Evaluation of the Individual Budget Pilot Projects Karen Jones, Ann Netten, José-Luis Fernández, Martin Knapp, David Challis, Caroline Glendinning, Sally Jacobs, Jill Manthorpe, Nicola Moran, Martin Stevens and Mark Wilberforce

Individual Budgets (IBs)  At heart of ‘personalisation’ agenda  Promoting choice  2005 Cabinet Office Strategy Unit report  2005 Social Care Green Paper  Built on experiences of:  Direct payments  In Control

Principles underlying IBs  Greater role for users in assessing needs  Users should know resources available before planning how needs met. Resource Allocation System (RAS) recommended  Encourage users to identify desired outcomes and how to achieve these  Support individuals in using IBs  Test opportunities to integrate funding streams and simplify/integrate/align multiple assessment processes and eligibility criteria  Experiment with different ways of deploying IBs

Funding streams in IBs  Adult social care (gateway to IB)  Supporting People (DCLG)  Independent Living Fund (DWP)  Disabled Facilities Grant (DCLG)  Access to Work (DWP)  Integrated Community Equipment Services (DH)

Potential deployment options Considerable local and individual flexibility:  Cash direct payment  Care manager-held ‘virtual budget’  Provider-held ‘individual service account’  Indirect payment to third party  … or combinations of these

The IB pilots  13 local authorities  representative mix but higher than average take-up of direct payments  Mix of user groups (OP, LD, MH, P/SI)  Mix of funding streams

Evaluation  Do IBs offer better way of supporting disabled adults and older people than conventional methods of resource allocation and service delivery?  Which models work best and for whom?  Evaluation covered:  User experiences, implementation experiences, funding stream integration, impact on care managers, impact on providers, risk and protection, outcomes, costs, cost-effectiveness

IBSEN evaluation Do individual budgets offer a better way to support disabled adults and older people than conventional methods of resource allocation and service delivery? If so, which models work best and for whom? User experience Carer impact Workforce Care management Provider impact Risk & protection Commissioning Outcomes Costs Cost-effectiveness Evaluation dimensions

Evaluation design  Randomised trial – 500 each IB and comparison groups across sites and user groups  Baseline data on circumstances and current support arrangements  Outcome interviews after 6 months  IB group – content and costs of support plans  In-depth user interviews 2 – 6 months – support planning process  Interviews with IB leads (x 2), providers, commissioning managers, other managers  Interviews and diaries, front-line staff and first-tier managers

Data collection  Randomised controlled trial – within each site, users allocated to IB or comparison group  Baseline data from LA records  Follow-up outcome interviews after 6 months  Analysis IB support plans  In-depth user interviews – support planning process  Interviews with IB leads, funding stream leads, providers, commissioning and other managers, support planning organisations  Interviews and diary study, front line staff and first tier managers

People included in the evaluation 1594 of the 2521 individuals randomised (63%) consented Final sample of 959 people:  34% physically disabled  28% older people  25% with learning disabilities  14% using mental health services Wide variations in age, functional need and FACS level IB and comparison groups not different at baseline Note: IB not in place at 6 months for everyone

Costs Average weekly value of an IB: £359 learning disabilities £228 older people £310 mental health users£149 disabled people Average weekly cost across all user groups = £279 for IB group …£296 for comparison group Care manager support for IB group (£19) was higher than for those with conventional support (£11) Cost variations: higher costs for those who declined an IB; and for those without a support plan at 6 months

Funding streams  Funding stream integration  99% support plans contained social service funding  11% of support plans contained SP funding  8% of support plans contained ILF monies  1 support plan contained Access to Work funding  No support plans contained funding from DFG

Deployment options  67% IB managed as a DP  MH (89%) more likely  OP (56%) less likely  20% managed by local authority  13% managed by an agent  1 IB administered through a Trust  4 had services organised through a provider

Patterns of Expenditure Direct payments Managed budgets % Mean annual expenditure % Personal assistant64£8,94047£7,420 Home care20£7,14040£7,480 Leisure activities43£2,02024£1,750 Planned short breaks**24£1,75015£5,460 Other23£93021£270

Examples of Innovation Accommodation (N=24) Employment and occupation (N=16) Health-related (N=3) Cleaning serviceGoing out: trips/cinema etc Private health care Decorating serviceClasses/arts and crafts Massage for carer Gardening serviceGym membership/swimming Alternative therapy Computer maintenance Admission fees for service user and PA

IB Process  45% IB services in place at interview  10% for less than one month  51% for more than 3 months  11% not all in place  Do IBs impact on outcomes?

Do IBs improve outcomes?  Interviews at 6 months; only 45% had IB support in place  Measures:  Quality of life (7-point scale)  Psychological well-being (GHQ12)  Social care outcomes (ASCOT)  Satisfaction (7-point scale)  Differences between IB and comparison groups  Multi-variate analyses

Outcomes  Quality of life  Overall sample – no significant difference  MH – IB group better QoL  Psychological well-being (GHQ12)  Overall sample – no significant difference  OP – IB group lower well-being  Both measures – bigger IBs = better outcomes  Social care outcomes (ASCOT)  Overall sample – no significant difference  IB group - higher scores in ‘control over daily living’ domain  LD – higher levels of control  Satisfaction  IB group more satisfied overall  P/SD IB group more satisfied

Overall outcomes  Positive effects of IBs  QoL, social care outcomes and satisfaction  Older people  Concerns about managing budgets?  Anxiety about change?  Lower budgets, more personal care, less flexibility?  Level of IB affects outcome

Are IBs cost-effective?  Are improvements in outcomes justifiable in terms of costs?  Combined data on costs and outcomes  Some evidence of cost-effectiveness in overall sample in respect of social care outcomes  Weaker evidence of cost-effectiveness with respect to psychological well-being  But significant variations by user group:  IBs more cost-effective for PD and MH groups  No evidence of cost-effectiveness for OP