Letter on Obstacle for Personal Budgets
This letter has been sent to the Ministers responsible for personalisation of social care for children and adults in England, to the CEO of the NHS and to the leaders of the two associations for Directors of Social Services (children and adults). It describes a serious policy problem that exists because current systems of commissioning are operating in accordance with out-of-date policies. The principles of personalisation have not been applied to procurement and commissioning systems. Without proper attention it is likely that progress on personalisation will be seriously impeded.
Text of letter sent 15th March 2017
I am writing to you because progress on one of the key elements of the cross-government personalisation strategy (for children and adults and in health, education and social care) has now stalled.
One of the most important reasons for this problem seems to be a policy confusion about best practice in procurement. This problem could be resolved by a clear statement of policy and a change in the current monitoring systems for personalisation.
Best practice in support and the policy of personalisation both depend on ensuring that decisions about care and support are individualised and that they are made by the person, the family or someone close to them who has a good understanding of their needs and aspirations.
In 1996 the Direct Payments Act made it possible for people to take control of the budget for their support. Over the past 21 years this policy has been extended to enable growing numbers to use direct payments. Usually people are then required to use this money to employ their own support team.
However, not everybody wants to manage a direct payment nor to employ their own staff and take on the relatively onerous responsibilities of being an employer. It seems likely that we are close to the upper limit in the use of direct payments in this way. If the goal is to ensure that everyone can receive personalised support then another approach to personalisation is necessary.
Fortunately it is possible for people to get personalised support without forcing people to become employers:
- People can use their direct payment to purchase support from an organisation that will employ and manage any support staff. The additional management costs necessary can be built into the direct payment.
- Commissioners can enable people to choose who will provide them with support and then fund this support by contracting directly with the support provider in a way that gives the support provider flexibility to personalise the support and gives the person the right to terminate that contract.
These two approaches enable commissioners the opportunity to set up a system of managed personal budgets which give people choice, control and the ability to design more effective support solutions. This kind of support solution has persistently been associated with higher rates of satisfaction, safety, effectiveness and efficiency. These systems enable personalised support without burdening people with unnecessary additional responsibilities.
However, despite the fact that personalised support has been in operation for at least 21 years, it has not benefited from the same level of attention as direct payments. Currently it is only available in a few areas of England and for very small numbers.
In principle the idea that people can have personalised support without having to manage a direct payment and without having to become an employer has been either an explicit or implicit feature of official policy. Recent guidance from TLAP and from the NHS continues to reinforce the importance of this model. However, in practice, progress towards Personalised Support has been blocked by a series of significant obstacles:
- Many commissioners do not make it clear that people can choose to spend their direct payment on a service provider, nor do they calculate the size of the personal budget in a way that makes this choice feasible.
- Many commissioners believe that EU Procurement rules dictate that they must put contracts for support out to tender and that they therefore cannot give people control over the decision about who provides them with support.
- Currently national monitoring systems do not count progress in providing managed personal budgets, although they do count nominal budgets, despite that fact these do not create any meaningful flexibilities or opportunities for personalisation.
Unless there is much greater clarity about these matters it is unlikely that there will be any significant further progress in personalisation. For this reason we are requesting that policy-leaders address these issues directly. We would recommend:
- Make clear that the existing obligation to offer eligible people and families a direct payment includes a responsibility to define that offer appropriately. That means people should be told clearly that they do not need to become an employer in order to receive a direct payment and that they can pay a third party to provide support or manage their budget.
- Make clear that people are also free to choose a suitable service provider with whom the commissioner can contract on their behalf. This kind of citizen-led procurement should be treated as best practice in procurement, rather than as it is currently, somehow questionable.
- All monitoring systems should be modernised to include a clear measurement for managed third party personal budgets, distinct from self-managed direct payments or commissioner controlled budgets.
- Greater recognition of the value of personalised support and greater encouragement to service providers to develop more personalised solutions.
Dr Simon Duffy, Director of the Centre for Welfare Reform
Sam Sly, Coordinator of Citizen Network England
W D Blewitt, Chairman of the Cornerstone Carers’ Reference Group
Steven Rose, CEO, Choice Support
John Dalrymple, CEO, In Control Scotland
Frances Brown, Director, Radical Visions
Tanya Moore, Senior Clinical lecturer in social work and social care, TheTavistock and Portman NHS Foundation Trust.
