SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers
Moving to a personal budget
Expectations and concerns
Many of the younger personal budget holders with mental health problems said that thinking about a personal budget had opened up new possibilities for them. It was often the prospect of being able to access different kinds of services and support, particularly those available to the community at large, which gave people the incentive to take up a personal budget. Most carers of people with mental health problems had initially focused on what the personal budget might do for the person they supported, again highlighting the scope for people to do things in the wider community, and through this to socialise and regain confidence and independence. However, they also hoped that this in turn would give them a break. It was the possibility of this 'dual benefit' that gave many carers the incentive to get involved in managing the personal budget.
For older people and carers, the prospect of being able to arrange care in a different way, to meet their individual needs and wishes or to better fit with family life, was a big incentive for taking up a personal budget. Many older people said that they saw a personal budget as a way of improving the quality of care they received or of enabling them to stay living in their own home. Carers also highlighted quality and continuity of care issues, especially where they cared for a person with dementia, but they also believed that a personal budget would allow them to arrange care in a way that better fitted with their family and work commitments. Although the focus for many older people and their carers was on 'care provision', they also saw how a personal budget could help them regain independence, feel less socially isolated, and in some situations address the impact on the carer and/or the caring relationship.
Personal budget holders and carers felt strongly that the opportunities a personal budget could create should be presented to people at an early stage. This highlights the importance of practitioners having a thorough understanding of personal budgets and how they can be used, and conveying this to people who use services. It also reinforces the need for a number of sources of information about personal budgets so that if a person using services does not have a good relationship with their social worker or community nurse, or the practitioners working with them are poorly informed, they are not denied or put off considering a personal budget. Personal budget holders and carers felt that being able to talk to other people who were already using a personal budget would be very valuable.
Inevitably, personal budget holders and carers initially had some concerns about taking up a personal budget, although these were not as deep or insurmountable as might be imagined. The biggest concerns for older people and people with mental health problems were managing the money, keeping records and being clear about what the money could be spent on. Some were worried that they would not manage the money 'properly' or might spend it on something that was not 'allowed'. Younger people with mental health problems were worried about not being able to control their spending, especially if they were given their personal budget as a lump sum, or were concerned that they might be tempted to 'misuse' their money in some way. However, in this study, as in the recent Audit Commission report (2010), such pitfalls rarely seem to have occurred in reality, and for many personal budget holders the sense of being 'trusted' to manage their budget more than outweighed their concerns.
Coping with paperwork was a particular concern for older people and older carers. Social workers, community psychiatric nurses and support providers played a key role in encouraging and reassuring people.
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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