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Keeping personal budgets personal - Social Care Institute for PDF

97 Pages·2011·0.66 MB·English
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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 020 7089 6840 fax 020 7089 6841 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. 1 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 2 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. 3 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.) 4

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