it will risk the agenda becoming a tick-box exercise, and will limit the potential to transfer or integrate personalisation into other service areas in the future.

Questions and comments

Attendees participated in a discussion following the speakers presentations and identified many important issues and concerns associated with the debate. The importance of giving service users fair representation and a full say was highlighted, along with the overall need to recognise that the personalisation debate is not just about services but is about people. As part of this we need to broaden the view of what self-directed support means and look not just at budgets but at the way users approach and engage with provision, including wider service such as housing. Personal budgets are not the drivers of change, people are; it is about driving change in how people engage services, and that is what will determine whether personal budgets become the norm. We need to focus on the overall outcomes, and not on the funding systems. Another issue raised was the role of volunteers in supporting the personalisation agenda: there is a potential to use volunteers at a low-cost to commissioners to support service users in the move to self-directed support. However, within this it would be important to balance the risk of expecting volunteers to provide support, against wasting money when volunteers could be used. Issues concerning peer support more widely were also discussed, including the benefits it has not just for individuals but as a collective. Peer support is community led and can also pass information back up to providers to inform future provision (through market intelligence

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on what services people are buying). Mechanisms for collective action where service users could pool resources and skills could be particularly effective in leading to genuinely user-led services. Finally, one of the big issues raised by attendees was the need to disseminate information and advice more appropriately and to publicise personal budgets more effectively (including through digital engagement). This was highlighted as a particular issue for individuals with deteriorating conditions (for example the blind or partially-sighted) because when they are assessed for eligibility they may not qualify for social care support, yet once their conditions worsen it is harder for them to then find out about personal budgets and how to access support. After the discussion the seminar was closed by Clive Miller, and since then attendees and the wider public have been continuing the debate on Twitter. If you are interested in finding out about future OPM Public Interest Seminars please register your interest at: seminars@opm.co.uk.

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