New research commissioned by SSCR from the Social Policy Research Unit (University of York) suggests many older people may be missing out on the benefits of personal budgets (PBs) because they have limited opportunities to shape services to their personal preferences and circumstances.
Read the full summary findings document:
How far do managed personal budgets offer choice and control for older people using home care services?
Older people are often unwilling to take on responsibility for managing a cash direct payment and employing their own carers. The majority of older people therefore have their PB managed by the local council and used to pay for council-commissioned services – most commonly home care.
The in-depth study by the Social Policy Research Unit at the University of York in three English councils found the main restriction on older people’s choice and control was the level of the PB, which usually covered only essential personal care needs.
Professor Caroline Glendinning, one of the researchers, said:
‘One of the main problems faced by older people was the low level of their personal budgets. Once essential personal care needs were met, there was little opportunity for flexibility and choice. Greater freedom is needed for older people to decide how and when to use their PBs, even within the constraints of the smaller budgets they often receive.’
Furthermore the study found that councils were retaining much of the decision making power: some restricted the tasks that home care agencies could undertake to personal care only; others required any changes to care plans be approved by them.
Flexible options for PBs such as time banking or Individual Service Funds were not fully utilised. Time banking, where time is saved from routine visits to use later on for alternative activities, was restricted in both availability and scope. This was due to fears by some home care agencies and older people that a PB would be reduced if the council perceived there was spare capacity that could be banked.
Individual Service Funds, where budgets are held by home care agencies and managed in direct negotiation with users, did not appear to be fully operational in the study councils, as budgets were all still held by councils.
Study councils were gradually replacing block contracts with home care agencies with framework agreements which specify service price and quality but give no guarantee of clients. Framework agreements may increase competition between providers, make it easier to purchase individualised packages of care and can be particularly helpful when services need to be arranged quickly.
However, framework agreements have the potential to destabilise local markets, so councils initially restricted numbers of providers on framework agreements, thus reducing local homecare options. These constraints on local provider capacity further limited the choices available to older PB users.