SPA Conference 2014 – Tuesday 15th July Katrina Ritters, Nicole Steils, John Woolham, Guy Daly Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers, users,

Personal budgets for older people ‘People should be in control of their own care and support. Things like personal budgets and direct payments, backed by clear, comparable information and advice will empower individuals and their carers to make the choices that are right for them. This will encourage providers to up their game, to provide high-quality, integrated services built around the needs of individuals. Local authorities will also have a more significant leadership role to play, shaping the local market and working with the NHS and others to integrate local services’ (Department of Health (2012) White Paper Caring for our future: reforming care and support, p.3). Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Our study Currently personal budgets for older people are: Mainstream – with expectation of growth of direct payments Managed in different ways – managed budget, direct payment, ‘hybrid’ approaches etc Our study: Are personal budgets always the best way of providing care to older people? Mixed methods – postal; interviews; 3 local authority areas; 52 local authorities (1/3rd of English local authority SSDs) Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

How users experience personal budgets Given a choice, 75% of older (direct payment) personal budget holders would opt for a personal budget. But even with direct payments, a substantial minority did not have control of help with basic daily living: 35% had to compromise over when they had a bath/shower 27% had to compromise over bedtime 26% had to compromise over timing of meals Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Personal budgets can – and do - give older people… Choice of carer – friend, family member, ‘someone you can trust’ Continuity of carer Ability to spend on respite care, cut back on care when family members are available But – Little evidence of budget being spent on social activities Little evidence of innovation – such as pooling budgets Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Unpaid carers Value control over: who provides care when and where care takes place flexibility – to plan their own free time But problems with: paperwork, bureaucracy, restrictions and regulations lack of information and advice worry about back up if care needs change Significant levels of stress found amongst carers Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Personalisation leads and social workers More choice More control Greater independence No loss of dignity …. A qualified ‘yes’ to all of the above … but take up is low for older people …. and direct payments work better for younger than older people Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Social workers’ view of ‘barriers’ Personalisation leads: Culture - 25% Market (lack of choice due to service non-availability, lack of flexibility and innovation) - 25% Admin - 14% Low expectations - 10% Resources, budget - 10% Information, communication - 8% Stress, emotion (emotive nature of arranging and maintaining care packages) – 3% Front line staff: … all of the above, plus complexity, system ‘churn’ Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Perceived reluctance of social workers to ‘push’ personal budgets. We found concerns about Safeguarding risk Perceived low expectations of older people Lack of choice Budget constraints restricting options Admin burden on the local authority Success depends on effective (and often expensive, time consuming) support Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Support/ service development Improving information and advice Personal assistant service Pre paid cards Closer working with – providers; GPs; voluntary sector; older people’s fora Staff training, supervision, risk enablement panels Active use of performance indicators Monitoring complaints Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Where next for personal budgets? Greater ‘push’ for direct payments Cross-party support Roll out of personal budgets to health Combined with: Austerity Tightening of eligibility criteria Attitudes to public spending on older people hardening Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

The last word …. from an unpaid carer ‘I’m not sure whether the emphasis about personal budgets is really about saving money or whether it’s about giving more choice…. I think for the people who are in the know, who can sort things out a bit, who know care agencies, who know what is available to older people who are living in their own homes; it might give them a bit more dignity.... I just think there’s two agendas going on. There’s something about saving money and then selling it as, “oh well, actually this is about empowering people and it’s giving them a better standard of care.”’ (Unpaid carer). Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly

Thank you Katrina Ritters, Nicole Steils, John Woolham, Guy Daly Personal Budgets in the Real World: Views of social services personalisation leads, users, unpaid carers and social workers SPA Conference, 15 th July, 2014 Katrina Ritters, Nicole Steils, John Woolham, Guy Daly