Briefing 2: Factors that enable personal budgets to have a positive impact
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Briefing 2: Factors that enable personal budgets to have a positive impact

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In 2008, Essex County Council (ECC) commissioned ecdp and OPM to follow people over 3 years as they use cash payments for adult social care within Essex. ...

In 2008, Essex County Council (ECC) commissioned ecdp and OPM to follow people over 3 years as they use cash payments for adult social care within Essex.
This study provides a unique opportunity to fully understand the experiences of people living with a personal budget over this time - a perspective that is often overlooked.
This is one 5 briefing papers that contain findings from the third and final round of research with service users, frontline practitioners and providers in Essex who are working to facilitate self-directed support across the county.
You can read the full, final report, the 4 other associated briefing papers and 3 videos that provide the lived experience of users over the last 3 years on ecdp's website: www.ecdp.org.uk.

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Briefing 2: Factors that enable personal budgets to have a positive impact Briefing 2: Factors that enable personal budgets to have a positive impact Document Transcript

  • Briefing paper 2: Factors thatfacilitate Personal Budgets tohave a positive impactFindings from the third round of a three-yearlongitudinal study in EssexSeptember 2012OPM252B Gray’s Inn RoadLondon WC1X 8XGtel: 0845 055 3900fax: 0845 055 1700email: office@opm.co.ukweb: www.opm.co.uk
  • Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impactIntroductionOPM and ecdp (formerly Essex Coalition of Disabled People) were commissioned by EssexCounty Council (ECC) in October 2008, at the time of introducing Personal Budgets for adultsocial care, to conduct a three-year, longitudinal study into the system of Personal Budgets.The study aimed to: 1. Capture the impact of self-managed Personal Budgets on the lives of people who use them, including evidence of how and why impact is being achieved over time; 2. Assess the effectiveness of practices and processes being used by ECC and its partners to support the delivery of Personal Budgets, including evidence of how the market is evolving over the study period.This is one of a series of briefing papers containing findings from the third round of researchwith service users, frontline practitioners and providers in Essex. These brief papers havebeen produced to share key findings with audiences involved in personalising social care,including practitioners, managers, commissioners, service providers and policy makers.Other papers in this series include:• Briefing paper 1: Positive impacts of Personal Budgets on service users• Briefing paper 2: Factors that enable Personal Budgets to have a positive impact• Briefing paper 3: Ways to improve the impact of Personal Budgets• Briefing paper 4: Family, friends and Personal Budgets• Briefing paper 5: Impact of Personal Budgets on providers For copies of any of the above or for a copy of the full report, which contains details of our findings, please email Sanah Sheikh at OPM. (ssheikh@opm.co.uk) OPM page 1
  • Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impactKey points• The support provided by family members and friends in the direct provision of care and as a source of advice, information and advocacy has to date played a significant role in ensuring that Personal Budgets have a positive impact on service users.• Those service users that have been able to draw on their own financial resources to supplement the care they receive under a Personal Budget have inevitably had a more positive experience of being on Personal Budgets.• Those service users and their family members who are more confident, assertive and determined have been better able to ensure that their Personal Budget covers all their care costs and can be used flexibly and creatively.• The availability of a range of providers has meant that many service users have been able to exercise choice by changing providers if they have been dissatisfied with the standard of care they are receiving.OverviewThe positive impacts associated with Personal Budgets that have been found through thisresearch are associated with a range of factors. These factors have been identified in thisresearch and are as follows: “Internal” factors “External” factorsIn this briefing, we describe some of ways in which these factors appear, and the differencethey make in the outcomes service users achieve.(Please note: since ECC processes are specific to the local area, these are not includedhere.) OPM page 2
  • Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact“Internal” factors that facilitate positive impacts1. Family and social networksThe support provided by family members and friends in the direct provision of care, as asource of advice, information and advocacy and in taking on the responsibilities of managingthe Personal Budget has to date played a significant role in ensuring that Personal Budgetshave a positive impact on service users.For example, service users very strongly feel that being able to employ people they are closeto has really improved the quality of care that they receive, because as carers they tend to goover and above what is expected of them. "Because shes a friend as well and if we need her then she will come. She does lots more than what is essential to do, but thats down to her, you know." (PSI service user)Friends and family members also often play an advocate role and work hard to ensure thatservice users are able to maximise the benefits associated with Personal Budgets. This caninvolve ensuring that the Personal Budget covers the full costs of care needed by serviceusers, or ensuring that the budget can be spent creatively and in a way that meets broaderwellbeing outcomes. This kind of advocacy and support is particularly useful when serviceusers or those who manage their budgets do not feel they have the knowledge or