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
Holding the budget
Across the case study sites personal budget holders were offered four ways of holding their personal budget:
- services directly commissioned and/or managed by the LA
- third-party managed accounts (usually a support provider organisation)
- a direct payment held and managed by the personal budget holder
- a mixture of these options.
Decisions about how to manage the personal budget can have a powerful knock-on effect in terms of the ways in which people can exercise choice and control. personal budget holders emphasised the importance of ensuring people were able to make informed decisions about which option would be best for them and the support they would need to make it work. There was concern among support providers and some LA/trust staff that many personal budget holders, especially older ones, were being steered away from direct payments and towards managed accounts or services commissioned by the LA. personal budget holders, staff and providers suggested this could be addressed by:
- ensuring staff have time to discuss different deployment options (fully, at an early stage and more than once) with potential personal budget holders
- using staff training to break down assumptions about which deployment option may 'suit' any particular group of service users
- providing information about deployment options throughout the personal budget process
- a much more flexible interface between reablement and people taking up a personal budget
- a much more flexible approach to reviews so that people could initially opt for commissioned services but move to other options at a later date without having to be reassessed
- making it much easier for personal budget holders to move between management options as their needs change or their condition fluctuates
- providing clear information about the support available to people for managed accounts and direct payments, and allowing time for staff to discuss this with personal budget holders
- providing opportunities for personal budget holders, particularly those who have opted to have their personal budget as a direct payment, to share their experiences with potential personal budget holders.
Personal budget holders using direct payments clearly felt this had given them much greater choice and control. For personal budget holders with mental health problems the sense of responsibility increased their confidence. Older personal budget holders who had opted for a direct payment were equally positive. A number of older personal budget holders had taken their personal budget as directly commissioned services or a managed account. Although this could work well for some (with the right input from their social worker and a flexible, creative support planning process), the evidence suggests that currently these deployment options often result in less choice and control than a direct payment.
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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