What can we learn from the National Personal Budget Survey?

In this blog post John Waters, In Control's research and evaluation lead and Professor Chris Hatton from Lancaster University consider the findings from the Third National Personal Budget Survey and what lessons we can draw.

The Third National Personal Budget Survey is out this week, produced by in Control and Lancaster University and published by Think Local Act Personal. It details the experiences of some 4,000 personal budget holders and carers. The report provides us with a detailed and up to date overview of how local authorities, and now NHS organisations, are implementing personal budgets. It gives us a comprehensive insight into what is working well, what is not working and what needs to change, and we hope it is a useful contribution to ongoing efforts to improve the way personalisation works for people.

As we look at the facts and figures in the report and start to consider the findings it is important to recognise they are the result of an immense collective effort. For the past 12 months all over England thousands of people have been sharing their individual experiences and revealing to us their own personal story. They have been opening up their lives for us to see, giving us a little bit of themselves. For that we should all be very grateful indeed. Thanks to them and to the many people who worked hard to collect the surveys, we have a tremendous opportunity to listen to 4,000 voices. Voices coming from people of different backgrounds, different ages, from our cities and villages, from people of all religions and none, people who support loved ones everyday and people who need support for a whole host of different reasons.

As we start to listen to these voices, what do we hear? People are telling us quite clearly that personal budgets can and do work, they make a positive difference to people's lives. Eight out of 10 people with a personal budget reported an improved quality of life as did eight out of 10 carers; in fact seven out of 10 carers said their own quality of life had also improved as a result of the person they support having a personal budget.  Most people also said that their personal budget had a positive impact on the relationships they have with people working with them. Three quarters of people said their personal budget had improved the relationship they have with people paid to support them and a large majority of personal budget holders reported their views had been included when their needs were assessed (82%) and when their plan was developed (77%). So far so good.

But that's not the end of the story. If we divide the 4,000 voices into groups according to where they live, then cracks begin to appear. The positive picture above is an average of all the areas that took part. We would expect some local areas are going to be doing better than others; the reality is that some areas are doing a lot better than others. For example if we look at whether people felt their views were included in the development of their support plan; in one local authority area nearly everyone (88%) said this, but in another this fell to only two thirds of people (65%). This variation depending on where you live exists for both the experience of taking control of a personal budget and the impact they make on people's lives.  There is a challenge to ensure that the positive experiences and outcomes being achieved in some places are commonplace across the country for everyone who has a personal budget.

Clearly where you live is only one factor that might influence whether having a personal budget is helpful to you. There are other factors as well. Why you need support for example; or how the budget is held. It has often been suggested that personal budgets do not work for some 'types' of people, mainly older people. It has also been argued that personal budgets are only helpful if they are taken as a direct payment into your bank account. Indeed previous personal budget surveys have been criticised by some who say sample is  of little value as is said to have too many people using direct payments and not enough older people.

Looking at who took part in the Third National Personal Budget Survey the proportion of older people is lower and the number of people with direct payments is higher than the general population of people using social care services.  However it is important to remember the survey is not conducted as a purely academic exercise but rather as an opportunity for as many people who want to, to share their views and experiences. If we listen carefully to those people it is possible to form some solid conclusions from our work.

We know by analysing the data that there were no statistically significant differences across social care groups for many of the outcomes areas examined. If we look just at the older people in the sample 83% of them reported a positive impact on the dignity in their support compared to 82% for the rest of the sample. For quality of life there is a similar picture, just looking at the responses from older people 80% said things had improved compared to 82% of the rest of the sample. Clearly in these two areas how old you are has little bearing on the value of a personal budget to you.

Again If we look at the same outcome areas but this time divide the sample between those people who had a direct payment and those who did not we see very little difference. For dignity in support  81% of people with a direct payment reported a positive outcome; for those without a direct payment the figure was 82%. For quality of life the figures were the same; 81% for both the direct payment group and the non direct payment group. We cannot just ignore the experiences of 4,000 people as they do not mirror   precisely the wider population of people who need support. Those who  have taken the decision to share their experiences with us deserve to be heard.

How old you are and where you hold your budget don't seem to be related to the outcomes you might expect to see from a personal budget, so what is linked to good outcomes? Which people in the survey were more likely to report good outcomes? And what can we learn from this?


The graph above shows the likelihood of people reporting a positive impact of having a personal budget in the 15 outcome areas in the survey. The graph shows the likelihood of people reporting good outcomes, expressed as an average odds ratios across all of the 15 outcome indicators, and how these change according to people's experiences. An odds ratio of 1 would mean that a positive impact was no more or less likely. An odds ratio significantly less than 1 would mean that a positive impact was less likely. An odds ratio significantly more than 1 would mean that a positive impact was more likely.

Looking more closely, again at Dignity in Support and Quality of Life, there were some big differences depending on people's experiences of how they were involved in their personal budget. For those people who said their views had been included in their support plan, 85% said their budget had a positive impact on Dignity in Support, compared to 67% for those who said their views were not taken on board.  For Quality of Life, these figures are 85% and 65%.

There are many factors associated with good outcomes, including how you spend your budget with people choosing to access community or leisure services or get their support from a personal assistant (PA) reporting very positive outcomes.  The process conditions associated with good outcomes are fully detailed in the report itself, but there are some important headlines if we are interested in securing good outcomes for people. We should ensure the process of taking control of a personal budget is as simple and easy as possible, we should make sure people feel heard, and we should make sure people have the support they need to develop a good plan and are able to make decisions about how their budget is used to meet their own individual needs and circumstances. We should certainly avoid restricting the way personal budgets are spent to traditional care and support services.

In difficult times, some local authorities are managing to get close to delivering personal budgets in ways that people find easy to use to get the support they need, when and how they need it. The challenge is to make this the standard for everyone.

Read our other POET blog posts here.

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Last Updated : 28 October 2014. Page Author: Laura Bimpson.