SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers
Support planning and setting up services
The interviews with support provider and user-led organisations working in each of the case study sites helped to provide a fuller picture of some of the support planning and personal budget management issues highlighted by personal budget holders. The majority of organisations were contracted under a service level agreement (typically stipulating the number of new referrals per month to be dealt with for a given number of meetings or hours). A few said that resources were getting tighter, with the recommended time for one organisation to deliver support planning and brokerage now being 'three hours on a one-to-one basis and seven hours for the rest'. Most organisations also marketed their services directly to personal budget holders and self-funders, and a number of them noted that this more 'user-directed' approach was likely to be the predominant model in the future.
Those organisations with service level agreements with their local authority had usually been commissioned to undertake discrete tasks, particularly concerning brokerage and payroll services, but they often got involved informally in other aspects of the personal budget process, notably support planning and sometimes self-assessment. This ad hoc involvement could be beneficial for the personal budget holder but could also cause confusion - for example, if a personal budget holder was given conflicting information about appropriate expenditure.
None of the support provider or user-led organisations appeared to have clear referral protocols agreed with their local authority and the majority estimated that across the various stages in the personal budget process they would only come into contact with about 30 per cent of all personal budget holders. Referral to a support organisation often seemed to depend on individual practitioners' views about who would benefit from this kind of input. As a result, providers felt that their particular skills in engaging with and advocating for personal budget holders were not being fully utilised. These organisations also felt that exclusively 'in-house' delivery of the personal budget process could result in significant delays due to approval panels rejecting support plans that did not show sufficient input from the prospective personal budget holder.
Overall, the discussions with the support provider and user-led organisations suggested that the experience for personal budget holders could be considerably enhanced if there were:
- clear referral mechanisms and protocols to and from the local authority with scope to expand the involvement of support provider organisations
- multiple referral routes to providers from all types of community organisations (e.g. via provider websites, third-sector organisations, GP practices, specialist clinics)
- outreach activity and 'warm-up' meetings facilitated or initiated by providers to enhance peer support
- stronger emphasis on the direct user accountability of providers when they tender for local authority contracts for support planning services
- more joint training between providers and local authority staff
- more opportunities for local authorities and all local providers to exchange ideas and information, and so increase mutual understanding and trust
- a closer working relationship between support providers and social care practitioners to promote their role and encourage referrals
- an integrated support network from which personal budget holders could choose to get support at all stages of the personal budget process.
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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