Personalisation of home care for older people using managed personal budgets

Introduction

Personalised services should reflect users’ preferences. PBs should make it easier to arrange services that best meet individual preferences. PBs can be:

• Given to the service user as a cash direct payment (often used to employ personal assistants or carers) – the government’s preferred option for allocating PBs;
• Held by the local council and used to purchase council-commissioned services;
• Held by a service provider under a contract with the council, with day-to-day arrangements agreed directly with the service user (ISFs).

Historically older people have not been keen to use direct payments; two-thirds of older people still have their PB managed by their council. However, those taking their PBs as a direct payment may experience significantly better outcomes than those with council-managed budgets. We therefore investigated what opportunities for personalised services are available to older people using council-managed PBs to fund home care support. What changes have councils made to commissioning and front-line practice; how have service providers responded; and how satisfied are older managed PB holders?

Objectives

Based in three English councils (two unitary boroughs and one shire county), this study explored factors affecting the delivery of personalised home care to older people who opt for council-managed personal budgets rather than cash direct payments.

Methods

The study was conducted between January 2011 and December 2012 in three councils that had large older populations, large proportions of people using managed personal budgets and had made changes to increase choice for people using managed PBs.

• Stage 1: interviews with commissioning managers about changes in commissioning and contracting home care services
• Stage 2: focus groups with local authority support planners/care managers who helped people plan how to use their PB, about how they shaped the choices of older people using managed PBs and the factors affecting opportunities for personalised home care
• Stage 3: interviews with home care agency managers about their experiences of commissioning and contracting changes; agencies’ roles in planning with older people how to use managed PBs; and factors perceived to enhance or restrict personalised home care
• Stage 4: face-to-face interviews with older people using managed PBs about their experiences and satisfaction.

Findings

• Most older people using personal budgets (PBs) have these managed by their council. They are generally used to buy council-commissioned home care services
• Councils were moving from block contracts with home care providers to framework agreements. However, the numbers of framework providers were initially limited to maintain market stability; capacity may be particularly restricted in rural areas
• Council brokers advertised new referrals to framework-approved providers; this could improve the efficient operation of local care markets, but risked introducing new communication barriers between council support planners and home care providers
• Council support planners experienced challenges in balancing creative support planning against their knowledge of limited capacity in local home care services and restrictions on local providers
• Providers’ responsiveness was constrained by having to seek approval for changes to care plans and by council restrictions on the flexible use of unspent PBs
• Individual Service Funds (ISFs), budgets held by home care agencies and managed in direct negotiation with users, may offer greater flexibility but were not fully operational in the councils in this study.