SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets

Introduction

'Perceptions of risk, legitimate use of public funds and concerns about safeguarding and duty of care need to be debated as these are potential barriers to implementation.' (Carr & Robbins, 2009)

What is the issue?

The personalisation agenda, outlined in the Putting People First concordat, proposes:

• to allow people who use services more choice and control
• to promote more independent and fulfilling lives
• personal budgets, which includes the option to have a direct payment if the individual chooses.

This implies a need for:

• changes in the way risk is understood, managed and negotiated with the person using the service
• organisational transformation to respond to new person-centred ways of working.

But some commentators see potential challenges in balancing:

• increased choice and control, with social care and support tailored to the individual, with
• practitioners' duty to protect 'vulnerable people', or adults at risk.

Some have suggested that by definition, extending choice limits safety, somehow absolves practitioners from their duty of care, or is inherently 'risky'.

These concerns may be caused by:

• a misconception that personal budgets are cash payments and that people needing social care and support will be left to organise their own services
• misunderstandings about the principles and practice of 'independent living'
• a lack of clarity about the personal budget option being unsuitable at times of crisis or as a response to crisis.

Further reading

• SCIE Report 20: Personalisation: a rough guide
• Putting People First (Department of Health)
• Glendinning C et al (2008a) Evaluation of the individual budgets pilot programme: final report York: York University Social Policy Research Unit

Points for reflection

• How far do you agree that increasing opportunities for choice and control can increase risks?
• Have you faced any such challenges in your own practice?