Individual budgets (IBs) - a government initiative allowing older, disabled and mentally ill people to control their own social care provision - are great for the majority of users but pose challenges for staff administering them, found a cross-institutional team brought together to evaluate them.
The team, called the Individual Budgets Evaluation Network (IBSEN), surveyed a two year IB pilot study involving 13 local authorities.
IBSEN, made up of academics from the Personal Social Services Research Units (PSSRU) of LSE, Manchester and Kent universities; York University's Social Policy Research Unit; and the Social Care Workforce Research Unit at Kings College London, concluded that IBs were generally welcomed by users because they gave them more control over their lives.
Their evaluation report, published this week, found that:
IBs were typically used to purchase personal care, assistance with domestic chores, and social, leisure and educational activities
people receiving an IB were more likely to feel in control of their daily lives, compared with those receiving conventional social care support
satisfaction was highest among mental health service users and physically disabled people and lowest among older people
little difference was found between the average cost of an IB and the costs of conventional social care support, although there were variations between user groups
However, the team did find some areas where processes could improve, including:
staff involved in the pilot encountered challenges including devising processes for determining levels of individual IBs and establishing legitimate boundaries for how IBs are used
there were particular concerns about safeguarding vulnerable adults
staff experienced numerous legal and accountability barriers to integrating funding streams
NHS resources were not included in IBs
One key issue the team found were variations in outcomes between user groups as Professor Martin Knapp (pictured right), director of PSSRU at LSE and IBSEN contributor explains:
'Disabled people and people who use mental health services appeared to have better outcomes with IBs than with conventional service arrangements. Other people included in the study did not enjoy the same benefits. But over time, as individuals gain confidence with holding an IB and as support arrangements develop, so there is potential for improved effectiveness and cost-effectiveness'.
In their reports, IBSEN recommends further research in a number of areas including:
relative benefits and drawbacks of different approaches for different groups of users
longer-term evaluation of costeffectiveness in comparison to conventional support
impact of different resource allocation
quality and supply of personal assistants, care-workers and other supporters
the role of carers in support planning, managing individual budgets and providing support paid for by individual budgets
The Department of Health is currently considering these proposals, as well as undertaking and planning development activity in a number of the specified areas.
Click here to download the full report, a report summary and the Department of Health response to evaluation report
Individual Budgets are designed to bring about independence and choice for people receiving care or support. It gives them a full understanding of the finance that is available, in order to empower them to take control and make decisions about the care that they receive.
The Individual Budgets pilot programme was a cross-government initiative led by the Department of Health working closely with the Department for Work and Pensions, and Communities and Local Government. The pilot was conducted over two years 2006-2007 involving 13 local authorities. The full independent evaluation reports were published on 21 October 2008.
22 October 2008