Councils still assess eligibility and allocate resources, but we’ve known for decades that letting people choose and pay for their own care works better.
Two recent high court judgments – Oxfordshire v Davey and Merton v JF – highlight the ways councils assess eligibility for social care and allocate resources. One vital issue they underline has so far gone completely under the radar: personal budgets.
When the Care Act came into effect in 2014, it was hailed as the most significant change in social care law for 60 years. A key measure was to make it a legal duty for councils to provide all service users with a personal budget.
The change was built on the premise that an up-front allocation of money would empower a person to choose the support they think will work best for them – instead of councils controlling what their needs were and how to meet them. The allocation would be calculated using a resource allocation system, a formula predicting how much support they would need, which could be adjusted once the person’s actual needs were known. The person would then be given the cash as a direct payment to manage themselves or the local authority would handle it as a council-managed budget. But either way, the same principle – a person should choose their own support using a sum of money – would apply.
The two high court judgments both concerned service users seeking legal redress against councils that had significantly reduced their levels of support. They brought into sharp focus how decisions were made about what services would be provided and at what cost.
But in the two very detailed court judgments – totalling 35,000 words – there is not a single mention of an “up-front allocation” or “resource allocation system”. These concepts played no part in either claimant’s case against the councils, nor in the councils’ defences, nor in the judges’ deliberations. It’s as if the personal budget strategy did not exist.
The term personal budget is used, but it means no more than the financial value of services the councils offered to meet the needs it had decided were eligible. This is precisely the meaning given to personal budget by the Care Act, which leaves unchanged the power of councils to decide what needs it will meet and what resources are required to meet them.
The effect is that “personal budget” simply replaces “care package” to describe the offer made to a person. Stripped of its transformative ambitions, it has become a phantom policy. New words to describe the same old, same old.
Yet politicians and social care leaders continue to proclaim the transformative ability of personal budgets. Surveys of personal budget holders carried out by Think Local Act Personal (TLAP), for example, have created a false and misleading narrative. Asking people if their personal budget has improved their lives is bound to elicit a different response if people understand personal budget to simply refer to the services they receive.
The most recent survey adds a new question, perhaps amid concerns that councils may not even be telling people what their up-front allocation is.
The report’s pre-amble states that a personal budget means “knowing, before care and support planning begins, an estimate of how much money will be available”. Yet the question put to respondents substitutes the word “before” with “when”. This may seem inconsequential, but it is not. “When” extends the time span to include the whole process – so it’s not clear at what point service users are being told how much money they have to spend on their care. Only 50% of respondents said they knew their personal budget when their support was planned.
A separate survey by TLAP on the impact of the Care Act found that it is yet to make the difference hoped for. The survey did find satisfaction from a small number of people using direct payments who organised their own support and managed their day-to-day support plans. But we have known this works since the early 1990s, when the independent living movement successfully made the case for the introduction of direct payments. We also know the “small number” has scarcely risen above 5% of service users in its 20-year history [pdf].
We have a two-tier service: the great majority of service users are subject to the same depersonalising and disempowering system that existed before the Care Act. Clinging to the false belief that change is on the way is preventing us from facing up to the real challenges. Councils continue to call all the important shots. The system must be transformed into one that is truly personalised for all, not just a small minority.
Colin Slasburg is a social care consultant