Keeping personal budgets personal - Social Care Institute for

97 Pages·2011·0.66 MB·English

PUBLISHED FEBRUARY 2011 ADULTS’ SERVICES REPORT 40
REVIEW FEBRUARY 2014
Keeping personal budgets personal: learning
from the experiences of older people, people
with mental health problems and their carers
Keeping personal budgets personal:
learning from the experiences of older people,
people with mental health problems and their
carers

Liz Newbronner, Ruth Chamberlain, Kate Bosanquet, Chris Bartlett,
Bernd Sass, Caroline Glendinning
The Social Care Institute for Excellence (SCIE) was established by
government in 2001 to improve social care services for adults and
children in the United Kingdom.

We achieve this by identifying good practice and helping to embed it in
everyday social care provision.
SCIE works to:
• disseminate knowledge-based good practice guidance
• involve service users, carers, practitioners, providers and policy-
makers in advancing and promoting good practice in social care
• enhance the skills and professionalism of social care workers through
our tailored, targeted and user-friendly resources.
First published in Great Britain in February 2011
By the Social Care Institute for Excellence

© Social Care Institute for Excellence
All rights reserved

Written by Liz Newbronner, Ruth Chamberlain, Kate Bosanquet,
Chris Bartlett, Bernd Sass, Caroline Glendinning

ISBN 978-1-904812-53-1

Social Care Institute for Excellence
Goldings House
2 Hay’s Lane
London SE1 2H
tel [phone]
fax [phone]
textphone 020 7089 6893
www.scie.org.uk
Contents

Acknowledgements 1
Executive summary 3
1 Introduction 12
1.1 Aims of the research 14
1.2 Structure and focus of the report 15
2 Methods 16
2.1 The research team 16
2.1.1 Researchers who use services 16
2.1.2 Advisory group 17
2.2 Overall structure of the research 17
2.3 Recruitment of the case study local authorities 18
2.4 Fieldwork in the case study local authorities 18
2.4.1 Personal budget holders and carers 19
2.4.2 Local authority/trust managers and practitioners 20
2.4.3 Provider organisations 21
2.5 Analysis and development of findings 21
2.6 Ethical approval and research governance 22
3 Moving to a personal budget 22
3.1 How people heard about personal budgets 22
3.2 Deciding on a personal budget 23
3.2.1 Information about personal budgets 23
3.2.2 Sources of information 25
3.2.3 Expectations and concerns 26
4 Assessment and resource allocation 28
4.1 Being assessed for a personal budget 28
4.1.1 Assessment and self-assessment 28
4.1.2 Assessing risk 31
4.1.3 Carers’ assessments and carers’ grants 33
4.2 Staff perspectives on assessment 33
4.3 Resource allocation and the level of personal budgets 35
4.3.1 Resource allocation systems 35
4.3.2 Understanding how personal budgets were calculated and satisfaction
with the budget received 37
4.3.3 Personal contributions 37
4.3.4 Contingency planning 38
5 Support planning and setting up services 40
5.1 Support planning 40
5.2 The role of external organisations in support planning 42
5.3 Involvement of carers in support planning 43
5.4 Setting up services and support (brokerage) 43
5.4.1 How people used their personal budgets 44
5.4.2 Enabling people to make the most of their personal budget 46
6 Managing the personal budget 48
6.1 Deciding how to hold the personal budget (deployment options) 48
6.2 Choice and control 50
6.3 Ongoing management of the personal budget 53
6.4 Support arrangements with providers 58
6.5 Peer support 59
6.6 Monitoring arrangements 59
6.7 Reviews and dealing with changing circumstances 62
7 Key themes and issues 62
7.1 Promoting personal budgets 63
7.2 Strengthening risk assessment 63
7.3 Encouraging creativity in support planning 64
7.4 Improving the supply of services 64
7.5 Maximising control regardless of deployment option 65
7.6 Offering choice of support to manage the personal budget 65
7.7 Establishing manageable monitoring systems 66
7.8 Recognising the central role of carers 66
8 Conclusion 66
Appendix 1: Profile of study sites 68
Appendix 2 - Profile of PB holders and carers involved in the study
85
References 89
Acknowledgements

We would like to thank all the personal budget holders and carers who
kindly shared their experiences with us – they are at the heart of this
report. We are also very grateful to the local authorities, mental health
trusts and support provider organisations in our five case study sites:

• Cheshire West and Chester Council
• Hartlepool Borough Council
• Lincolnshire County Council and Lincolnshire Partnership NHS
Foundation Trust
• Newham Borough Council
• Norfolk County Council and Norfolk and Waveney Mental Health NHS
Foundation Trust.

