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Individual budgets pilot
My personal experienceI first received support as a disabled parent when my son was six months old. At first, I received direct services but that wasn’t workable at all. Some weeks I’d have a different carer every day – I never knew who would turn up, when or for how long. When my son was two years old, I switched to direct payments, employed a personal assistant (PA), and life changed. With my PA, I started going out with my son for the first time. Individual budgets has given me greater freedom. With direct payments, it was stipulated in my care plan that my PA would enable me to take my son to school. This meant that she wasn’t allowed to take him by herself. The great thing about writing my own support plan under the individual budget scheme is that I am able to identify my own priorities. Now, my PA takes my son to school without me, which means I can get up more slowly, which really helps as mornings are difficult for me. The integration of funding streams minus the restrictions imposed by a traditional care plan, means I can prioritise how I spend my money. For example, I have opted for my husband to provide my support at weekends. The money I save on PAs has been spent on a special air conditioning unit, which helps my lung condition. This has helped keep me out of hospital so I can be around for my family. Self-directed supportThe delivery of support for disabled people in England and Wales is set to come of age, if pilot programmes on self-directed support are mainstreamed. Self-directed support – where the individual decides how their support needs will be met – evolved as a result of disabled people campaigning for more choice and control over the support they were allocated by social services. The direct payment scheme was introduced in the 1990s, enabling disabled people to choose who they employed or engaged to provide the services that the local authority had agreed to fund. However, this did not work for everyone because there were not enough support services available to help people manage their direct payments. Managing direct payments can be difficult for some people, particularly those with learning disabilities or mental health issues. In 2003, learning disability charity Mencap and the Valuing People Support Team launched a pilot project called In Control. The project was based on the premise that people with learning difficulties needed to know upfront how much money they would receive for their support and have control over how it was spent without necessarily being required to take on full responsibility for the day-to-day management. Individual budgets projectBuilding upon these principles, in 2005 the Department of Health piloted a new project, offering individual budgets across 13 local authorities, including Essex. The programme offered individuals a yearly financial allocation, which was paid monthly or quarterly, so that they knew how much they had to spend on their support. Individual budgets brought together a number of funding streams, which could include local authority provided social care; Independent Living Fund; housing support funds (Supporting People); support and equipment for employment (Access to Work); equipment for daily living (integrated community equipment services); equipment and adaptations for housing (Disabled Facilities Grant). The goal was that the user only had to go through one assessment process to access all six different types of funding, which meant less time spent having to give the same information. Each of the pilot sites tried out individual budgets in a different way. Essex County Council chose to integrate all six funding streams, whereas some of the sites only worked with two or more. Some, such as Oldham, worked with all disabled adults over 16, and others worked with specific groups such as those with mental health issues. Essex County Council offered individual budgets to people with physical impairments, learning difficulties, disabled children moving through transition into adult services, and carers. To be eligible to receive an individual budget, an individual had to be assessed under the fair access to care services eligibility criteria (Department of Health, 2003). Traditionally, after a community care needs assessment, direct payments were allocated in hours and paid as a weekly sum, closely monitored by social services. The assessment process for individual budgets was quite different. The pilot sites used a resource allocation questionnaire as the basis for allocating the money. This was a ‘tick box’ type questionnaire, which was completed by the person who needed the service, rather than by their social worker. The responses were fed into a computer system, based on the financial assessment used for direct payments. Each individual was told how much money was allocated for them per year, rather than being given an allocation in weekly hours and an hourly rate. Disabled people were asked to describe themselves, their family situation, what was important to them, what was or was not working in their lives, what support they would like and how they thought that may be achieved. The answers given were not necessarily the same as those offered by a social worker. How do individual budgets benefit disabled parents?Disabled parents who receive direct services or direct payments have a care plan drawn up for them, stating how they are allowed to meet their assessed needs, and restrictions are placed on the types of services they can use or purchase. With individual budgets, a user writes their own support plan, with the help of their supporters, such as family, friends and advocates. This may or may not involve the help of a social worker. The user has ownership of the plan, rather than it being something that is imposed on them. This system allows disabled parents to be experts on themselves. The local authority must validate the support plan by considering if it will enable the user to stay healthy, safe and well. Individual budgets shift the focus away from needs and services towards outcomes. An individual budget can be a cash payment, or arranged services, or a combination of both. Therefore, all or part of an individual budget can be received as a direct payment. The user can choose whether their payments are self-managed or managed by the local authority or a designated third party. This means that a user who does not want the hassle of managing payments or employing staff can retain control. Peer supportAs a user of direct payments for eight years and ex direct payments support services manager, I understand the issues that disabled parents face when trying to access support. I now work as a director of Liberation Partnership, a social enterprise, set up in March 2007 to provide peer support to disabled people in Essex who have moved onto the individual budget scheme. The users we have spoken to are finding that individual budgets work better than direct payments, but it can be difficult to think about what is important to you if you have never been given the opportunity to do so before. We provide peer mentoring and support to help people through the system. Further developmentsIn December 2007, the ministerial concordat Putting people first: a shared vision and commitment to the transformation of adult social care was launched. It sets out an holistic approach that aims, through a reform of public services, to enable people to live their lives as they wish, receive quality services, and promote their own individual needs for independence, well-being, and dignity. Direct services, direct payments and individual budgets: key differencesDirect services• Care plan is drawn up for the user. • Focus is on needs and services. • Received as arranged services. • Restrictions on the services used. • Local authority funding only. Direct payments• Care plan is drawn up for the user. • Focus is on needs and services. • Received as a cash payment. • Local authority funding only. Individual budgets• User draws up their own support plan and retains ownership of it. • Focus is on outcomes. • Received as a cash payment or arranged services or as a combination of both. • Access to several funding streams, such as social care, independent living, housing support, employment support, equipment and adaptations. Individual budgets programmeThe 13 pilot sites that participated in the programme were West Sussex, Lincolnshire, Essex, Norfolk, Barnsley, Leicester City, Coventry, Bath and North East Somerset, Kensington and Chelsea, Barking and Dagenham, Gateshead, Oldham and Manchester. Other local authorities have opted to join in, and more than 20 sites around the country plan to convert to using individual budgets within two or three years. The pilot programme finished in December but the disabled people involved are still using individual budgets. An extensive evaluation of individual budgets is being carried out by the universities of York, Kent and Manchester and the London School of Economics, comparing the experiences of people receiving individual budgets to those without. They are due to report on their findings in April. Useful organisationsIn ControlAn organisation set up to develop self-directed support and individual budgets as the route to independent living. National Centre for Independent LivingA national support, advice and consultancy organisation that is working with the pilot sites. MencapThe UK’s leading learning disability charity working with people with a learning disability and their families and carers. ReferencesDepartment of Health. 2003. Fair access to care services: guidance on eligibility criteria for adult social care. Department of Health, London. Department of Health. 2007. Putting people first: a shared vision and commitment to the transformation of adult social care. Department of Health, London. |
Julia Winter, a disabled mother, receives an individual budget, which she uses to manage her personal social care support needs. Previously, the provision she received from social services was in the form of direct services and, later, direct payments. Julia was involved in setting up a social enterprise in Essex, UK, called Liberation Partnership, to offer peer support to other disabled people using individual budgets. Here, Julia talks about the individual budgets pilot programme, to Shanta Everington, DPPI deputy editor.