Self directed support and personal budgets

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• Self directed support and personal budgets
  panacea or problem?
• A paper delivered at the 12th UK Joint Social
  Work Education Conference with the 4th UK Social
  Work Research Conference
• Guy Daly John Woolham

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SDS personal budgets panacea or problem?

• Structure
• Background
• Theoretical explanations
• Findings from an empirical study
• Methods
• Results
• Discussion
• Policy antecedents and wider questions
• Conclusions

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Introduction PBs, citizenship and public
accountability

• PBs have become synonymous with personalisation
• PBs may not be the means to the end of
  personalisation for all service users
• PBs for some service users may enhance their
  market/civil rights but at the expense of the
  social rights of others
• PBs are part of reconstruction of citizens as
  citizen-consumers with market democracy to secure
  public accountability
• But still require public stewardship
• how public social care is provided for one
  citizen has implications for others who may be on
  the receiving end of a distorted quasi or
  unfettered pure market

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Background

• Health and social care policy continues to move
  increasingly towards greater service user choice
  and personalisation (DH, 2005, 2006, 2008ab,
  2009ab)
• We will extend the greater roll-out of personal
  budgets to give people and their carers more
  control and purchasing power. (HMG, 2010)
• choice and control are seen to be empowering
  (Duffy, 2003 Leadbeater, Bartlett Gallagher,
  2008)
• Critiqued (Beresford, 2009 Carr, 2009 Clarke et
  al 2006, 2007 Daly, 2009b)
• Research findings (IBSEN - Glendinning et. al,
  2008 Daly Roebuck, 2009)

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THEORETICAL EXPLANATIONS - CITIZENSHIP,
ACCOUNTABILITY AND SOCIAL CARE

• Citizenship
• T H Marshall civil, political and social rights
• Diminution of social rights but paradoxical
  enhancement of civil/market rights for some?
• Public accountability
• Gyford from representative democracy to market,
  delegate and participatory democracy
• Does the development of PBs support the move to
  market democracy?

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SDS personal budgets panacea or
problem?Findings/methods

• Quasi-experimental design comparing budget
  holders and non-budget holders
• Samples responses
• Method of data collection
• Based on In Control 7 principles extent to
  which principles were being implemented in
  roll-out.

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SDS personal budgets panacea or
problem?Findings/results

• The right to independent living (people with
  disabilities should get the help they need to
  enable them to overcome barriers to fulfilling
  their role as citizens).
• SDS users did better
• Large numbers didnt fully get what they
  wanted/needed
• Older people were less likely to get what they
  needed compared to others

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SDS personal budgets panacea or
problem?Findings/results

• The right to a personal budget (the right to have
  direct control over funding for care and support)
  
• Over a fifth of budget holders had no say over
  how money was spent (capacity or assumptions)
• Older people less likely to feel they had the
  final say than others
• Younger adults with physical disabilities were
  more likely to say they had the final say than
  others

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SDS personal budgets panacea or
problem?Findings/results

• 3. The right to self determination (the ability
  to make choices and take decisions).
• In relation to basic tasks of everyday living
  bathing, washing, eating
• Budget holders less likely to say they had to
  compromise over when
• Budget holders less likely to say they had no
  choice
• Substantial minority of budget holders could
  still not exercise choice
• Older people who were budget holders were more
  likely to feel choice was compromised or that
  they had none.
• 4. The right to accessibility (information about
  services, support, rules and regulations need to
  be clear and transparent)
• Budget holders were more likely to feel theyd
  had enough information
• Younger physically disabled budget holders were
  more likely to feel theyd had enough information
  older people were least likely.

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SDS personal budgets panacea or
problem?Findings/results

• 5. The right to flexible funding (money made
  available should be spent as creatively and
  flexibly as the budget holder desires).
• Budget holders were more likely to feel
• theyd had enough help compared to
• traditional service users
• Older people and people with learning
• disabilities were least likely to feel
• theyd been given sufficient help.

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SDS personal budgets panacea or
problem?Findings/results

• 6. The principle of accountability (Budget
  holders should explain their decisions and what
  they have learned)
• Budget holders were more likely to feel their
  opinions had been sought
• Amongst budget holders, people with LD were more
  likely to feel their opinions had been sought but
  many/most of these would have been carers(!)
• Older people were less likely to feel theyd
  shared their views about care and support with
  anyone recently.
• 7. The principle of capacity (Budget holders
  contribution to planning and managing support
  should be optimised)
• Budget holders were more likely than traditional
  service users to feel in control of the things
  paid carers did for them,
• fewer older people felt in control compared to
  younger budget holders.

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• Deeper Questions
• are particular service users civil rights
  enhanced by SDS or PBs?
• are particular service users or care groups
  social rights diminished by PBs or SDS?
• are there greater opportunities for 'market
  democracy via the development of SDS and PBs?

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Do SDS and PBs enhance civil / market rights?

• equivocal evidence that SDS or PBs enhance civil
  or market rights
• for particular care groups
• less the case for older service users, because
  ....
• social care markets may be less developed for
  older people?
• or older people less interested in PBs or SDS?
• so, need to de-couple relationship between
  personalisation and PBs for some service users /
  groups

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SDS and PBs diminish social rights?

• if dont decouple the relationship between
  personalisation and PBs, social rights to care
  may diminish for some service users / groups
• service users without SDS or PBs may end up with
  the rump of provision once the market-based care
  providers have cherry picked the customers with
  PBs or SDS
• service users with PBs may also distort the
  nature of provision with the residual provision
  no longer being cost effective (e.g. day care if
  there is a reduced demand for it)

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Market Democracy and SDS and PBs

• market democracy is seen to be a replacement for
  or enhancement of traditional representative
  democratic structures
• we have seen examples of greater control by
  service users who have SDS but more the case for
  particular care groups
• older users in receipt of SDS, for example, have
  not reported significant increases in levels of
  control
• SDS and PBs may enhance some service users
  opportunities for market democracy to a greater
  extent than for other care groups