Older people and personal budgets: What can be done?

The policy goal of 100% personal budgets, including for older people was bound to come under challenge. ADASS in its paper 'The Case for Tomorrow: Facing the Beyond' has now raised this with government. ADASS calls for a joint review with the government of how to make personal budgets work for older people and for a longer time period to make this happen. This was perhaps inevitable for a number of reasons. Since the last ADASS review of personal budget numbers we haven't had a numbers update. However it was clear then that although overall numbers had gone up markedly, direct payments numbers, after big rises, were stalling. I have talked to dozens of local authority managers this year and most have expressed general positivity towards personal budgets and direct payments but also fear the risk of unintended consequences of the 2013 goal. Most felt that as they needed to get many more older people included, there would be a high risk of superficial compliance but not a great actual extension of choice and control. They were concerned that outcomes for people would be put at risk in pursuit of a very challenging target.


So what might this intervention by ADASS mean for the future of personal budgets, and in particular for older people? Some might see this as a simple suggestion that personal budgets can't work for many older people and other approaches to personalisation should be pursued instead. However this would potentially be a discriminatory denial of the potential benefits of personal budgets to older people, and it is clearly not what ADASS is saying. At the same time there are clearly practical, systemic and cultural challenges to making personal budgets work well for older people, that should not be denied. The National Personal Budgets Survey of over 2,000 personal budget holders and family carers found that outcomes and satisfaction for older people (the biggest group in the survey) were improved (some reporting of the ADASS statements misinterprets this). The survey also found however, that older people were not benefitting as much as other groups:

In terms of social care need groups, older adults tend to report less positive outcomes than other social care need groups in six out of the 14 outcome domains. However, these differences are ones of degree (older adults are more likely to record personal budgets as making no difference; they are not more likely to record personal budgets as making things worse).

It is also important to note that less positive outcomes for older adults may not be a function of age as such, but could reflect the fact that older adults are less likely to use personal budgets in ways that are associated with positive outcomes. For example, older adults are less likely to use direct payments, less likely to know how their personal budget was managed, and more likely to have a personal budget managed by the council - all these factors are associated with less positive outcomes

In Control would be very keen to work actively with ADASS on a review of how to make personal budgets work for older people. We know of pockets of good practice and approaches like Individual Service Funds that could really help. We suspect that most changes needed to succeed would need to take place at a local level but also encourage the government to see how it can help. We recommend that councils use POET to get a quick real-time understanding of what is happening and why and what changes are needed. We also expect that Think Local, Act Personal will want to prioritise this via their forthcoming Self-Directed Support Forum. With a good will we can make sure that the next steps are to really look at how to make personal budgets work for older people rather than (once again) denying older people what others can have.

We wonder, at this point in the development of personal budgets in policy and practice is there a reasonable deal to be done between the government and ADASS, with good will on all sides? Perhaps extend the period for achieving 100% personal budgets by a couple of years in exchange for a strong commitment to not just review but act on the findings needed to make personal budgets work for all?

Martin Routledge

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Last Updated : 19 March 2012. Page Author: Laura Bimpson.