SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets
'...arrangements leads to more independence. There are no detectable increases in risk to quality, trustworthiness, reliability and safety when compared with agency-directed services.' (Ottmann et al 2009).
The IBSEN study: main findings
The IBSEN study (Glendinning C et al, 2008a) is the main piece of UK research piloting a version of personal budgets (then known as individual budgets). This was undertaken in 13 English local authorities, with 959 participants from all groups of people using adult social care.
The research gives a clear indication of particular concerns surrounding personal budgets and risk. Staff highlighted concerns about the following areas of potential risk:
- poorer quality services (particularly the use of untrained, unregulated personal assistants)
- budget management and employment responsibilities
- misuse of funds
- financial abuse from family or paid carers
- neglect or emotional abuse
- physical harm
- breakdown of care arrangements and contingency planning
- extent of local authority responsibility for providing back-up if arrangements fail.
One specific area of risk highlighted by adult safeguarding staff was the lack of means to enforce Criminal Record Bureau checks on people (such as personal assistants) employed directly by personal budget holders.
The study authors note that:
- many social care staff in the pilot sites struggled 'to decide how far those risks should sit with the individual, how they should be managed, and, crucially, what were the implications for safeguarding adults'
- there was a tension between how far individuals were allowed to take risks and where the [local] authority had to retain responsibility for protecting vulnerable adults (suggesting a need for a clearer understanding of duties)
- the administration and management of personal budgets had few clear mechanisms for monitoring and identifying risk once the support was in place
- people receiving personal budgets were still subject to the same monitoring and review systems as those of their counterparts receiving traditional services directly.
As with the traditional approach, unstable or complex situations were likely to remain the responsibility of a named care manager. The development of appropriate monitoring and review systems for personal budgets was seen as essential and further exploration indicated that the following could help with managing risk in the context of personal budgets:
- firming up adult safeguarding policies
- regular expenditure reviews
- building risk assessment into the support plan
- better guidance for care co-ordinators
- better information for people using personal budgets
- staff, service user and carer training
- regular [proportionate] audit.