SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers

Key issues

Maximising control

A number of previous studies have highlighted the danger of a 'one size fits all' approach to self-directed support, and have emphasised the importance of people having a range of options for the management of their personal budget. Clearly, decisions about how to manage a personal budget can have a powerful knock-on effect on the ways in which personal budget holders can exercise choice and control. There was evidence that those personal budget holders who had managed accounts or directly commissioned services, rather than a direct payment, had less control over how the services and support they received were provided. Addressing this problem required a number of strategies. Staff training, particularly involving people using services, could be used to break down assumptions about which deployment options 'suit' different client groups, but personal budget holders themselves also need information and discussion about deployment options and support at different stages in the personal budget process to enable them to make an informed choice. For older personal budget holders in particular, there needs to be a much more flexible interface between reablement and take-up of a personal budget, and for all personal budget holders it should be made much easier to move between deployment options. Many user-led organisations would argue that the direct payment form of personal budget should be more actively promoted and this is most likely to result in people having maximum choice and control. However, there also needs to be recognition that some personal budget holders may at times, be unable to cope with a certain deployment option or simply do not want the responsibility. Steps therefore need to be taken to ensure that, even with managed accounts and directly commissioned services, every effort is made to maximise personal budget holder choice and control. These deployment options should not be seen as 'second class', just different choices according to what an individual feels is right for them.