Catherine Hale, Researcher, Centre for Welfare Reform
Mike Llywelyn Cox, member of Equal Lives
Helen Collins, Day Care Lead, Meadow Well Connected
Dr Liz Ellis, Researcher, University of Gloucestershire
Melanie O'Neil, Mother to Mark Phillipson
Jenny Carter, Partners in Policy-Making Graduate, Lifelong Member of Learning Disability England and Co-lead for Self Advocacy in Wirral
Jo Hough, Co-Director Inclusion East CIC
Lynne McCarrick, Mother of Chris, who has autism
Lisa Watchorn, Self-advocate, Partners in Policy-Making Graduate and Mum of two young men with disabilities
William Case Partners in Policy-Making Graduate, Self-Advocate, Independent Disability Consultant and Executive Director of Your Support Matters CIC
Susan Kellett, founder of Learning Disability Carers Community, mother to autistic daughter with comorbid learning disability and language disorder and grandmother to child with learning disabilities, sensory disorder
Jacky Martel, Mother of Tomas
Virginia Moffatt, Ex-Commissioning & Contract manager of Learning Disabilities Services
Antony Thorn, The Oxfordshire Wheel
Everyone at PFG Doncaster (the home of peer support)
Sarah Maguire, Managing Director, Choice Support
Debs Aspland, Director, Bringing Us Together
Laura Waters, Personal Assistant
Kathleen Ainsley, Parent Carer and Representative of Cornerstone Parent Carer Support and Info Group
Dr Claudia Gillberg, Social Scientist and Disability Activist
Wendy Perez, Self-Advocate and Trainer, See Me As Me
Sophie Scott-Harman, Service Manager and PBS Specialist
Les Scaife, West Lancs Peer Support
Jules Hipkiss, Parent
Rosemary Farr Burslem, Parent
Alain Catzeflis, Steering Group Alliance for Camphill
Norma Curran, Values Into Action Scotland
Jenny Steeples, Claire’s Mum, CPST
Marie Norman, Director, Freedom Support Solutions
Chris Moon-Willems, Independent personalisation consultant, Director, Relative Matters Ltd
Joanne Salomon, Director, 1st Enable
Miranda Graham, Business Development Manager, Freedom Support Solutions
Laird Ryan, Vice Chair, Faiths for Change
Jane Gregory, Mother and Researcher
Bob Rhodes, Lives through Friends
Rachel Mason, Freelance Personalisation Consultant and Parent Carer
Tess Ellis, Independent Physiotherapist
Jane Foggin, Senior Lecturer in Social Work and Working Carer
Aarne Rajalahti, KVPS, Finland
John O'Brien, USA
Don Derrett, France
Stephen Sloss, CEO, Salvere
Liz Leach, Imagineer
Susan Helman, Head of Major Gift Fundraising at Cranfield University and mother to Zoe
Sarah Hurst, Parent
Ali Lyons, Social Care Practitioner
Natalie Palmer, Managing Director, Quovita Limited
Kate Adams MBE, Director, Project Art Works
Tom Daldry, Project Art Works
Matthew Pitts, Project Art Works
David Smith, CEO, Hull & East Yorkshire Mind
Margaret Spencer, Senior Lecturer and Consultant Occupational Therapist
Jane Dodgeon, Parent and Carer, Director of Love Life Projects CIC
Rob Gillespie, Managing Director, IDEM Living
Julian Haxby, Chairman, Alliance for Camphill
Emma Soanes, CEO, Unity Enterprise
Donna Gillespie, NWTDT/Pathways Associates CIC
Simon Cramp, Lifetime member, Learning Disability England
Tom Baker, Chair of Trustees Halton Disability Partnership
Jamie Emberson, Senior Partner, Positive Behaviour LLP
Dr Karl Nunkoosing, Principal Lecturer, Dept. of Psychology, University of Portsmouth
Jonathan Taylor, NHS Commissioner
Dr Sylvia Duffy
Lorraine Lish. Learning Disabilities Nurse
Tom Baker, Chair of Trustees, Halton Disability Partnership
Denise Huscroft, Parent and Independent Social Worker/Mediator and Trainer
Larry Gardiner, Vice Chair - Service User Network, HQIP
Marita Ludlam, HCPC registered Art Psychotherapist
Christopher Watson, Joint Commissioning Manager - Learning Disabilities & Mental Health
Marion Trabe, Parent
[Please note, if you would like to add your name in support of this letter please contact the Centre for Welfare Reform by email.]