Personal budgets can and do work. Why are some not prepared to let them?

Peter Beresford has been a consistent and vocal critic of personal budgets, as elaborated in the Care Act 2014.  This week he wrote a further familiar piece under the headline ‘Personal Budgets don’t work. So why are we ignoring the evidence’, a headline betraying his theory that there exists a conspiracy of silence among ‘the supporters of In Control’ (who he considers to be the architects of personal budgets) regarding faults in design or implementation.  To drive this point home Peter launched a volley of tweets accusing these ‘supporters’ of attacking any criticism. For example:

 16h16 hours agoLondon, England
In Control’s supporters criticise anyone who challenges their failed model of PBs which undermined disabled pple’s’

 

Moreover, Peter appears to regard anyone disagreeing with his analysis not only as an supporter of In Control but as offering unconditional support for the government:

depressing how many supporters this govt’s IL policy seems to have however disastrous it is’

Two disabled people who responded to his article to set out why they believed personal budgets had improved their lives were met with the (since deleted) tweet:

‘check out who supports this govt’s disastrous personal budget policy http://www.theguardian.com/social-care-network/2016/may/05/personal-budgets-health-care-nao-report#comments … do they support its welfare reform too?’

Nice….

A great many people value the idea of personal budgets yet express disappointment and concern about how they have been implemented, not least the corrosive effects of spending cuts, the undermining impact of welfare reform, the red-tape and bureaucracy needlessly imposed by some councils and the lack of investment in local support infrastructure such as disabled people’s user led organisations.    What they do not question though is the basic principle of finding ways to extend choice and control over support, and over life, to more disabled people.

For many, including me, their support for personal budgets can be traced back to the Number 10 Strategy Unit report ‘Promoting the Life Chances of Disabled People’ (2005), much of which was written by Dr Jenny Morris.  As Jenny reminds us in her excellent blog ‘Personal Budgets and self determination:’

‘(a key message) was that some people, or the family members supporting them, wanted more control over resources but were daunted by the responsibility of taking a direct payment and organising their own support.’

Jenny goes onto note how Life Chances proposed:

“a simplified resource allocation system, including ‘one stop’ assessment and information”, which “addresses all aspects of needs for support and/or equipment or adaptations”

–  Individuals being able to “take some or all of their budget as a cash payment and/or to have control over the budget (with support if necessary) without actually receiving the cash”

–  “self-assessment, with advice/information or advocacy support where required”

–   Each local authority area having a user-led organisation, modelled on existing Centres for Independent Living, which would provide support to disabled people to enable them to use individual budgets and direct payments.'”

 

That, I feel, remains many people’s ambition, which is why their many criticisms do not add up to an absolute rejection of personal budgets, which in policy intent at least, reflect a number of these goals or at least represent a further step towards them. It is also why outright attacks on the very idea of personal budgets and those invested in making them work, such as those made by Peter Beresford and his ‘supporters’ are met with the kind of response which Peter has encountered.

Direct payments represented a major breakthrough for the realisation of disabled people’s right to independent living and Peter correctly pinpoints factors that determined their success, such as effective and sufficiently resourced local centres for independent living (factors which appear equally determinative of the success of personal budgets in extending choice and control, however a person elects to have them expressed).  It would be good to see many more people supported to take up the opportunities they present.  But the evidence that lay behind the Life Chances report found that they were not a panacea and that pursuing only the policy of direct payments, as Peter appears to advocate* would deny opportunities for choice and control to many.  Individual/personal budgets were never intended to supplant direct payments, but to build upon them by extending their benefits to people who for one reason or another did not want to assume such responsibilities.   The acid test – whether for direct payments or other methods including individual service funds, or council managed support – is therefore whether as a consequence of the Care Act people feel able to exert greater control over their support and over their own lives, irrespective of the approach that they choose.

Far from indulging in a conspiracy of silence, organisations that have come together under the umbrella of the Independent Living Strategy Group have with the financial and technical support of In Control been monitoring implementation of choice and control under the Care Act 2014.   The first survey was carried out in 2015 and the findings published in October 2015 which can be read here.  I challenge anyone having read this report to suggest that In Control and its ‘supporters’ are engaged in a conspiracy of silence regarding the shortcomings of current implementation.

The 2016 survey has just been launched and I encourage as many people as possible to complete it.  The findings will be presented directly to Ministers in July and published in the autumn.

What distinguishes this approach from that of Peter and his allies is a desire to see the Care Act 2014 deliver on its promise by holding national and local government’s feet to the fire over implementation, rather than rejecting the policy it contains only one year after it came into force.  We want to pinpoint inconsistencies between what the law and statutory guidance requires and the experiences of people using or seeking care and support in order to improve implementation and to bring to the attention of national and local politicians the difficulties that are being encountered in the ground so that they might be addressed.  Where necessary we will explore opportunities for strategic litigation.  But we will also highlight good things where we find them, such as the decision by Hammersmith and Fulham Council to scrap charging for care services.

We also hope to  find opportunities to pick up where initiatives such as the Right to Control left off – reconnecting with the proposal in Life Chances to see integrated personal budgets – focusing on people’s whole lives, not dictated by service silos.  The forthcoming Employment, Disability and Health White Paper is one such potential opportunity, as are personal health budgets.

Despite many problems, personal budgets can and do work.  Let’s not reject them as Peter Beresford so prematurely advocates but focus instead on addressing the problems in order to realise their potential.

 

*I have asked Peter if he believes that models other than direct payments could work but have not received a reply, so apologise in advance if this misrepresents his position.

 

 

 

 

 

 

 

 

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One thought on “Personal budgets can and do work. Why are some not prepared to let them?

  1. I am on direct payments and far happier than I was when receiving agency care. There is simply no comparision.
    That said there are a lot of problems with the system, which you duly recognise here.

    The biggest, imo, is that social services wash their hands of all responsility and we legally become small businesses (??!) with all the duties that entails. Worse, we get no training or help to deal with this.
    Our PAs should rightly have adequate protection as employees, but far more support should be available to us, as employers. In fact, I can no longer cope with it and will only take on people who have been confirmed as self employed PAs by the HMRC (yes, this really is possible under certain circumstances, but you need a bunch of paperwork confirming it to cover yourself).
    There is also the issue of what happens when the disabled person dies. Social services stop paying immediately, but PAs may be due leave if they have been working for over 2 years. This can easily exceed the standard insurance, leaving the immediate family in debt.

    On a more mundane and frustrating level, my social services don’t implement direct payments in the way they are intended.
    For instance at my review they wanted to know when my PAs “clocked in and out” and minutiae like which days I had my showers and what time I eat etc.
    They couldn’t cope with the fact that we vary the hours and what is done on any specific day according to what needs doing, how well I am, and what social events happen to be going on that week. My PAs still get paid pretty much the same as it all evens out in the end, but we’re flexible. Which is, after all, the whole point.
    In the end, to satisfy their red tape, I had to invent a timetable and make sure the hours all added up to what I had been allocated…

    So yes, direct payments have a lot to offer. But we have a very long way to go before they are an ideal solution.

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