Introduction
Advocates of Personal Budgets (PBs) argue that possession of a budget – particularly a Direct Payment (DP) – confers real empowerment, better enabling the control of personalised services and support. This is claimed to lead to better targeting of services and support upon need, thereby improving outcomes. However, evidence before and immediately after the announcement of the Transforming Adult Social Care Grant suggests that older people achieve less good outcomes from budget ownership than younger adults. Although the Department of Health and Social Care, the Social Care Institute for Excellence, Age UK and the Alzheimer’s Society have all published guidance on making PBs and DPs work more effectively for older people, little research has been conducted to see if this guidance and research evidence has improved outcomes for this group.
Objectives
This study set out to find out about the:
- extent to which local Adult Social Care Departments (ASCDs) recognised these issues, how they were assessing them and how they would assess their own success in achieving personalised services for older people
- experiences of older people, unpaid carers and frontline care staff of DPs and PBs, their views about the pros and cons of budget ownership and whether PBs had led to better outcomes.
Methods
The fieldwork for this study was conducted between July 2012 and September 2013.
In stage 1, telephone interviews were completed with 52 local authority senior managers responsible for implementing personalisation and PBs. In stage 2, postal surveys of older DP and MPB users, and unpaid carers of older budget users were carried out in three ASCDs in England. 339 older people and 292 unpaid carers replied.
Follow up interviews were completed with 14 older budget users, 31 unpaid carers, and 25 operational staff in these three sites.
Findings
Senior managers:
- felt that direct payments (DPs) offered more choice, control and independence to older people (aged 75+) than a managed personal budget (MPB);
- acknowledged that take-up of DPs was often limited due to limited choice, the administrative burden (despite efforts to provide support), budgetary limitations, low expectations, lack of information, stress over operationalising support plans and risk averse staff;
- felt that younger adults had different expectations to older people, wanted different things and were more willing to take risks;
- felt that direct payments had more to offer younger than older people.
Older budget holders and their unpaid carers:
- often did not know that they were receiving an MPB, and many who did were unaware of the budget amount;
- both DP and MPB users liked the idea of having a personal budget, but this did not necessarily confer control: a quarter of DP users needing help with these things said they had impaired control over when they ate, went to bed or bathed/ showered;
- DP and MPB users experienced little difference in relation to health, stress and social care related quality of life outcomes. For both groups, needs for personal care were adequately met for most, but most also reported unmet needs for control, social contact and occupation;
- unpaid carers were centrally involved in helping older budget holders with their personal budgets;
- many unpaid carers, particularly carers of DP users, experienced high stress levels.
