Independence pays? The implications of personal budgets

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Professor Jon Glasby

As we head towards a 2015 general election, all the signs are that the future of health and social care will be a key battleground. However, one area where there seems to be more agreement (superficially at least) is around the need to ‘personalise’ services so that they are much more tailored to the needs and circumstances of the individual. This language appears in many different contexts, whether it’s involving people more meaningfully in decisions about their care and about service services generally, carrying out more person-centred assessments of need, giving people greater say over what services are provided or working together as equals rather than assuming that ‘doctor knows best’.
Particularly important are the concepts of direct payments and of personal budgets. The former were invented by disabled people and their organisations seeking to achieve greater ‘independent living.’ This doesn’t mean doing everything for ourselves, as none of us are fully independent (we’re all interdependent on others to meet various of our needs). It simply means having the same choice and control over your life as a non-disabled person. In this context, a direct payment involves giving the person a cash equivalent of the service they may otherwise have received so that, with support, they can design their own care and, if they wish, hire their own care staff.
Linked but slightly different is the more recent concept of a personal budget – which involves being clear with the person upfront how much money is available to spend on meeting their needs and allowing them greater say over how the money is then spent. This could be through a range of 6 or 7 different mechanisms from a direct payment at one end of the spectrum to more of a notional budget at the other end (where the social worker and the Council retains the money and spends it on the person’s behalf, but where the person knows how much there is to spend and controls the decisions that are made). The crucial element is knowing straight away how much there is to work with, so that the person and the practitioner can be creative and innovative in seeking to meet need. It’s also about getting decisions that really matter to people as close as possible to the people they affect – ideally so there are taken by the person themselves (but if this isn’t possible, then by someone who knows the person well and cares about them).
For many disability rights campaigners, these could be some of the most important reforms introduced since the creation of the welfare state – yet there are significant tensions. In particular, it’s possible to emphasise direct payments and personal budgets for two very different reasons. On the one hand, it is argued, is a neo-Liberal agenda which wants to reduce public services, promote individual responsibility and ‘roll back the frontiers’ of the welfare state. On the other are groups of civil rights campaigners who see this as a political struggle for greater citizenship, very much like similar struggles that have taken place around gender and race. Both groups tend to promote the same concepts – but their value base and desired outcomes are fundamentally different. The danger throughout has been that different groups (and often fairly uneasy bedfellows) come together to call for change but that things unravel once the change is introduced (because we all meant something different by the changes and have different notions of what we want to achieve). Early on this can be a good thing as it creates a real momentum – but further down the line problems tend to occur.
At the moment we are trying to personalise services whilst also taking large amounts of money out of them in a period of austerity – and there’s a risk that we simply use the language of personalisation as a smokescreen for cuts. Direct payments and personal budgets could be two of the most radical reforms the welfare state has seen in decades – but we have to be clear about our motives and we have to pursue them for the right

reasons.

Jon Glasby is Director of the Health Services Management Centre (HSMC) and Professor of Health and Social Care. For further information on HSMC, see http://www.hsmc.bham.ac.uk.

For HSMC’s work on personalisation, see: http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/work/personalisation.aspx.

Key books also include:
• Needham, C. (2011) Personalising Public Services: Understanding the Personalisation Narrative, Bristol: The Policy Press
• Glasby, J. and Littlechild, R. (2009) Direct Payments and Personal Budgets, Bristol: The Policy Press

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