Supporting People and Individual Budgets
Phil Saunders examines a recent Government report
March saw publication of an important study on the implications of Individual Budgets (IBs) for Supporting People. Communities and Local Governments (CLG’s) guide Learning and experiences from the Individual Budget Pilot Sites (Learning and experiences from the Individual Budget Pilot sites: Sharing practice from the Individual Budget pilot sites, Kate McAllister and Shaun Bennett, March 2009, www.spkweb.org.uk) is based on the experience of 13 pilot sites who took part in an Individual Budget Pilot exercise, which ran for two years from December 2005 to December 2007. It aims to provide practical information to any Supporting People Administering Authorities who wish to develop personalisation and choice in their local communities, by including Supporting People funding within IBs.
During the pilot, all the pilot sites offered the option of allocating Supporting People funding within an IB, in most cases earmarking up to 10 per cent of their overall Supporting People allocation. In practice, take-up of Supporting People funding through IBs was slightly lower, except in one authority, Oldham, where IBs were offered to all people subject to a Fair Access to Care (FACS) assessment. Forty per cent of Oldham’s total Supporting People budget was eventually made available to Individual Budgets, with any efficiencies found re-invested into support for socially excluded groups. These are the Supporting People clients who are mostly ineligible under FACS.
Getting the FACS right
Up to now, the only access route for an IB has been through local FACS assessments. During the IB study, if someone met the FACS criteria and was from one of the client groups covered by the local pilot, then they would be offered the option of an IB.
In many authorities, only people with critical and substantial needs would be eligible. There was, therefore, no access to IBs for people with lower care and support needs during the pilot period. This had a big impact on the sites’ ability to evaluate potential for including Supporting People in IBs, since many people requiring housing related support have low to moderate support needs.
The study found that if, in future, authorities wish to offer IBs to people with lower needs, below the FACS thresholds, they will need to set up alternative systems to monitor and administer IBs. For example, local authorities could put resources into funding a Supporting People-related assessment service. Alternatively, now that the Supporting People funding ring fence has been removed, there may be opportunities for integrating any framework for assessing housing support needs into existing Social Care assessment
frameworks. Furthermore, as national FACS policy is currently being reviewed, there may be opportunities to create a framework that can take into account the assessment of lower support needs as a means of preventing people from requiring high care services.
Commissioned services
The pilot sites agreed that there will continue to be a role for “commissioned services”, not purchased through IBs, in providing housing related support. These services are most likely to be commissioned for socially excluded groups (that is, for those who require a fast response service) and potentially for individuals who want greater choice but not the added responsibility of managing the funding associated with their own budget. However, as an alternative to IBs, commissioned services will need to be personalised using other methods, with access to these services involving:
- www.spkweb.org.uk
Outcomes
All sites agreed that an approach to needs assessment and resource allocation which is outcome-focused works best. While existing In-Control2 style self-assessment questionnaires are person-centred, the support plans resulting from them focus on identified needs, rather than on the outcomes which the individual would like to achieve.
Only one of the pilot sites (Coventry) had adopted an outcome-based selfassessment questionnaire, including Social Care outcomes. Their outcomes model is based on one produced by York University’s Social Policy and Research Unit. Other than that example, none of the pilot sites had yet produced a self assessment questionnaire which links the individual’s desired outcomes to wider strategic outcomes and targets, including Supporting People outcomes.
However, the pilot report posits the view that such an approach would be very beneficial. It would enable the individual to track the progress they were making towards their personal outcomes, while also providing key stakeholders and funders with key data about the overall success of Individual Budgets in helping them to meet wider strategic objectives, including those in the Local Area Agreement.
Quality, risk and performance
The study found that systems current at the time of writing were not designed for Individual Budgets and that even ‘lite’ versions can appear a touch too cumbersome. Although there is a collective desire to change the relationship between the local authority and service users (to empower people to make informed choices is a fundamental principle of Individual Budgets), the sites agreed that there is a need for some kind of ongoing oversight of service quality and monitoring of potential risk.
There were two key drivers identified for this:
1. Authorities have an on-going responsibility to monitor the appropriate use of public money and individuals are potentially more vulnerable to abuse as they take responsibility for their own budget and, in many cases, the actual cash which funds their support. Although an authority has a duty of care to an individual who is eligible for services, this duty of care can be met by providing funding for personalised services.
2. Staff could be potentially at higher risk of poor employment practice if employed directly by individuals who do not have an understanding of employment law and good practice.
The focus should be on identifying potential risk to:
• the individual
• the framework for ongoing service delivery
• the appropriate use of public funds
• individual members of staff.
The old approach to monitoring quality and risk within Supporting People funded services may not be appropriate for Individual Budgets. However the QAF lite was currently being reviewed at the time of writing and may prove to be more adaptable than the old version.
Resource implications
None of the monitoring and review activities set out above are cost neutral and the pilots felt that there will be potential resource implications to local authorities as Individual Budgets grow. This is mainly because there is currently no infrastructure in place to monitor quality and risk in Individual Budgets which do not include Social Care funding. The sites have also highlighted a current lack of skills in this area. There is a need for trained care managers, with experience of direct service delivery, rather than the case management approach in place at present. Any review of IBS should ideally include a review of financial arrangements, quality of provision and any potential risk. If Supporting People is involved, at least a working understanding of what the funding is for and what it hopes to achieve should be in place.
Based on experiences to date, all the pilot sites feel that IBs have a key role to play, but that they should not be considered as the only option for personalising housing related support services and increasing choice. Commissioned services can also be responsive and person centred. At Sitra, we support the principle of Supporting People IBs, but have doubts about the extent to which national, regional and local outcomes monitoring can be built upon the detail of truly self directed support planning. And, while robust accountability, risk management and quality control systems need to be put in place, there is a danger that “micro management” of service provision by funding authorities will unintentionally become the order of the day.
