SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers
Managing the personal budget
Choice and control
Those personal budget holders who received their personal budget as a direct payment clearly felt it had given them much greater choice and control over the services and support they received. For personal budget holders with mental health problems, this was not only about being able to choose support that matched their lifestyle and interests, but also about the sense of responsibility and increased confidence that managing their personal budget gave them. Support providers working with people with mental health problems echoed this view.
Older personal budget holders and carers who had opted for a direct payment were equally positive. Many described how unhappy they had been with the care they had been receiving from care agencies and said the personal budget had enabled them to employ personal assistants. Although this had been a big step for many personal budget holders and their carers, it had generally worked well.
Other personal budget holders in the study had used their personal budget to contract directly with a care agency and again felt this had given them more control over when and how their care was provided. A few personal budget holders employed family members (usually a son or daughter) or friends as personal assistants. For some, particularly those with dementia or mental health problems, it was a way of getting support from someone they knew well and felt comfortable with. In most cases the personal budget holder or carer used a support provider to handle issues such as payroll. This was partly to reduce the administrative burden, but it also created a 'firewall' between their role as a family member or friend and their role as a personal assistant.
A few support provider organisations voiced concerns about family members being employed as personal assistants because they felt it could reduce the independence of the personal budget holder and might have a detrimental effect on family relationships, but there was no evidence of this in the research with people using services and their carers. A small number of personal budget holders reported that employing friends as personal assistants could be difficult because friends sometimes felt uncomfortable being paid or were reluctant to take time off. None of the local authorities or support provider organisations appeared to have produced specific guidance for personal budget holders, carers or LA and provider staff on employing family members or friends as personal assistants, but there was a clear sense that people would find guidance on this matter helpful.
A number of older personal budget holders had taken their personal budget as directly commissioned services or a managed account, and there was evidence that this could work well. Here again, however, the attitude of their social worker and the flexibility and creativity of the support planning process was crucial.
Other personal budget holders using managed accounts or directly commissioned services described similar experiences, suggesting that currently these deployment options often result in less choice and control than a direct payment. A few older people, who had simply had their existing services 'switched' to a personal budget, were unaware that they had a choice of provider. Others wanted to change their care provider but were anxious about doing this, fearing that there may be a 'break' in their care or that such a request might trigger a full review of their personal budget. Some had changed their care agency but often they had needed the help of a support provider or family carer to do this. Some were happy to remain with their care agency but clearly would have liked more control over how their care was provided. In a few cases, LA or provider organisation staff helped personal budget holders to shape their contract with the care agency so that the support they received was more personalised and flexible.
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- SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers