A patchwork quilt

Think Local, Act Personal, the sector-led partnership which is helping providers and councils to push forward with personalisation, has teamed up with SCIE to publish “Improving Personal Budgets for Older People: A Review” which you can find here: http://bit.ly/YyWRZR. Some of the findings are based on data from the ADASS personalisation survey (2012) of councils and the 2011 POET survey which is a large annual survey carried out by Think Local, Act Personal of people’s experiences of personal budgets.

It’s quite common to hear people say “personal budgets and Direct Payments don’t work for older people” so it’s useful to have some real evidence to look at in testing whether those doubts are based in reality, or in assumptions about older people and choice. The report finds that in some areas many more older people are using personal budgets, so the argument that older people aren’t interested or can’t use personal budgets does not seem to hold up. However, that picture is really patchy and the report finds lots of barriers to older people taking up personal budgets, including confusing processes and lack of support to make choices; lack of understanding about the things personal budgets and direct payments can be spent on (not just Personal Assistants) or little real choice of new provision; and reluctance on the part of older people or their families to take on responsibilities like being an employer. All of these factors are relevant to younger people as well as older people, but perhaps the most telling differences are that some of the powerful features of using a personal budget for younger people – such as taking that budget as a cash Direct Payment and having complete control over a care package or a team of staff – appear not to be so relevant or available for older people, who are often working with lower budget allocations and who may be looking for quality and consistency of service above control for its own sake (although the report cautions against the risk of these conclusions being influenced by ageist assumptions.

Of course, if the high numbers of older personal budget holders in some areas were present everywhere, we would be talking about how well they work for older people. The apparent success in some areas could mean that those areas have made real change, or just that they are good at the ‘tick box’ personal budgets which we see in the areas which have the weakest understanding of the difference between moving money around differently, and genuine choice and control. Some areas, however, are reporting Direct payments as a percentage of personal budgets to over 65s of as high as 70%, which unless something very odd is going on, suggests that those areas have accessible processes and some really attractive choices of service, especially compared to those areas at the bottom reporting 10%.

There is a chicken and egg aspect to the uptake and impact of personal budgets. There’s no point in me taking up a personal budget option if there’s nothing new to buy. But it can be hard to develop new services and approaches without the impetus of personal budget holders with money to spend on new things. The report chimes with our experiences and those of our sister organisation, Community Catalysts (www.CommunityCatalysts.co.uk), which is working with around 40 councils to change provider markets, particularly through helping them develop a new market of micro-enterprises, some of which can be highly imaginative, such as the art project in which residents of sheltered housing complexes in Leicestershire created a huge patchwork memory quilt. No council can commission something like that, or the men’s woodworking enterprise set up by two older men with Community Catalysts support: at least not in the traditional sense of ‘commissioning’. Planning highly tailored responses requires support for small groups of older people to pool their budgets, and more importantly their creativity, often in partnership with local practitioners or social entrepreneurs. As the report notes, this is a “major cultural shift” for commissioners and “improving personal budgets delivery arrangements needs to take place within a set of broader developments that promote personalisation.”

The creation of the ‘Personal Assistant’ as an entirely new kind of social care provision is for me, the great triumph of personal budgets and Direct Payments. But not everyone wants a PA and few older people have budgets big enough to afford one. Creating people-sized solutions and stitching them together into a new patchwork of enterprises and approaches is the next challenge for personalisation and if we can do that we will find that Direct Payments are just as popular with older people as with everyone else.

Other linked reports on this subject: the 2012 ADASS report The Case for Tomorrow, which identified a range of implementation challenges and the Alzheimer’s Society  report on personal budgets for people with dementia, “Getting Personal”. Shared Lives Plus is working with the Dept Health to commission a Commissioning for Micro-Diversity guide, which will be published later in the year.