In 2011, Demos warned that personal budgets are a vehicle for personalisation – one of many – and not an end in themselves. We warned that the Government’s narrow focus on personal budgets as a proxy for personalised services could lead to complacency – that once someone had a personal budget, the care and support they receive would be personalised by default. Through successive whitepapers and legislation, even the terms started to become worryingly interchangeable.
Our research showed the folly of this way of thinking, cemented by the 2015 legislation, which set a 100 per cent take-up target for personal budgets. This could well represent an administrative task for local authorities, organising a wholesale transfer of their financial processes, without any real regard to the underlying objective of ensuring 100 per cent of care users have person-centred care.
The reality is that while personal budgets are an important way of achieving personalised support, they are not the only – and indeed not even the best – way for everyone. We identified people living in residential care, those at the end of life and those with highly complex needs as just some of the groups who either needed additional support to achieve personalisation alongside a personal budget, or who actually might benefit from alternative approaches, including stronger co-design and co-production, and democratic group-governance arrangements in residential care.
Today’s PAC report suggests our prediction that personal budgets will not guarantee personalisation in and of themselves has proven correct, with the Committee identifying similar groups to those we identified as struggling to achieve personalisation through budgetary transfers alone.
True personalisation requires support that thoroughly understands the preferences and needs of a person, and is responsive to that. Giving individuals power over where and how they spend their funding simply isn’t enough. Neither, in fact, is having a wide choice of care providers – unless those providers are themselves committed to person-centred ways of working, with solid processes in place to really understand the people they support and give them an active say in how their support is shaped.
In this regard, while the PAC’s report is welcome in highlighting the limitations of what personal budgets have achieved thus far, it seems to fall into the trap of assuming personal budgets must always be the starting point. It judges the limits of person-centred care by judging the limits of personal budgets, rather than the limitations of the care system – the way quality is quantified and measured, the way care is commissioned, the way providers are judged and funded accordingly.
Until person-centred care is the heart of every element of our care system – from regulation and inspection to training, commissioning, funding, quality development and inherent in the overall culture – it will remain elusive for many, regardless of who holds a personal budget.