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
Making the most of a personal budget
There were a number of factors which helped or hindered personal budget holders' abilities to make the most of their personal budget. One of the most important was clarity about what their personal budget could be spent on. Concerns about spending personal budgets on the 'right' things were common to all personal budget holders and carers but the implications for them making the most of the personal budget were different for older personal budget holders and those with mental health problems. Those with mental health problems often had quite clear and innovative ideas about how they wanted to use their personal budgets and the main issue was ensuring that these ideas fitted the support plan, and then helping people to set up the support they wanted. Older personal budget holders and carers tended to be more cautious and some almost felt they needed 'permission' to spend their personal budget on certain things.
A number of support provider organisations, particularly those that were user-led, were concerned that personal budget holders' choices were sometimes limited by what was presented to them by social workers and community psychiatric nurses, while one provider felt that personal budget holders themselves could be limited by their own 'conservatism'. Providers emphasised that time was needed at the support planning stage to help people think about different options, and again they highlighted the importance of personal budget holders having a choice between support (planning) providers.
personal budget holders and practitioners suggested four things which they had found helpful:
- clear basic guidance on 'using your personal budget' which explains the link between personal budget expenditure and the personal budget holder's support plan
- a named member of staff (or team) who was familiar with the personal budget holder's circumstances, and whom they could contact for advice and guidance
- guidance (and training) for local authority, trust and provider organisation staff on the use of personal budgets and scope for team managers to approve special requests
- the opportunity to exchange ideas with other personal budget holders about how they were using their personal budgets; some of the case study sites were also 'logging' examples of how personal budget holders had used their personal budgets creatively.
Availability of the service and support which people wanted was also an important issue. Sometimes this was related to local factors. For example, the recruitment and retention of personal assistants was sometimes difficult for personal budget holders living in very rural areas, especially if they only needed a few hours of support each day or week. They also found it more difficult to arrange holiday and sickness cover. The use of day services in many areas also highlighted issues of choice and availability. Some mental health services had moved away from 'traditional' day services. Although personal budget holders were being encouraged and supported to set up other forms of support, several provider organisations and mental health staff felt that the personal budget process made it harder for people to pool funds and purchase or create an activity as a group. For older personal budget holders, the opposite problems appeared to exist in some areas – traditional day services were available but a number of personal budget holders did not want to use them. There was evidence, however, of staff working with older personal budget holders and carers to find alternatives which suited them. For example, one personal budget holder in his 90s, whose wife was in a care home, arranged 'daycare' for himself at the same home four days per week (even though the care home did not normally offer this service) so that he could be with his wife, have a cooked meal and get help with bathing.
Overall however, there was a sense that it was still too early in the implementation of personal budgets for them to have had a significant impact on the 'market'. Most managers and staff involved in the personal budget process felt that there had been only minimal change in the pattern of provider services and many acknowledged that the pressure of implementing personal budgets within their organisations had to date left little time to work with existing and potential providers. However, they recognised that this needed to change, a view echoed in recent work carried out by the National Market Development Forum (NMDF 2010). They suggested a number of things which local authorities could do to encourage diversification and development of provider services:
- training and development work with existing providers (e.g. home care providers) to help them understand the principles and practice of personal budgets, and encourage them to adapt their services where appropriate
- creating an infrastructure which makes it easier for personal budget holders to pool their 'purchasing power' to jointly commission new services or support
- giving staff time to work with personal budget holders with unconventional or innovative ideas to help them source new types of support, and to share the learning from the experience.
Staff attitudes and knowledge were crucial in enabling people to make the most of their personal budgets. During support planning, social workers, community psychiatric nurses and support organisation workers were in a position to encourage people to think about different ways of meeting their needs, and they often played a vital role in setting up services and support. local authority and mental health trust staff themselves noted that there were still differing views among practitioners about what was 'appropriate' use of a personal budget. This, coupled with the fear of negative stories in the press if a personal budget holder was 'allowed' to use their personal budget for something unusual, sometimes constrained practitioners' discussions with personal budget holders.
All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:
- SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers