Abstract
Individual Budgets (IBs) are central to the aim of ‘modernising’ social care in
England. They build on the experiences of direct payments and In Control and are
intended to offer new opportunities for personalised social care. Since the1980s there has been growing interest among policy makers and service users alike in England in developing ways that enable adults who need support and help with day-to-day activities to exercise choice and control over that help. Growing
dissatisfaction has been articulated, particularly by working age disabled people,
about the inflexibility and unreliability of directly provided social care services. These have been argued to create dependency rather than promoting independence and impede disabled people from enjoying full citizenship rights (Morris, 2006). Instead, disabled people have argued for the right to exercise choice and control over their lives by having control over the support they need to live independently. This, they have argued, can be achieved by giving them the cash with which to purchase and organise their own support in place of in-kind provided services (Glasby and Littlechild, 2006; Morris, 2006).
A rather different set of policies have reflected the attempts of successive
governments to reduce the control of social care service providers over the
composition, timing and flexibility of services and make providers more responsive to the circumstances of individual service users. Thus the 1993 community care reforms made front-line care managers responsible for purchasing individualised ‘packages’ of services from a range of different providers, tailored to meet individual needs and preferences. At that time, the position of monopolistic authority service providers was challenged by the active encouragement of a ‘mixed economy’ of social care services, funded by local authorities (and increasingly also by individuals funding their own care entirely from their own private resources), but provided by a range of charitable and for-profit organisations.
More recently, policy commentators have argued for the active involvement of users in the co-production of services. By putting users at the heart of services, enabling them to become participants in the design and delivery, services will be more effective by mobilising millions of people as the co-producers of the public goods they value. … (Leadbeater, 2004: 19-20)
Co-production is argued to introduce new incentives for providers to respond to
individual demands; and new incentives for service users to optimise how the
resources under their control are used in order to increase cost-effectiveness.
Co-production approaches: … create a new way to link the individual and the collective good: people who participate in creating solutions that meet their needs make public money work harder and help deliver public policy goals. Self-directed
services work because they mobilise a democratic intelligence; the ideas,
know-how and energy of thousands of people to devise solutions rather
than relying on a few policy makers … Leadbeater et al., 2008: 81)
By the mid-1990s, many local authorities were circumventing the legal restrictions on giving cash payments to individuals by making indirect payments to a trust fund or third party organisation which then passed them on to disabled individuals. The 1996 Community Care (Direct Payments) Act (implemented from April 1997) gave local authorities power to make cash payments, in lieu of services in kind, to adults aged 18 to 65 who were deemed ‘willing and able’ to make the necessary decisions. However, direct payments could not be used to purchase health care, local authority services or employ a close co-resident relative.
Subsequently three developments have taken place in direct payments policy and
practice. First, the groups of people able to receive a direct payment instead of
services have been extended. Since 2000 people aged 65-plus in England have
been able to receive direct payments, as have carers, people with parental
responsibility for disabled children and disabled 16 and 17 year olds. Secondly, to
encourage people to take up direct payments, a £9 million Direct Payment
Development Fund was launched in England in 2003. The Fund aimed to stimulate
the development of organisations providing information and support to people
wishing to use direct payments. Thirdly, Section 57 of the 2001 Health and Social
Care Act made it mandatory (not just optional) for local authorities to offer direct
payments to eligible individuals (that is, those eligible for social care services, who
consent to and are able to manage payments).
There has been extensive research on patterns of take-up of direct payments and the factors that appear to facilitate or hinder take-up. Despite the measures listed above, take-up has remained highly variable: between the different countries within the UK; between local authorities within those countries; and between different groups of social care service users. Take-up rates are highest in England and lowest in Northern Ireland. People with physical and sensory impairments have consistently had higher rates of take-up while older people, people with learning disabilities and, particularly, people with mental health problems have much lower average take-up rates (Riddell et al., 2005; Priestley et al., 2006; Davey et al., 2007). Direct payments appear to be more popular among more severely disabled people and among younger age groups. There appear to be no differences in levels of income or wealth among direct payment users once benefit levels and age are controlled for (Leece and Leece, 2006). Local political and policy factors also appear to have a significant role (Fernández et al., 2007).
Meanwhile, a White Paper on services for people with learning disabilities, Valuing
People (DH, 2001), led to the development of a different approach to enable this
group of social care service users to exercise choice and control over their support
arrangements. Supported by social enterprise organisation In Control, this approach promoted a greater role for service users in assessing the level of support they need; the allocation of resources to individuals according to relative levels of need rather than according to the value of services allocated (as with direct payments); transparency over the level of resources allocated to each person; and support in planning how those resources are used to meet individual priorities and preferences. Whereas direct payments are generally used to employ personal assistants to provide help with personal care and daily living activities, In Control encourages greater flexibility and promotes the use of a wide range of ordinary community-based services and supports. In Control connects closely with the principles underpinning direct payments but has a broader aim of redesigning social care systems towards ‘self-directed support’ (Duffy, 2004). Initially, In Control piloted this approach to selfdirected support in six local authorities but has since been extended to many more English local authorities.
