An Evaluation of the Individual Budgets Pilot in Coventry: service users’ accounts of having an individual budget

West Midlands Regional Housing LIN Meeting Stoke On Trent, 22 January 2008 An Evaluation of the Individual Budget Pilots in Coventry: service users’ accounts of having an individual budget Dr Guy Daly Faculty of Health and Life Sciences Coventry University

Aims of the CCC Evaluation whether and to what extent service users are engaged in the Council’s Individual Budgets scheme barriers to service user participation effective mechanisms in promoting service user involvement other barriers to the effectiveness of the promotion of Independent Budgets general views of those involved in Individual Budgets Pilot

Context (1) 13 local authorities chosen to pilot the introduction of individual budgets during national pilot programme evaluated through the Individual Budgets Evaluation Network (IBSEN). national research project aims:  experiences and outcomes for service users  resourcing and management  cost effectiveness, workload management, training, legal and professional issues  Randomised Controlled Trial - hard data with nationwide validity.

Context (2) choice independence personalisation outcomes-based care direct payments individual budgets personal budgets

Learning From Previous Studies (1) develop and manage social care markets effectively commission social care effectively develop effective partnership working develop an understanding and raise the profile of individual budgets

Learning From Previous Studies (2) overcome various barriers including attitude of certain local authorities and social care professionals promote outcomes focused social care ensure users are empowered ensure real choice is provided

CCC Methodology (1) Aims capture service users’ and carers’ thoughts and experiences empower the service users to tell their own stories in ways that were meaningful to them.

CCC Methodology (2) Sample all service users were ‘in transition’ from one care setting to another 44 service users in the Pilot 30 service users participated in the evaluation 19 male, 11 female third – years, third 19-25, third over 25 vulnerable individuals with additional communication needs

Methodology (3) Approach action research

Methods one-to-one support sessions with researchers use of computers to create ‘blogs’ dictaphones PowerPoint presentations posters and artwork group artwork project film observation of service users

Evaluation Findings Benefits service users able to set the agenda increased choice and autonomy over how their needs were met able to grow and develop holistically Increased flexibility of service provision service users are more fully part of the community

Setting the agenda (1) The Individual Budget pilot has allowed [my] needs and aspirations to be understood in a way that a traditional assessment would not allow. In the past [my] ability to perform tasks would be the main focus of an assessment and the consequences of doing the task would not be considered. (service user)

Setting the agenda (2) So we intend to employ a personal assistant who will support him in a person-centred way, putting his needs first, and promoting his well- being (family)

Setting the agenda (3) The Individual Budget gives us the flexibility to use the resources we have as and when we need them (parents) For example E does not always go out for the same number of hours every week – social lives are not always predictable (parents)

Holistic Growth - physical, emotional and spiritual (1) I prefer living in the new house because I do not have to do everything in a group and I am also allowed to do more things for myself. I feel like more of an individual. (service user) The money from the Individual Budget means I can live here …. I’m much happier here than where I lived before because … this is my flat and I am supported to live here independently. (service user)

Holistic Growth - physical, emotional and spiritual (2) My sister and I get on better now since I have moved into my new house because we spend more quality time together and she is not just my carer now. (service user)

Challenges varied levels of knowledge and awareness of Individual Budgets difficulties experienced by some service users in obtaining an Individual Budget or available services difficulties in securing adequate supply of good care staff need to be skilled up in order to take on the responsibilities of being an Individual Budget holder need for supply to become more flexible and responsive need for professionals to recognise to a greater extent that their roles are changing

Suggested Developments effective advocacy services and support database of available care staff* support/assistance for service users and families in taking on roles of an employer effective communication between departments agencies work in partnership aligned funding streams real work opportunities developed appropriate housing supply

CCC - Overall Findings Coventry City Council’s Individual Budgets Pilot has been a very positive development: independence family roles promoting person-centred, outcomes focused support the process of getting an IB….has been hard at times …. But having it has helped me to become more independent

National Evaluation Can IBs help people get better outcomes from social care resources and services to improve their lives? Can improvements be achieved without additional costs? What might make individual budgets work best for different people in a range of circumstances? What are the challenges and obstacles that need to be resolved?

Overall Findings (1) holding an IB was associated with better overall social care outcomes and higher perceived levels of control the IB group were significantly more likely to report feeling in control of daily lives, their support and how it was accessed

Overall Findings (2) specific benefits for particular groups for people with mental health problems, significantly higher quality of life… and a tendency towards better psychological well being* physically disabled people with IBs were significantly more likely to report higher quality of care and more satisfied with help received people with learning disabilities with IBs more likely to feel that they had control over their daily lives

Overall Findings (3) less positive findings for some groups most significant was that findings were less positive for older people psychological well-being was not improved for some groups for people with mental health problems, while experiencing potentially significant benefits, still major barriers to greater take up

Department of Health response national evaluation confirms to DH that introduction of personal budgets in social care is the right approach specific challenges for older people and people with mental health problems prioritise personalisation for people with learning disabilities implications for carers of personal budgets and personalisation Putting People First programme to meet commitment to co-production

Some references Coventry City Council (2008) Our Voices – Service Users’ accounts of Individual Budgets, Coventry City Council Daly, G and Roebuck, A (2008) 2008 ‘Gaining Independence: Evaluating Individual Budgets Pilot’, Journal of Integrated Care Daly, G et al (2008) Evaluating Individual Budgets in Coventry, Coventry University Faculty of Health and Life Sciences – DH (2008) Moving Forward: Using the Learning from the Individual Budget Pilots - Response to the IBSEN evaluation from the Department of Health IBSEN (2008) Evaluation of the Individual Budgets Pilot Programme Final Report - SPRU/PSSRU/SCWRU