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Making sure personal budgets work for everyone across health and care.

Posted on:    June 27, 2013

People receiving personal budgets for care and support show improvements in mental and physical health, a survey shows.

It has been difficult to avoid the drive towards personal budgets for care and support over the last five years. Not least because since 2008 there have been targets councils have worked towards – most recently the 70% target for 2013. This milestone passed at the end of March, but it will be several months before we know the full picture.

I expect the numbers to be good, though there remains some debate about the most useful measure to reflect performance.

Targets are double-edged swords: they can lead to unintended consequences and behaviours that “feed the beast” rather than actually changing things for the better. But on balance, I’m pleased we had these particular targets.

The extension of choice and control through self-directed support and personal budgets remain profoundly counter-cultural innovations. Doing it well means fundamental changes in the way care is organised and delivered and in the relationship between citizens with skills and aspirations, as well as needs, and the system set up to meet them. Without the added catalyst of targets, personal budgets might well have stayed on the “too difficult” pile, only available to those with the capacity and inclination to push their case to receive one. Targets have played their part in ensuring that we are in a very different place now from five years ago.

But targets can also have a shelf life, a point beyond which they cease to be useful levers for change and start to become an unhelpful lens through which to view progress. I think this is where we now are, especially since personal budgets are to be put on a statutory footing in the care bill. I am encouraged by the willingness I increasingly hear to move the debate beyond numbers towards ensuring that things are working well for people. That is why I am delighted TLAP has published the second national personal budgets survey, including responses from more than 2,000 personal budget holders and 1,200 carers, as well as the first national personal health budgets survey involving more than 300 people.

 

The findings show much progress and demonstrate that even at a time of sustained pressure on public finances, people’s outcomes are improving in most areas of life following receipt of personal budgets. This includes feeling more independent, and being supported with dignity, as well as improvements in mental wellbeing and physical health. All this is good to know, but the real value of the survey lies in helping us better to understand the factors that lead to the best and worst results.

This information is far more valuable than numbers. It can be used to develop and improve local delivery and to inform business planning. Used alongside other intelligence, it can help with exploring questions about how to ensure all groups benefit equally, how to ensure all forms of personal budget offer maximum choice and control and how to make best use of innovations such as individual service funds and budget pooling.

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