England. They build on the experiences of direct payments and In Control and are
intended to offer new opportunities for personalised social care. Since the1980s there has been growing interest among policy makers and service users alike in England in developing ways that enable adults who need support and help with day-to-day activities to exercise choice and control over that help. Growing
dissatisfaction has been articulated, particularly by working age disabled people,
about the inflexibility and unreliability of directly provided social care services. These have been argued to create dependency rather than promoting independence and impede disabled people from enjoying full citizenship rights (Morris, 2006). Instead, disabled people have argued for the right to exercise choice and control over their lives by having control over the support they need to live independently. This, they have argued, can be achieved by giving them the cash with which to purchase and organise their own support in place of in-kind provided services (Glasby and Littlechild, 2006; Morris, 2006).
A rather different set of policies have reflected the attempts of successive
governments to reduce the control of social care service providers over the
composition, timing and flexibility of services and make providers more responsive to the circumstances of individual service users. Thus the 1993 community care reforms made front-line care managers responsible for purchasing individualised ‘packages’ of services from a range of different providers, tailored to meet individual needs and preferences. At that time, the position of monopolistic authority service providers was challenged by the active encouragement of a ‘mixed economy’ of social care services, funded by local authorities (and increasingly also by individuals funding their own care entirely from their own private resources), but provided by a range of charitable and for-profit organisations.
More recently, policy commentators have argued for the active involvement of users in the co-production of services. By putting users at the heart of services, enabling them to become participants in the design and delivery, services will be more effective by mobilising millions of people as the co-producers of the public goods they value. … (Leadbeater, 2004: 19-20)
Co-production is argued to introduce new incentives for providers to respond to
individual demands; and new incentives for service users to optimise how the
resources under their control are used in order to increase cost-effectiveness.
Co-production approaches: … create a new way to link the individual and the collective good: people who participate in creating solutions that meet their needs make public money work harder and help deliver public policy goals. Self-directed
services work because they mobilise a democratic intelligence; the ideas,
know-how and energy of thousands of people to devise solutions rather
than relying on a few policy makers … Leadbeater et al., 2008: 81)
By the mid-1990s, many local authorities were circumventing the legal restrictions on giving cash payments to individuals by making indirect payments to a trust fund or third party organisation which then passed them on to disabled individuals. The 1996 Community Care (Direct Payments) Act (implemented from April 1997) gave local authorities power to make cash payments, in lieu of services in kind, to adults aged 18 to 65 who were deemed ‘willing and able’ to make the necessary decisions. However, direct payments could not be used to purchase health care, local authority services or employ a close co-resident relative.
Subsequently three developments have taken place in direct payments policy and
practice. First, the groups of people able to receive a direct payment instead of
services have been extended. Since 2000 people aged 65-plus in England have
been able to receive direct payments, as have carers, people with parental
responsibility for disabled children and disabled 16 and 17 year olds. Secondly, to
encourage people to take up direct payments, a £9 million Direct Payment
Development Fund was launched in England in 2003. The Fund aimed to stimulate
the development of organisations providing information and support to people
wishing to use direct payments. Thirdly, Section 57 of the 2001 Health and Social
Care Act made it mandatory (not just optional) for local authorities to offer direct
payments to eligible individuals (that is, those eligible for social care services, who
consent to and are able to manage payments).
There has been extensive research on patterns of take-up of direct payments and the factors that appear to facilitate or hinder take-up. Despite the measures listed above, take-up has remained highly variable: between the different countries within the UK; between local authorities within those countries; and between different groups of social care service users. Take-up rates are highest in England and lowest in Northern Ireland. People with physical and sensory impairments have consistently had higher rates of take-up while older people, people with learning disabilities and, particularly, people with mental health problems have much lower average take-up rates (Riddell et al., 2005; Priestley et al., 2006; Davey et al., 2007). Direct payments appear to be more popular among more severely disabled people and among younger age groups. There appear to be no differences in levels of income or wealth among direct payment users once benefit levels and age are controlled for (Leece and Leece, 2006). Local political and policy factors also appear to have a significant role (Fernández et al., 2007).
Meanwhile, a White Paper on services for people with learning disabilities, Valuing
People (DH, 2001), led to the development of a different approach to enable this
group of social care service users to exercise choice and control over their support
arrangements. Supported by social enterprise organisation In Control, this approach promoted a greater role for service users in assessing the level of support they need; the allocation of resources to individuals according to relative levels of need rather than according to the value of services allocated (as with direct payments); transparency over the level of resources allocated to each person; and support in planning how those resources are used to meet individual priorities and preferences. Whereas direct payments are generally used to employ personal assistants to provide help with personal care and daily living activities, In Control encourages greater flexibility and promotes the use of a wide range of ordinary community-based services and supports. In Control connects closely with the principles underpinning direct payments but has a broader aim of redesigning social care systems towards ‘self-directed support’ (Duffy, 2004). Initially, In Control piloted this approach to selfdirected support in six local authorities but has since been extended to many more English local authorities.
| Original language | English |
|---|---|
| Place of Publication | York |
| Publisher | Social Policy Research Unit, University of York |
| Commissioning body | DHSC Department of Health and Social Care |
| Number of pages | 327 |
| ISBN (Print) | 978-1-871713-64-0 |
| Publication status | Published - 1 Jul 2008 |