Personal budgets

Accessible summary Direct payments can help people with learning disabilities or autism to have good support. Often, family carers manage the direct payments for people who would find this very difficult. We asked family carers who managed direct payments to tell us why they decided to do this and what their experiences were. Family carers told us they found managing direct payments difficult and stressful at first, but this got easier over time. They also said that direct payments helped their family members to have more person-centred support.

Summary: The policy of personalisation in English adult social care prioritises choice and control by service users over the support they receive. Carers also have rights to assessments and support, but these rights have developed separately, so interdependencies between carers and service users may be overlooked. Moreover, it may be difficult to reconcile these divergent policies in routine practice.

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012-2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health-related social care needs.

Discusses the benefits of personal budgets for carers, which are a priority for government's new vision for adult care, due next month. A short case study of a couple who benefited from Surrey's carers' personal budget scheme is also included. The scheme gave them the choice to use the money for a joint activity rather than for short break respite care.

Key messages:

• Many older people see personal budgets as offering them more independence, as well as choice and control. The biggest concerns are managing the money and understanding what it can be spent on.

• Personal budgets can be held in several ways. Personal budget holders need clear information about what is involved – including risk and safety and help with assessment and planning. Knowledgeable staff are particularly important.

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, users experienced inadequate service supply, service cutbacks and increased emphasis on cost subsidisation and assessment processes.

This e-learning training module aims to support re-orientation and re-skilling of staff directly involved in decision-making using Fair access to care services (FACS) and eligibility criteria, their supervisors and line managers, and those monitoring and reporting on the operations of the system.

The author argues that more people with learning disabilities and their carers would opt for individual budgets if they were given better support to make them work. Two short case studies are presented where parents explain how individual budgets have proved successful for their sons, each of who have complex learning disabilities.

In eight short films people in the Department of Health's personal health budgets pilot programme share their experiences so far. They describe in their own words what the process is like, what they spend their money on and how they decided on this. The stories also include the perspectives of family carers and health care professionals. An introduction by Minister of State for Care Services Paul Burstow is also available.