Many managers and practitioners made time in their busy ‘day jobs’ to
help us with this research, both in supporting the fieldwork and
contributing their views, and without them the work would not have been
possible.

We would also like to thank the members of our advisory group, who
brought their personal and professional experience and guided the
research. Lastly, we are particularly grateful to our colleagues at the
Social Policy Research Unit. Their expertise, advice and support has
been invaluable.
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Abbreviation List
BME Black and minority ethnic
CASSR Councils with adult social service responsibilities
CPN Community psychiatric nurse
IB Individual budget
LA Local authority
LGBT Lesbian, gay, bisexual and transgender
PA Personal assistant (employed by the PB holder)
PB Personal budget
PB holder Personal budget holder
RAS Resource Allocation System
SAQ Self-assessment questionnaire
SPO Support provider organisation
ULO User-led organisation
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ADULTS’ SERVICES REPORT 40
Executive summary

Introduction
This report is a summary of people’s experiences of using self-directed support
and personal budgets. The national evaluation of the Department of Health (DH)
individual budgets pilots concluded that while individual budgets could enhance
people’s sense of control and satisfaction with services, there was substantial
variation in the benefits and experiences of older people and people with mental
health problems. These findings were consistent with the large body of earlier
research evidence on the barriers to the take up of direct payments, and have been
supported by a number of more recent reports. In the light of this evidence, the
Social Care Institute for Excellence (SCIE) commissioned this practice investigation
to explore further the experiences of these groups and their carers.

The overall aim of the research was to provide evidence to inform good practice
in personal budget (PB) processes for people with mental health problems and
older people. It draws primarily on the experiences of PB holders and carers,
supported by the views of practitioners and managers from local authorities (LAs),
trusts and support provider organisations. The findings are structured around the
main stages of the PB process.

Methods
The research was conducted by a joint team from Acton Shapiro, the National
Centre for Independent Living (NCIL) and the Social Policy Research Unit
(SPRU). An advisory group was also established to help steer and inform the
research. The research team began by bringing together the key policy and
research literature to ensure that the project could build upon what is already
known about PBs. This information was also used to inform the development of
the research instruments and to establish the criteria which would guide the
selection of case study sites. The research was then conducted in three main
stages.

Recruitment of the case study local authorities
Interviews with 10 national organisations and the knowledge and contacts of the
research team were used to identify possible case study LAs. Five LAs (two with
partner mental health trusts) agreed to take part. They provided a broad mix of
councils, and different geographical, demographic and socioeconomic
characteristics.

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ADULTS’ SERVICES REPORT 40
Fieldwork in the case study sites
For each LA/trust, the research team began by drawing together basic contact
and PB information. A combination of approaches to data collection was then
used:
• individual telephone or face-to-face interviews with PB holders and carers
• focus groups with PB holders and carers, drawing on existing groups or
networks
• interviews and small group discussions with officers with responsibility for
implementing Putting people first (DH 2009, 2010), and practitioners and staff
from social services and local support provider organisations.
A number of approaches (tailored to each site) were then used to find people who
use services and carers willing to take part in the study. The exact mix of
interviews and groups varied, but 69 PB holders and carers, 40 practitioners and
managers and 12 support provider organisations (including five user-led
organisations) eventually contributed to the research.

Analysis and development of findings
All the interviews and discussions were recorded and transcribed using detailed
notes and quotes. The data was then analysed thematically and illustrated using
‘personal stories’ from PB holders and carers, and ‘positive practice examples’.
Some of these are provided throughout this report.

Moving to a personal budget
The majority of PB holders and carers in the study had heard about PBs from
their social worker or community psychiatric nurse. Many would have liked earlier
access to information about PBs and highlighted the importance of key groups of
healthcare staff and providers knowing about PBs.

Deciding on a PB
PB holders and carers emphasised the importance of clear and understandable
information about what a PB is, how it can be used and what is involved in
holding one. In particular they highlighted:
• leaflets/booklets being written in plain English with minimum use of jargon
• providing information about different aspects of PBs in ‘bite-sized chunks’
• information being presented in a format that is accessible and manageable
• offering alternatives to written information (e.g. DVDs, podcasts etc.)
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