confidenceneeded to effect change.Additionally, sourcing recommendations about providers from family and friends meant thatservice users were likely to be very satisfied with their providers and the quality of care theywere receiving. "A friend recommended it, because we had tried everywhere and there were lots of places that my daughter and I went to see and we didn’t like." (Wife of older service user)2. Financial resourcesThose service users that have been able to draw on their own financial resources tosupplement the care they receive under a Personal Budget have inevitably had a morepositive experience of being on Personal Budgets.For example, they have been able to cover the costs of care when the budget does not coverall care needs. Some service users reported that they did not have any personaldevelopment or leisure activities built into their support plans and that they therefore had tocover these costs themselves. Other service users report that their budgets do not cover thetransport and travel costs associated with PAs or carers accompanying service users onleisure or other personal development activities. "Weve always said we would pay extra for the transport if she was going out, if she – you know, if they took them somewhere, they go to Peter Pan’s down the seafront, and I don’t mind, I would give her the extra money myself." (Mother of service user with LD)Other service users have been able to draw on their financial resources to cover the cost ofcare when there are delays associated with reviews. For some this has been because of thetime taken for a revised budget to be approved after a review and for others it has beenbecause health needs have worsened but a review has yet to be arranged. OPM page 3
  • Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact3. Knowledge and skills of service usersThose service users and their family members who are more confident, assertive anddetermined have been better able to ensure that their Personal Budget covers all their carecosts and can be used flexibly and creatively. For example, one service user’s familymember described how she has had to be ‘assertive’ and ‘pushy’ in her communication orderto convince decision makers of the need to increase the budget: “If I wasnt one of these people that couldnt speak up for Chloe I dont know where wed be, I really dont know.” (Mother of service user with LD)Being confident, persistent and assertive has also meant that service users are better atdealing with delays associated with Personal Budgets, for example with regards to delays inrevised budgets being approved after a review. One older service user’s daughtercommented that it was important to ‘be on people’s case’ because she recognised theworkload that local authority staff have. Another service user’s parents reported that theyhave had to rely on their own determination and persistence to get the cash flow problemsaddressed: "In the end I was going up there every other day … And then my husband would get on (the phone) and he kept saying “Im not getting off of the phone until I talk to…”.” (Mother of service user with LD)Additionally, those service users who were used to administrative and record keeping workas well as managing budgets and running their own businesses, found it easier to manageand navigate the Personal Budgets system. "See Emma used to work in the cash office in Morrisons, she was supervisor, so figures and money – if she didn’t have it in her then it would probably be ten times harder." (Husband of PSI service user)“External” factors that facilitate positive impacts4. The role of the local marketThe availability of a range of providers has meant that many service users have been able toexercise choice by changing providers if they have been dissatisfied with the standard ofcare they are receiving. This ensures that service users are able to purchase services fromproviders who offer the highest quality of care. Service users gave a range of reasons forchanging providers including: a lack of consistency in carers; carers coming at inappropriatetimes of the day; carers being late or not turning up; carers not being professional or notdelivering appropriate care; and service users not developing a good relationships withcarers.Some service users reported specifically had moved from a private agency to a freelancecarer when they were dissatisfied with their care agency. They felt this resulted in: value formoney, due to not paying agency fees; a better quality of and more flexible care becausethey could negotiate directly with providers about what care was required; and also meantthey could develop trusting and personal relationships with their carers. OPM page 4
  • Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact5. The role of frontline staffService users keenly felt that having one consistent social worker as a point of contact isassociated with lots of the positive impacts associated with Personal Budgets. In particular,they felt that having one contact meant that they were able to start receiving paymentsquickly, have a review of one’s needs when necessary, receiving an adequate level ofPersonal Budget and also being able to access advice and guidance when necessary.Some service users who did have a single point of contact emphasised how important thiswas for accessing support and advice. "In the end she allocated Rebecca a social worker and so I had one person to speak to and that helped... when you have just the one person you don’t have to keep going over and over and that did it." (Mother of service user with LD)Some service users have also been able to work with their social workers to developPersonal Budgets that do not only focus on traditional social care needs, but also on widerwellbeing and independence outcomes. On the other hand, some service users arefrustrated because they feel their Personal Budgets have been quite inflexible and restrictive.Those with more creative and flexible budgets therefore tend to benefit more – benefits seenmore generally for service users with learning disabilities and those with physical or sensoryimpairments. OPM page 5