Amongst the criticisms of personal budget systems doing the rounds at the moment is one based on research which purports to show that there is often a significant difference between the ‘upfront allocation’ which an individual is offered at the beginning of a personal budget based support planning process, and their finally agreed allocation. The research suggests that complex and bureaucratic processes which produce the upfront allocation are therefore a waste of time and money (which I agree with) and that this calls into question the whole concept of personal budgets (which I don’t agree with, not least because the only large scale survey of people using personal budgets consistently shows that for most people, most of the time, personal budgets result in better lives than the alternatives).
An upfront allocation of resources is essential if people are to start the planning process with some idea of the amount of money they have to spend. But it’s only supposed to be a provisional, ‘ball park’ figure, and it should be relatively easy to change, as the individual and those supporting them to plan home in on the most effective approaches. There is a chicken-and-egg dilemma inevitable in any personal budget based system: you can’t plan realistically without knowing roughly how much money you have to spend, but you don’t know exactly how much money you need until you’ve come up with a plan to spend it. In a traditional, professionally-led system, this doesn’t arise, because you are allotted a service from a limited menu of services, which have already been purchased and in which any vacancies need to be filled, in order to make the council’s books balance.
Critics of personal budget approaches argue that you can still help people to plan creatively without an upfront allocation. They point to the difference between upfront allocations and final budgets as evidence that money and time invested in complex or time/resource hungry Resource Allocation Systems (RAS) is wasteful and just puts barriers between people and their choices. In this, I agree with them. If an upfront allocation is supposed to be a ballpark figure, why invest in a complex computer system or bureaucracy to generate it? Local authority Finance Directors might respond that if you don’t do that, there is a risk that people will be given upfront allocations which are too high, and which are harder to lower at a later stage, thus bankrupting the council. It’s worth noting that any approach to dividing up limited resources will always involve some kind of RAS – but traditional systems have hidden the process of dividing up resources, rather than attempting to make it transparent. In a traditional system, resources are divided up and allocated after a person’s support plan has been produced, rather than attempting to do this ‘up front’. As a colleague says of the long period when the system was based on person-centred planning, people’s plans were beautiful, but the response was the same old narrow range of block purchased services, because the state retained control on planning and spending resources, not the individual.
At the root of this problem is what I’ve referred to before as the lie at the heart of individual control of public service budgets: you are told you can have individual control of that money, but actually, resources are limited (and increasingly oversubscribed) and the council FD retains a legal duty to balance the books, regardless of your choices.
There is also an assumption amongst those in charge of public budgets that people will generally want to spend every penny they have been ‘given’, rather than to find cheaper alternatives. This is true where people are offered inadequately funded support from a limited range of services. If all a person is offered is homecare, s/he will probably want as many hours of it as they can get, even though it might not be able to help them achieve a good life. The more genuinely open and creative the planning process, the more likely people are to think outside the box.
So the critics of the RAS argue that we should abandon upfront allocations as a blind alley. The problem with doing that, is that it returns us to traditional care management. If traditional care management had been great at helping people to make individual choices, there would have been no need to introduce something so deliberately disruptive as personal budgets, but care management was far from great in that regard. Only systems which enable individuals to exercise choice, control and power have shown any evidence of being able to widen the range of support approaches people access. It is very striking that the current criticisms of personal budget systems do not include clear descriptions of alternative approaches, but tend to conclude with fairly general calls for things to be done better. They often call for a faith in social workers’ ability to construct truly individual care packages, which ignores the power constructs within which those workers have to operate. So is there a practical alternative to the way in which personal budgets are currently implemented in many areas?
To my mind – and I’d be interested in your view on this – we need to retain upfront allocations, but we need to do so with a lightness of touch which reflects their provisional, ballpark nature. One way of doing that would be to let people know the current range of resources which people with similar levels of need are currently accessing, along with some examples of the range of support approaches which people are accessing. Not as a prescriptive menu from which to choose, but as a guide to start the planning process and with the proviso that final agreed amounts may change. Sensible councils would make approval processes for budgets towards the lower end of the current range as quick and resource-light as possible. Resources will ultimately still need to be rationed and some people will not get what they wanted, which means that councils will still need a clear and challengeable system (not an arcane and secretive one) for allocating those resources where there are disputes. People who use services and family carers should be involved in those decision-making processes, preferably in paid roles, not just as volunteers.
The other change I would make is based on a belief that people should be able to access and exercise not just power, but also responsibility. One way of framing the ‘lie’ I refer to above, is that it is a promise of power without responsibility: individual choice without the responsibility to share limited resources with others, or to act collectively where that is compatible with an individual’s rights.
Collective action has a bad name in public services: after all the old long stay institutions – and some contemporary large care homes for older people – are examples of a certain kind of collective response: the people warehouse. But collective action can be compatible with individual choice, providing individuals choose the people they associate with and have a genuine share in decision making. This can be achieved through peer-led support planning processes, citizens taking a leading role in commissioning decisions, collective purchasing / budget pooling and mutual ownership governance models within provider organisations. At the moment, individuals are positively discourage from making savings in their personal budget, by the punitive nature of systems which are quick to remove or reduce budgets, but extremely slow to replace any entitlements once ‘lost’. Instead, people should be able to retain a share of any reductions in budget as a contingency fund, and there should be fast-track systems for reinstating budgets which are reduced, in order to make choosing something less costly less of a risk.
When people are treated as isolated individual consumers, they have the illusion of individual choice, but the old power imbalances between individuals and large corporate bodies and institutions remains firmly in place. But when people are helped to come to together throughout the planning process with others with similar goals, there is a genuine chance both of individual choice, but also of managing public budgets in ways which are affordable.