Personal budgets herald public service revolution – but will it mean value for money?

Providing better health and social care services to more people for less is at the heart of the personalisation agenda. But while tailoring services offers greater choice and control to users, local authorities need to recognise what long-term benefits can be gained from radically changing how they commission services.

People’s capabilities vary, but many authorities now recognise the importance of a different approach. “There’s a whole spectrum of people, from young, physically disabled people who can self-assess, run their own budget and organise their own care, to people suffering dementia who lack capacity,” says Tony Dailide, assistant director for access and personalising services at Leicestershire county council. “But we’re encouraging everyone to make as many decisions as possible.”

The council, which has also set up a social enterprise, the South Leicestershire Care Cooperative that can act for individuals, aims to have 30% of social service users – around 5,000 people – using personal budgets by next year, with plans eventually to roll out personalised services to all users.

“We really believe in this approach, both for individuals and families who have greater choice and empowerment, but also because of the current demographic and financial climate,” says Dailide. “If we don’t change from the assessment and care management model, the current system of social care simply won’t be able to cope with the increase in demand.”

Moving away from a one-size-fits-all approach offers service users a chance to manage their own care and choose from whom they want to receive it – from private, public or voluntary sector providers. It will have a big impact on the way service delivery organisations need to work and think long-term – and it could also lead to more targeted spending and better services being better delivered.

One of the biggest cultural shifts for local authorities will be to move away from a target-driven mindset to one based on outcomes.

“Looking just at inputs – such as how many people and how much it costs – is useful but limited,” says Dailide. “Individual outcomes are more difficult to measure but we still need to validate public money. In Leicestershire we have a simple tool that asks users to rate 10 different outcomes at different stages. We can then identify common themes, see where things have got better or worse and where to put more resources.”

Other challenges include changing the traditional methodology used by local authorities in areas such as risk assessments. “By definition, giving people more choice and flexibility introduces more risk,” says Derrick Anderson, chief executive of Lambeth council, who argues that one of the challenges facing councils will be to build in a more flexible approach. “We had a man who had MS, and the first thing he did was buy a caravan with his personal budget. But in the space of six months he’d changed in positive ways no one could have predicted.”

Despite the challenges in the short term, local authorities should be able to take on a more strategic position as service developers – and that should also enable them to identify priority groups and take a step back to make sure suppliers are working more efficiently.

“Longer term, authorities will be at the forefront of developing public service, acting as market shapers not just providers,” says Dan Burke, central government and consulting director at Pricewaterhouse- Coopers. “They’ll be able to better identify priority groups and take a step back to make sure suppliers are working more efficiently.”