They were brought in amid promises of cheaper, more efficient provision and greater choice and control. But Professor Peter Beresford says the evidence shows that personal budgets are simply not delivering.
A situation report on the current state of social care can only be concerning. Findings from LSE research commissioned by the Care and Support Alliance indicate that half a million older and disabled people who would have received social care support five years ago no longer do. Cuts in local government funding mean that eligibility criteria have narrowed even further and people who are still eligible are likely to receive even less help. If this was happening in the NHS, it would be seen as a national emergency and even the word ‘crisis’ would seem inadequate. But for social care, the ‘ignored and unknown’ social service, chronically under-funded and lacking priority, the problem passes almost without headlines.
It’s even more worrying that there seems to be little sense of urgency about this on the part of government. Its social care policy and funding reforms show no sign of resolving the massive problems facing social care. Policy-makers continue to appear convinced that personal budgets policy will deliver the promised gains and economies. Indeed all three political parties continue to appear committed to personal budgets and from April this year they are extended to the NHS, when everyone accessing continuing care will be entitled to a ‘personal health budget’.
The evidence underpinning the present policy of personal budgets has never been strong. But increasingly evidence is highlighting the policy’s failings rather than its potential or actual delivery. Remember, personal budgets were sold as delivering better for less money, with less bureaucracy and more choice and control. But what the most recent independent evidence shows is that The Resource Allocation System is adding additional bureaucracy rather than helpfully predicting cash allocations: those benefitting from personal budgets are disproportionately people receiving direct payments, who are doing so because they are getting proportionately more money and they tend to be the more confident, supported and assertive people.
Research suggests that personal health budgets based on the same model as social care personal budgets are unlikely to be any more successful. Personal budgets are not providing a magic bullet as was unrealistically imagined. Instead, the findings of the four-year Joseph Rowntree Foundation’s The Standards We Expect, the largest independent study of personalisation and person-centred support seem to hold. What is urgently needed is much more fundamental and systemic change in social care. Its workforce, market, practice, and organisational structure all need to be improved. Most of all, two major problems need to be addressed and this needs change at a national level: a shift overall to a more person-centred culture in social care against the one-size-fits-all, institutionalising and batch service approach that continues and a serious increase in funding.
Such reform is unlikely to carry much political clout at these times of austerity and severely reduced public spending. There appears to be an almost lemming-like desire to continue along the same track with personal budgets as though there were no warning signs. A blog by the charity In Control highlights this by dismissing the latest evidence and increasing concerns about the present In Control inspired approach to personal budgets as a ‘failure narrative’. The authors write: “At a time of severe cuts, it’s understandable how this failure narrative can take hold and starts to undermine support for personalisation.”
Like personal budgets policy itself, that comment demands closer inspection. First, personal budgets are equated with personalisation. We know that the two are far from synonymous: the present system of personal budgets is a technique. Personalisation is a goal. So far the former seems to be very far from delivering on the latter. Dismissing disturbing negative evidence as a ‘failure narrative’ as if it could be responsible for the undermining of personalisation, is a worrying sign of the low level of current debate. Surely what the issue really is about is the degree to which personal budgets as currently being implemented are improving the lives of hundreds of thousands of older and disabled people. The evidence is far from encouraging.
Simon Duffy, the originator of personal budgets as rolled out by government, has issued a public apology for them. He doesn’t accept responsibility for their failure and blames local authorities and professionals for how they have been implemented. But the evidence suggests that his model is inherently defective. Perhaps it is time for him to return the award he won for this innovation. Perhaps it is also time for In Control to answer its critics. Both have a very serious responsibility to the many older and disabled people who are currently experiencing greater hardship and less control in the social care system, even as government, policy-makers and the personal budgets industry continue to talk up personal budgets and seek their expansion in health, regardless of their evidenced limitations in social care.