Personalisation of care and individual budgets

Personalisation of care has been evolving over some time. The new coalition government has committed to continuing and extending this agenda.  Debate still exists about how far services should be personalised, but it is largely agreed that personalisation provides a positive way forward both for providers and consumers. 

The approach focuses on individual rights, user empowerment, the right for people to control their own lives, and improved quality of services created by providing choice.  It recognises that people are experts in their own lives and therefore best placed to make choices for themselves. This reframing of citizens as active participants rather than passive recipients represents a shift in the balance of power from state to individual. This movement is echoed in the localism agenda.

A large part of this agenda has seen the spread of the use of direct payments and individual budgets. This is giving service users control of their budget and enabling them to purchase services from their choice of provider. 

What are the implications?

  • Public services opened up to markets and the development of new or hybrid organisations to meet the needs of different individuals (see blurring boundaries between sectors).
  • Closer relationship between users and professionals, with the potential of strengthening ties and collaboration, and providing greater accountability of organisations to individuals and citizens. 
  • Changing attitudes towards the welfare state as people increasingly approach services as consumers rather than citizens.
  • Inequality as choice leads to some people receiving an inferior level of care compared to other people.
  • Healthcare migration as people move to areas where there are known high quality care providers on which they can spend their personal budgets.
  • A focus on individual choice taken to the extreme could damage collective action.
  • Potential confusion and even abuse of vulnerable people as they deal with choice and employing people for the first time. 
  • Implications for administration, with a potential increase in level and complexity
  • Implications for strategic planning as sustainability in previously reliable funding streams is reduced,
  • Shift in accountability from a small number of funders to many individual service users.
  • Organisations that already provide strong support and empowerment to people may be most successful at delivering and supporting services related to individual budgets.
  • A need to support those people using individual budgets for the first time.

Moving forward

Users increasingly expect to be given opportunities to influence providers and shape the services they provide.  With an interest in user voice and involvement, the VCS has a competitive advantage.

  • To what extent is your organisation prepared to listen to and involve your users?
  • Do you feel confident that your organisation fully understands your users and their needs?
  • Do you capture learning and knowledge from your front line staff? This information could feed back into shaping a response to this trend.
  • What role do your users have in feeding into your future strategy?
  • Other sectors are getting better at listening to and involving their users/customers.  How can your organisation demonstrate your experience and expertise in this area and retain your competitive advantage? 

Personalisation of public services is increasing the number of options open to users, but also provides a potential risk related to a lack of experience in managing their own budgets.

  • Can you provide advice and help citizens to negotiate the wide range of options available?  How else can you support people through these changes?  Could you offer a brokering service?

As individuals begin to manage their own budgets, organisations that would normally hold large contracts for this work may find less sustainability in their funding. 

  • How can your organisation plan for this? 
  • Do you need to diversify your funding?

Having to be accountable to many individuals may require a change in your monitoring and reporting.

  • Will you need to alter the ways you do this currently?

Having a wider range of service providers may mean increased competition to deliver services. 

  • How can you ensure individuals use your services? 
  • How can you support people to use the services that best suit their needs? 
  • How can you campaign for an increases in standards of care?

Want to know more?

Personalisation: The future of Personal Budgets Summary Report

Published by: Office For Public Management (OPM)

Date: 2010

What is it? A summary of an OPM seminar titled “Personalisation and the future of health and social care” examining the key facilitators and barriers to success as well as potential steps to take for future delivery.

How useful is this? This seminar discussion summary provides a recent overview of the current state of the personalisation agenda, and in particular the extent to which personal budget success relies on the skills of the frontline workers delivering them.  The main facilitators of success looked at are: choice and confidence of individuals, and devolution of responsibility and risk (mainly the changing relationship between individuals and service providers). The main barriers examined include the lack of understanding and support amongst frontline workers, and the perceived threat to professionalism.  The summary ends by touching upon ideas for the future and how the delivery of care and personal budgets can be improved – mentioning in particular opportunities for third sector organisations to support service delivery.

Other comments: A full sized version can be found here. The OPM also has a page linking to several other interesting and relevant articles and reports revolving around the subject of personalisationand individual budgets.

The adviser in the International Context: Where next for personalisation?

Published by: Institute of Public Policy Research

Date: 2010

What is it? Write up of a seminar run by ippr examining how the personal adviser role varies between different countries. It examines different options for moving forward with personalisation.

How useful is this? Advisers have played a key role in the successful implementation of different social welfare schemes across the globe.  This seminar featured speakers from organisations who have successfully implemented advisers role to help facilitate different approaches to personalised services and discussed the role advisers play in the successful implementation of these agendas.  The speeches offer an interesting discussion of the different options, and offer possible learning for British personalisation schemes.  The write up offers a summary, slides from the presentation and downloadable podcasts of the speeches given.

Other comments: Podcasts on a number of other subjects are available from the ippr website.

Making it personal

Published by: Demos - a left of centre think tank

Date: 2008

What is it? A report advocating transforming public services into self-directed services.

How useful is this? The report follows a policy statement in December 2007 promising a more personal approach to social care.  The report examines why participative approaches are attractive, how and why they work, risks involved in adopting this approach, challenges involved in transferring this approach to mass services, and how far personalisation could spread into other public services such as health and education.  A useful examination of the pros and cons of self-directed services, including recommendations on making it work. 

Progress in the delivery of personal budgets

Published by: Department of Health

Date: 2010

What is it? Results from a survey completed by local governments to measure their personal budget uptake and outputs.

How useful is this? Although crucially missing any qualitative research on users and what affects their uptake of personal budgets, this report does provide the most recent statistics regarding how personal budgets have progressed since 2008.  Results indicate that take up of personal budgets is still low (averaging 52% even in the most successful 4 councils surveyed).  It also examines how much is being spent on personal budgets, and looks at the percentage of direct payments which contribute to these budgets.

Other comments: The report is held on the Department of Health’s personalisation pages with a number of other links available.

Person-centred support: what service users and practitioners say

Published by: Joseph Rowntree Foundation - a social policy research and development charity.

Date: 2008

What is it? A summary of their recent research report investigating the success of service personalisation.

How useful is this? The research focuses on service users’ perceptions of person-centred approaches, investigating meaning, paths for success, potential and actual barriers, actual experiences good and bad, and therefore outlining models for success.  A useful document for examining what personalisation means to customers themselves and providing good practice examples and suggestions.

Other comments: Centres on disabled people, but the findings are largely applicable to other service users.  Complete document available as an e-book and to buy.

Last updated at 12:35 Thu 24/Feb/11.

Recent comments

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Kathryn's picture

Kathryn

Third Sector Foresight

If this is a driver that affects your organisation, you might find it useful to keep track of how current care providers are engaging with social media. Effectively, they're blazing the way for you and you could learn from what they find! Have a look at Social Responsibility: Social Media Opportunities and Pitfalls for starters. It's focused on nurses, so you may be thinking 'Bit niche! how does this relate to me?' but if for example you're thinking of getting involved in providing personalised care you could be sharing quite similar areas of interest! The post talks about topics such as how social media could be used as a way of learning what patients are saying outside the clinical setting.

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