Wednesday 7th May 2008 10am - 4pm
Caroline Glendinning,
Professor of Social Policy and Assistant Director Social Policy Research Unit,
York University. Caroline has been heavily involved in the evaluation of the
Individual Budget Pilot
Projects and the report of the
evaluation is currently being considered by the Department of Health. Caroline's
presentation.
Dr Guy Daly Coventry University. Guy's presentation.
Neal Lawson Compass
Frances Pearson,
Toynbee Hall 28 Commercial Street, London E1 6LS (nearest tube Aldgate East)
The following is based on my understanding of the situation following the SHA
seminar 7th May 2008 and also draws on the work of Jon Glasby at Birmingham
Health Services Management Centre. Thanks are due to our speakers and the participants
in our seminar.
Direct payments - traditional assessment; convert ‘hours’ of care into £;
typically used to employ personal assistants
What is the difference between personal budgets and individual budgets?
Personal Budgets refers to an upfront, transparent allocation of social care funding; user control over deciding how this is used and greater flexibility in how it can be used. . This could be managed by councils or another organisation on behalf of individuals should they choose, or paid as a direct payment, or a mixture of both.
The Individual Budgets Pilot is like Personal Budgets but testing the combination of a number of funding streams to give a more joined up package of support. The funding streams involved in the pilot are Access to Work, Disabled Facilities Grant, the Independent Living fund, Integrated Community Equipment fund, Supporting People fund as well as social care money.
In each case there is an assessment - hopefully only one – which forms the basis of a financial package considered sufficient to meet the individual's needs for social care. Decisions about how that money is spent are then made either directly by the person concerned or by a person or organisation acting with or for them. Take up of Direct Payments has been highest among working age disabled people, but much lower among people with learning disabilities or mental health problems or older people. In most case they have actually had the money and employed their own personal assistants. . The money could be in the hands of a social care organisation, and the people employed might work for that or for another organisation. The important question is about who controls the decision making. Because personal and individual budgets can be used in more flexible ways, they may also be used to pay friends and close relatives for the support they provide.
Choice and control are fundamental to …
These constraints will clearly play differently with different sort of people. There is a lot of interest in the learning difficulties field. “In Control” has led developments with younger learning disabled people. .
Caroline Glendinning et al found in 2000 that social care money (direct payments)
was being used to pay PAs to carry out tasks traditionally defined as health
care (such as injections, dressings, footcare, tissue care, bowel and bladder
management etc).
• Although direct payments were blurring the boundary between health and social
care, this was of potential concern to everyone involved (albeit it for different
reasons), including public service managers, front-line practitioners, the disabled
people themselves and their PAs.
• Disabled people did not find the distinction between health and social care
meaningful – both were combined within a broad area of help that they thought
of as personal care. Direct payments allowed both choice and control, and the
integration of the different (health and social care) elements of personal care.
There could be scope to extend direct payments to some forms of health care – in particular, to people with complex needs already using direct payments for their social care, continuing health care/long-term care, health care equipment and palliative care. A major problem at the moment is the widespread refusal to allow people who have been receiving direct payments or personal budgets, but who become eligible for Continuing NHS Care to continue with their previous support arrangements. The new guidance on Continuing Care specifically precludes its deployment as a direct payment. This is very distressing for people who are seriously ill and risk losing the relationships with carers/personal assistants which they have built up over a considerable time. It also risks deterring potentially eligible people for applying for NHS Continuing Care and therefore ‘cost-shunting’ healthcare costs onto local authorities. One fundamental issue which needs to be confronted is the supposed ban on top up payments in health care. Patients who want to pay for drugs which are not available through the NHS are sometimes told that the statutory requirement that NHS services are to be provided free at the point of delivery unless specifically provided for otherwise by statute (eg, prescription charges) means that if they pay for their own treatment nothing will be provided by the NHS. This supposed principle does not seem to be applied to people who pay privately to have their toe nails cut. or buy additional physiotherapy or health-related equipment .
Early results from social care are so positive that the implications for health seem worth exploring to see if similar results might be possible here too. Not only are individual budgets delivering their primary purpose of giving people more power and control over their own support, they also seem to be leading to overall improvements in well-being and to greater efficiency (Poll et al., 2006). There is considerable overlap between people who use social care and those who use the NHS, with such connections leading to ongoing scope for tensions and/or innovation. A substantial proportion of the NHS budget is spent on people who have conditions that are long-term in nature, and this includes people who already receive direct payments for their social care (Waters and Duffy, 2007). But while there are indeed considerable overlaps, the policy and practice issues are actually very complex. We need more evidence (eg from the National Evaluation of the Individual Budget Pilot Projects) on the problems/issues at the personal budget/NHS interface, for a start.
Putting people first: a shared vision and commitment to the transformation of adult social care
Official Personalisation website
Care Services Improvement Partnership: Health and Social Care Change Agent Team; Better Commissioning
Personalisation: The DH decides to roll out individual budgets nationwide - Melanie Henwood and Bob Hudson
Social care as an equality and human rights issue Baroness Jane Campbell
Personalisation through Participation Charles Leadbeater
last updated 22/06/08