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11 Nov 2011

Bill Mumford, chairman, VODG, chief executive, MacIntyre and Su Sayer chief executive, United Response, a member of VODG

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Before a recent pilot mental health scheme in Stockport, one vulnerable woman, prone to frequent moments of crisis, would routinely call for an ambulance, sometimes twice a day. Distressed and hearing voices, she would dial 999 and then, at the hospital, staff would calm her down before sending her home in a taxi. One can only imagine that the cost to the public sector ran into tens of thousands of pounds a year.

But the Stockport self-directed support scheme – handing more power and control to the user through personalisation involving personal budgets, personal health budgets, direct payments or individual budgets – enabled the woman to use a personal budget to develop her interest in art. She thought about what might support her in her moments of crisis; she bought painting material and now regularly visits a local art shop where she chats to staff and often enjoys a cup of tea.

The successful 18-month pilot, launched in March 2009, aimed to have 60 service users taking up a personal budget in the first year. The drive was so popular, however, that the council ended up with 94 service users in the first year, rising to 179 by the end of the pilot.

This was just one example of success in self-directed support presented at a recent seminar in London run by the Office for Public Management (OPM) where participants debated the issue of whether self-directed support and personal budgets would be the norm in five years’ time.

We both spoke at the debate alongside Aileen Buckton, executive director of community services at the London borough of Lewisham and Vidhya Alakeson, research and strategy director at policy and research organisation the Resolution Foundation. Clive Millar, OPM principal and personalisation lead chaired the debate, which was held under Chatham House rules so comments were unattributable. The OPM has a good write up on the event that is available on the OPM blog.

Starting with the argument that self-directed support would be universal within five years, the debate heard about the advantages that personalisation can bring and how empowered consumers would encourage service providers to drop the traditional approach of “the professionals know best”. As one speaker said of self-directed support, “it taps into a powerful force, which is the empowered consumer society, so it is unstoppable”.

The seminar heard that the cultural shift that will allow full personalisation to take place and for the service user to be at the centre of provision is almost as great a leap in thinking as the astronomer Copernicus’ revelation in the 1500s that the earth circles the sun. A recent Social Care Institute of Excellent report (PDF) stressed that the attitudes of professionals is a key barrier to success in personal budgets. What will help this, however, is placing purchasing power in the hands of the consumer, or service user; this will encourage professionals to change their attitudes.

An example from a service provider illustrated a burgeoning cultural revolution among professionals, which might help in this issue. The debate heard how two providers were tendering for support provision, presenting what each thought would best suit the service users. But when commissioners, who have embraced the personalisation agenda, presented the options to users, the users said they would rather not have either of the support packages on offer, but would prefer something slightly different. Their purchasing power through personal budgets meant both providers had to change their respective offers and work in different way “because of people having personal budgets.”

Another reason to believe that self-directed funding will indeed be the norm in five years is the fact that councils are increasingly embracing personalisation. The work of the Think Local Act Personal partnership, for example, supports this drive. Recent work by the Association of Directors of Adult Social Services (ADASS) also concluded that a third of people entitled to social care support (338,000 people in total) now have personal budgets.

There was a feeling that professionals cannot keep doing “business as usual”. Despite public service cuts, service users will gain a better quality of life and the impact of self-directed support on chronic conditions will reap long-term rewards. Diabetes, for example, was described as the sort of condition those suffering from it have to take control of “and personal health budgets allow you to do that”. The more engaged patients are, the more they will manage their health.

Finally, according to those who believe self-directed funding will soon be widespread, “there is no single showstopper that has said this [personal budget approach] cannot work”.

Such arguments were not enough to convince those who questioned the assertion that self-directed support will be universal in the near future. Major barriers exist in both health and social care, they argued, which threaten the notion of personal budgets becoming “the norm”.

Firstly, it is a fallacy, hinted one speaker, that everyone will have access to a personal budget as definitions of self-directed support vary hugely. “Some of those [who are said to receive personal budgets] are what I call only ‘partial personal budgets’ so a very small amount of the total money for their support is a personal budget”.

Concern was rife that because councils are expected to offer personal budgets to all who are eligible by 2013, they will do their best to make that happen – but that a box-ticking exercise risks offering service users lip service to personalisation, rather than a full blown personal budget.

Four main barriers were outlined that could derail the self-directed agenda:

• the pace of change – it is 15 years since the government introduced direct payments but still only a third of the 1.7m people receiving social care support have a personal budget
• the postcode lottery – it is a confusing and complicated situation for potential purchasers of services as how much access you have to personal budgets depends on where you live
• fear and confusion among service users and families – most councils do not make it easy for people to understand personal budgets; buyer literacy is key
• the spending cuts – councils are drastically reducing spending, an additional barrier to increasing choice and control

There was a warning that from a service provider perspective, smaller organisations might struggle with offering personal budgets and, on the other side of the commissioning fence, councils facing enormous funding pressures would be unlikely to treat the drive as a top priority. As one participant commented: “We all shut down, we retreat - that isn’t the climate for change.”

As the debate turned to those in the audience – policy makers, academics, practitioners and commissioners among them – there was a strong feeling that the personal budget agenda still focused on services, not people. Service providers and commissioners should think in terms of outcomes, not funding, the seminar heard.

Housing was also mentioned as a support service that is not always regarded as part of the person-centred drive. Volunteers were highlighted as being too often overlooked in terms of their supporting role in personalisation. Similarly, peer support and user-led organisations, participants were reminded, must not be cut out of the loop.

Yet despite differing views on the likelihood of self-directed support becoming the norm in the next few years, there was a palpable sense of agreement that the drive can only improve the quality of life for those who are among society’s most vulnerable. And where there is a will, surely we will find a way?