IBSEN- The Individual Budgets Evaluation Network – has published its block buster report on the individual budgets. It is a mixed picture overall. Older people did not find the individual budget system used during the pilot as easy to use as the other groups, and they did not appear to like the idea of managing their own support. Equally there were no significant savings from the adoption of individual budgets.
For mental health service users those with individual budgets reported significantly higher quality of life than those in the comparison
group. A number of these service users had not found the services available under conventional arrangements to their liking, and saw an IB as an opportunity to access more appropriate support. Although not significant statistically, the data also suggests some tendency for psychological well-being to be better for the IB group.
The IBSEN identified both organisational and cultural challenges, including: - Joint funding and integration of services made it difficult to disaggregate social care resources.
- Managers responsible for introducing individual budgets working with frontline NHS staff without having a line management relationship.
- Some staff finding the shift to individual budgets a significant challenge to their existing ways of working.
The Department of Health has said that some action is already underway and the next phase of the Putting People First programme will include a range of activities aimed at sharing the most positive practice relevant to mental health. This will include:
- The production of a ‘guide to action’ for personal budgets in mental health.
- Identification and sharing of best practice examples of how advanced councils and PCTs have broken down organisational barriers.
- Production and dissemination of a mental health and personal budgets information materials, including a DVD.
- Development of a mental health personalisation good practice exchange within the broader Putting People First network.
SCIE has backed up the personalisation movement with its publication Personalisation: a rough guide.
First mental health service users need to be given high priority in developing individual budgets and can derive real benefits. Second the rush to Partnership Boards and Foundation Trusts has created a whole new set of organisational barriers to the delivery of this change which can empower service users. Third there are huge cultural changes in delivering change because staff are likely to feel threatened by the changes and risk averse in their approach. So there remains a big ‘ tell and sell’ job in which service users and social care staff need to work together to persuade the doubters that this really can deliver improved quality of life for users as well as the independence which comes from controlling one’s own future.
The next step is the extension to health of the concept promised by Lord Darzi. The timetable here is set out below by DH.
Where are we? Expressions of interest for the health pilots will be sought in December with decisions in the spring and projects starting in summer 2009. Consultations so far have thrown up some consistent themes.
Don’t be too restrictive about who could be offered a personal health budget –think about the types of services, rather than conditions, and what would most benefit the individual
Not everything should be included within a budget–e.g. acute/emergency care, elements where there is very little choice (e.g. certain drugs or interventions where there are no alternatives mechanisms
Information and support for the individual and their carers/relatives is crucial.
Making this work needs wholesale cultural change.
There will need to be careful risk assessment, and a healthy attitude towards taking appropriate risks, with the appropriate safeguards in place –both financial and clinical.
Regular monitoring will be essential.
This is about personalisation, not about money. In some cases, the budget may be the lever for the other changes necessary to bring about the personalised approach. In other cases the same outcomes may be possible without a personal health budget being in place -the person-centred approach is the prize.
Watch this space as we try to keep you updated with new developments.
Terry Bamford
October 2008
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