Department of Health
Published: 22 May, 2014
guidance on personal budgets
The Care and Support (Personal Budget Exclusion of Costs) Regulations 2014
Back to personal budgets
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I am concerned about the use of personal budgets in the area of health as it is one way of rationing care. If a person is given a finite budget – and this, in many cases, would be difficult to exactly assess – then I would argue that this is not the same as someone receiving care for their actual needs where there is no finite cut-off point.
This section is not sufficiently clear, examples which distinguish different budgets and funding streams and how they can be both combined and used would greatly improve the guidance. This appears to be a positive aim but lacking in practical guidance which would support implementation.
More consideration needs to be given at how local authorities should determine an indicative personal budget and the timeliness of giving this to the customer. Guidance suggests that the indicative personal budget is agreed with the customer following assessment and eligibility. Then through care and support planning the eligible needs will reflect the use of universal services as well as informal care to arrive at the final adjusted personal budget. However if a customer is given an indicative personal budget to then determine their own care and support plan independent from the local authority i.e. for a direct payment, how can the local authority ensure that the customer is reflecting appropriately eligible needs that can be met by universal services and informal care to adjust the personal budget to an sufficient amount. Once universal services and informal care are included the final budget will in most cases be less than the indicative amount.
I am concerned that there is insufficient guidance on the degree of flexibility that personal budgets can give, this is also reflected in the direct payment section.
I also have a concern that the questions posed in this section of the consultation are limited.
From my perspective it leaves a gap in how councils set resource allocations. For example if councils base it on how much it would cost them. This would not work at the beginning of the planning process as it is only through the process is it clear the level of support someone needs.
I fear the existing system will remain i.e budgets are calculated based on minutes of support and service e.g. the council uses 4 half hour calls a day to calculate budget without any real knowledge of the amount of support someone needs, this only leads to conflict later. I am unsure of how to solve this but it needs addressing.
The guidance should address the need for councils not to use unjustified blanket policies of time allocation, where these are not linked to individual need. This is regular current practice in many local authorities.
Some detailed case studies of how a good system would work may help.
The guidance does not clarify the contractual basis for Individual Service Funds. It should do.
Will the government relook at the provision of a national RAS ?
This is a key area where guidance to health on integrating personal budgets and personal health budgets could be promoted.One assessment, one budget and one support plan using funding from both health and social care. Guidance on dealing with chanrging which is the main barrier would be helpful.
The PB guidance seems to reflect current practice and as such is welcome. The range of money management options is fine. It is the capacity and means to monitor the outcomes from PBs spend and aggregate these to see population and service successess and gaps and the actual spend that can sometimes prove difficult and onerous on service users and their familes and put them off. Perhaps there could be mention of payment cards and other more efficient and effective means of managing budgets on line. IT suppliers need to consider and develop more user friendly outputs from their systems so that people can access these and control their own affairs reducing reliance on local authority professionals to do this or translate from complex in house systems information.