Early experiences in extending personal budgets in one local authority

Abstract

Purpose\ud <p>The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011.</p>\ud \ud <p>Design/methodology/approach</p>\ud \ud <p>Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users’ experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life.</p>\ud \ud <p>Findings</p>\ud <p>Service users (n=7 older people and carers; n=7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups.</p>\ud \ud <p>Research limitations/implications</p>\ud <p>Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty.</p>\ud \ud <p>Practical implications</p>\ud <p>Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.</p>\ud \ud <p>Originality/value</p>\ud <p>Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.</p

Questioning “choice”: A multinational metasynthesis of research on directly funded home‐care programs for older people

“…Gill et al () report that in their secondary analysis of interviews with DF clients, staff, and informal caregivers in Australia, “most of the clients and carers expressed views that the range of services offered under [DF] were unchanged and that the services offered were limited to what has been traditionally offered” (p. 482). Norrie et al () present a similar finding in their study of DF in England, noting that “most [users] did not feel that [DF] had made a significant difference because their support plan had remained much the same” (p. 181). As Gill and Cameron () summarise:

The translation of [DF] into a service currently appears to result in the service looking much like traditional community aged care packages, as the primary focus continues to be on domestic services delivered in the home.

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“…Without access to information about the services available to them, clients are unable to exercise choice fully; their choice is limited by the options known to them. Norrie, Weinstein, Jones, Hood, and Bhanbro () likewise note that of the seven older people and their carers interviewed for their study on early user experience of DF in England, “most expressed limited understanding of how personal budgets worked and what they were intended to achieve” (p. 180). This limited understanding left older people feeling confused, to the point where many simply continued to rely on traditional home‐care or day‐care services, as opposed to actively choosing their care arrangements (Norrie et al, , p. 182).…”

“…Norrie, Weinstein, Jones, Hood, and Bhanbro () likewise note that of the seven older people and their carers interviewed for their study on early user experience of DF in England, “most expressed limited understanding of how personal budgets worked and what they were intended to achieve” (p. 180). This limited understanding left older people feeling confused, to the point where many simply continued to rely on traditional home‐care or day‐care services, as opposed to actively choosing their care arrangements (Norrie et al, , p. 182). Ottmann and Mohebbi () similarly note that in their multimethods longitudinal comparative cohort study of DF interventions in Australia, the most important barrier to uptake was “a lack of perceived knowledge, authority, and expertise” (p. 607).…”

“…For instance, Moran et al () find in their mixed‐method study of outcomes for older users of DF in England that while some users found the increased responsibility exciting and rewarding, others found it challenging. Norrie et al () found that the majority of older DF service users interviewed for their study on DF in England were not keen to manage their own budgets. Moore and Jones () make a similar point in the British context, noting that social care staff involved in the West Sussex County DF pilot project found that many older people were uncomfortable talking about money at all, while Thornton () suggests that in the absence of effective support, many older people will also find the legal risk associated with hiring employees unacceptable.…”

Themed section: the person-centred turn in welfare policies: bad wine in new bottles or a true social innovation?

“…Another big issue is represented by the fact that older people's health status may change rapidly and frequently, so that providers need to develop safeguards such as systematic risk assessment strategies and contingency plans, as well as extensive compensatory and capacity building features. Norrie, Weinstein, Jones, and Hood (2014) underlined that service users found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a direct payment.…”