Social care directors question personal budgets target

Personal budgets for older people are not improving outcomes, says the Association of Directors of Adult Social Services

The pace of further growth of personal budgets has been thrown into doubt after social care directors questioned the “practicality and wisdom” of the target that all eligible users of services in England should have a budget by April next year.

In a discussion paper, the Association of Directors of Adult Social Services (Adass) is calling for a review of the implementation of personal budgets and direct payments for older people to “identify how they can be overhauled to work more effectively in the future”.

Ministers are insisting that they remain committed to making personal budgets “the norm” for service users and carers. But it is understood that Department of Health officials have been receptive to Adass’s proposal.

The coalition government has continued Labour’s drive for personal budgets, by which people are allocated a set sum for their care and support and given freedom to spend it in the way that best suits their needs.

The budget may be taken as a cash direct payment or administered on the individual’s behalf. The system has proved popular with younger disabled people, but older service users and carers have often struggled to come to terms with it and say they have lacked support to do so.

More than a third of service users already have a budget allocated and councils are supposed to reach 100% of those eligible in 12 months’ time.

The Adass paper, The Case for Tomorrow, says that the principles of choice, control and personalisation that underlie the approach remain sound. But it adds: “Many believe that personal budgets and direct payments are not having sufficient impact on changing personal experiences and outcomes for older people.”

Peter Hay, Adass president, said: “We firmly support and believe in personal budgets and direct payments. However, we believe there is now significant research which suggests that in some cases personal budgets for older people are not improving outcomes.”

Although ministers are unlikely formally to drop the April 2013 target, a review as proposed by Adass would carry the clear understanding that it would not be achieved or enforced.

Paul Burstow, care services minister, said in a statement: “Personal budgets give choice and control to individuals and their carers. We want to make that the norm.”

But it appeared that there would be little opposition to relaxation of the target. Liz Kendall, Burstow’s Labour shadow, said: “Care users and their families desperately want services that meet their individual needs, but not everyone wants to take on responsibility for managing their own budgets or employing their own care staff, particularly if they don’t get the right advice and support.”

Even In Control, the social enterprise that has promoted personal budgets and other forms of self-directed support, acknowledged that the key test of the system was “better outcomes” and that, for older people, “the preferred option may not always be to take and manage the cash payment personal budget”.

The Case for Tomorrow, drawn up in consultation with Adass’s older people network, calls also for the creation of ring-fenced local innovation funds to develop community and preventive services for older people and shift the emphasis from acute healthcare.