Your money and your life: the impact of self-directed support and personal budgets John Woolham

The impact of SDS & personal budgets Structure –Context of SDS & PBs –Description of local research site –Objectives (& what this presentation will cover) –Methods –Findings –Conclusions

The impact of SDS & personal budgets Context –Personal budgets & SDS –another means of achieving: personalisation empowerment choice o Evidence base remains weak at the present time o Contested areas – service users as customers or citizens?

The impact of SDS & personal budgets Context –Personalisation: an elusive policy aspiration over last quarter of a century Disability rights in USA Case /Care Management Social model of disability Valuing people Personhood & Kitwood’s work Core social work values

The impact of SDS & personal budgets Description of local research site Shire county, 600,000+ pop Conservative controlled Population growing (and ageing) rapidly Spends more than it should on younger & less on older people 26% of entire SSD budget tied up in residential care Struggling to manage budgets – expecting the worst Aspirations for radical change Decided to use ‘In Control’ to transform local social services A ‘transformation’ team within Adult Social Services responsible for driving change.

The impact of SDS & personal budgets Objectives of research Extent to which principles established in the ‘In Control’ approach were being realised in ‘roll-out’ Satisfaction of recipients with SDS/PBs Impact of SDS/PB on lives of recipients. –This presentation – focus is only on impact.

The impact of SDS & personal budgets Design & methods Research design Choice of methods Questionnaire design Choice of questions Layout and design Piloting Sampling REC review Survey administration

The impact of SDS & personal budgets Response rates & comparability of samples

The impact of SDS & personal budgets : health, personal safety, empowerment, isolation & dignity SDS users were more likely to say their health had improved, and that they felt safer in their homes than people who used ‘traditional’ services.

The impact of SDS & personal budgets: health, personal safety, empowerment, isolation & dignity SDS users were more likely to say they felt safe when they went out and that they felt they had more control over the support they used

The impact of SDS & personal budgets: health, personal safety, empowerment, isolation & dignity SDS users were also more likely to feel their social life had got better, and that people treated them with more dignity.

The impact of SDS & personal budgets: care & support The kinds of care and support purchased were also different amongst SDS users.

The impact of SDS & personal budgets: impact on ‘areas of life’ On a range of different ‘areas of life’ SDS users felt that their funding package or budget had been helpful. However…..

The impact of SDS & personal budgets: impact on ‘areas of life’ ….Substantial proportions of people also felt that SDS had not made a difference to them over the past year.

The impact of SDS & personal budgets: impact on ADL (higher scores = higher levels of functioning) IBSEN service users had higher scores. Comparison of ‘traditional’ and SDS groups showed little difference: on some measures traditional users had higher levels of functioning

The impact of SDS & personal budgets: impact on well-being/ill-being SDS users had lower ‘mental distress’ scores. Lower aggregate scores were evident amongst SDS users across all main care groups

The impact of SDS & personal budgets: impact on quality of life Locally, slightly more SDS users reported that the quality of their life was ‘good’ on the whole.

The impact of SDS & personal budgets: differential impact by care group The difference between ‘traditional’ and SDS groups was slight amongst older people, and large amongst people aged under 65 years

The impact of SDS & personal budgets: costs and cost effectiveness It was extremely difficult to get reliable information about package costs. SDS users received more money than traditional service package users (44% more overall). Differences were much greater in some care groups: (111% for older people).

The impact of SDS & personal budgets: costs and cost effectiveness There was a clear ‘skew’ in traditional packages toward less expensive packages.

The impact of SDS & personal budgets: costs and cost effectiveness Data above the horizontal line = worse than average. Data to the right of the vertical line = more expensive than average. Little evidence of benefit on ADL, but greater cost.

The impact of SDS & personal budgets: costs and cost effectiveness For GHQ, benefit is evident, but so is cost.

The impact of SDS & personal budgets: costs and cost effectiveness IBSEN found no benefit for older people. This study suggests limited benefit but greater cost.

The impact of SDS & personal budgets: costs and cost effectiveness For younger adults SDS users (on left) had better outcomes than older people on both ADL and GHQ scales. Costs were also greater

The impact of SDS & personal budgets Conclusions SDS users were more likely to report improvements in health, feelings of personal safety, control over their support, being treated with dignity that their social life had improved, and less likely to be experiencing mental distress. However….

The impact of SDS & personal budgets Conclusions There was little evidence that SDS users were any more likely to be able to perform ADLs Substantial numbers of SDS users said their budget hadn’t made a difference to them in respect of ‘areas of life’ Impact was differential – younger adults had the best outcomes on the measures used. For older people differences between traditional and SDS users were much less marked. Transformational impact greatest amongst ‘self completers’ - implications.

The impact of SDS & personal budgets Conclusions Costs more for SDS users o SDS as the ‘means’ not the end. If SDS costs were equivalent to ‘traditional’ packages, would this lead to poorer outcomes for SDS users? o If costs of ‘traditional’ packages were increased commensurately with SDS costs, would this lead to better outcomes for ‘traditional’ package users? Are there better ways of achieving personalised services for some people than personal budgets and SDS?

The impact of SDS & personal budgets Conclusions : SDS/Personal budgets: a false prospectus? Are people who use budgets customers or citizens? Is being a ‘customer’ empowering – now and in the longer term? What impact will SDS have on people who have impaired mental capacity? Are the improvements in outcome sustainable within a local care economy based on market principles & values and a shrinking resource base? If SDS isn’t the most effective way of achieving personalisation for some people – will there be any turning back from market forces?

References Carr, S. & Dittrich, R., Personalisation: A Rough Guide (2009) SCIE., London. Carr, S. Choice, Control & Individual Budgets: Emerging themes (2007) SCIE., London Clarke, J., Smith, N., & Vidler,E., The Indeterminacy of Choice: Political, Policy and Organisational Implications (2006) Social Policy & Society 5.3. p CUP. Clarke, J., Newman, J. & Westmarland, L., The Antagonisms of Choice: New Labour and the Reform of Public Services (2008) Social Policy & Society (7) p CUP Glendinning C., Challis, D., et. al IBSEN Evaluation of the Individual Budgets Pilot Programme (2008) SPRU, University of York. Hatton, C., Waters, J. et al. A Report on In Control’s Second Phase Evaluation and Learning (2008) In Control Publications, London. Poll, C., Duffy, S., et al A report on In Control’s First Phase (2006) In Control Publications, London.