Challenges of integrating personal budgets for people with mental health problems

Broadly speaking, the challenges faced by those implementing integrated personal budgets fall into the following categories: financial, cultural, organisational, and community and individual. Teams establishing systems to deliver integrated budgets in mental health will need to think carefully about how they might approach these areas and talk with their partners in other organisations about how to tackle them.

Financial

• The two budgets involved in personal budgets derive from two different funding streams: health care is free at the point of delivery whereas social care is means-tested. Different rules govern the expenditure of money from these different sources.
• It can be difficult to overcome some of the barriers to creating a pooled budget.
• Financial governance and accounting arrangements will be taking place in two separate locations and using different methods.

Cultural

• Personal health budgets require a significant culture change in the relationship that the NHS has with patients/citizens. For the approach to work, people have to be real partners in decisions about their care and support, drawing on the expertise of clinical professionals.
• Health services overly reliant on a medical model or clinical approach may find the idea of integrated budgets a challenge, as they may be spent on a range of options not endorsed by the National Institute for Health and Care Excellence (NICE).
• An overly risk-averse culture will not create the best environment for implementing integrated budgets.

Organisational

• Integrated budgets may mean an increase in bureaucracy for managers and front-line staff.
• Health and social care staff may not be located in multidisciplinary teams, making integration around the individual more problematic.
• Health and social care staff may not share an integrated approach to budget-setting.
• Staff may fear a loss of professional skills and/or more time spent in form-filling.
• Processes for sharing information across health and social care (including information technology (IT) systems) may not work well.
• Funding may be tied up in contracts, making it difficult to release funds to integrated budgets.

Community and individual

• Provider organisations, and people using their services, may fear the loss of funds brought about by the implementation of integrated personal budgets.
• Users may be reluctant to take up the opportunity of an integrated personal budget, preferring things to remain as they are.
• Users may feel that they do not have sufficient skills or confidence to take on an integrated personal budget.