Personal Budgets

There is now a range of ‘personal budgets’ either ear-marked for, or managed by individuals, supposedly giving them more choice and control over the services they receive. To begin with there were personal budgets, funded by local councils, for those with broadly social care needs. More recently, personal health budgets were introduced, initially for those with long term health conditions, funded by the NHS (specifically the local CCG). More recently still, integrated personal budgets are being introduced. These cover both health and social care services. They may be funded in a number of ways such as pooled funding from the local CCG and local authority.

Personal budgets (PBs)

Personal budgets (PBs) have been available for some time for those who need social care and support in order to live as independently as possible. The rationale given for introducing PBs is that, if people are given more choice and control over the services they use, this will improve the quality of their life.

Following an assessment, a service user is allocated a pot of money to buy the support that they think will help them most. This might be ‘meals on wheels’ or transport costs, for example, but until now it has excluded healthcare. A personal budget has, in the past, been funded by your local council.

According to Simon Duffy, who pioneered the use of PBs through In Control  (a social enterprise), the key to success is to make it clear to service users just how much money they have been allocated. But in doing so, he also suggests that personal budgets may be about rationing:

If you don’t tell people what the budget is, as a local authority you are forced into a position of planning for them in order to ration,” he says. “But if you give them a budget, doing the rationing up front, you liberate people and their families to do their own planning, and liberate service providers to do creative planning.

Research on personal budgets has suggested that, in practice, only those people that had the strongest abilities or support networks, or the highest budgets  (around 10% of all users), really benefitted.

Personal Budgets have been welcomed by some people as a way of gaining more choice and control over the services they use, as well as building confidence to ‘challenge the system’. Champions of PBs suggest that they work well where people are part of a local community or network. But, more negatively, PBs have also been associated with complicated systems for approving or renegotiating budgets, limited choices in relation to service users’ expectations, and massive paperwork for staff already struggling with unmanageable caseloads and cuts in staffing and funding. They are an attempt to deal with a system that is fundamentally dysfunctional, and operate in a system where there huge cuts being made in funding for social care.

There are also concerns that PBs were made available with little  concern about the impact on services or cost, or as a kind of market reform. Some see PBs and similar schemes as a prelude to introducing vouchers for services, a system that would limit choice and tend to push resources into either traditional or commercial services. PBs (and Personal Health Budgets and Integrated Health Budgets) can also be seen as  the privatisation of procurement.

Nonetheless, PBs have become the model for personal health budgets.

More information

https://www.opendemocracy.net/ournhs/simon-duffy/in-defence-of-personal-health-budgets

Updated October 2018

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