Angela Ellis Paine and Catherine Needham
Concerns have been raised about the extent to which personal budgets, and particularly direct payments, achieve the same benefits for older people as they have for younger disabled adults and people using mental health services. Several barriers to older people benefiting from personal budgets have been highlighted, including insufficient information, advice and support. Within this context Age UK secured funding from the Department of Health's Health and Social Care Volunteering Fund to develop a programme aimed at engaging volunteer support to maximise older people's use of personal budgets. A team of researchers from the School of Social Policy at the University of Birmingham, made up of ourselves, Rebecca Taylor, Rosemary Littlechild and Heather Buckingham, recently completed the programme evaluation
Programme monitoring data suggests considerable success. Over 10,500 people across the five local Age UK partners involved in the scheme were reported to have had their awareness of personal budgets raised, well above the original target. Over 1,500 older people were directly supported by the local projects. The expertise and, perhaps most importantly the time that was made available through the programme, in part through the paid project coordinators but also through the involvement of over 260 volunteers, proved crucial. Comparisons were made to what was often possible for social services to achieve alone, particularly given the short time that social workers were able to spend with individual clients - here each local team could spend as long as necessary ensuring that information about personal budgets has been fully understood and assimilated. In some instances older people, or their carers, had been able to use this newly acquired understanding to negotiate with their local authorities, leading to some successfully negotiating to use existing personal budget allocations for new purposes or to receive additional money. More broadly, however, the programme was found to have enabled older people to feel more involved in decisions about their care and more knowledgeable about their options. It had also contributed to older people feeling more informed about what's going on in their local communities, and to generally feeling better in themselves.
To leave the story here, however, would be only telling one side of the tale. The programme faced considerable hurdles in its implementation. Fundamental to its design was the partnership between the five local Age UKs and their local authorities. Whilst support was secured at the strategic level, operationalising it proved challenging in some areas. It was suggested that a challenging policy and funding environment made the establishment of referral mechanisms difficult and reduced the potential to maximise the use of personal budgets. For example, some suggested that a tightening of eligibility criteria for older people accessing social services, combined with a lowering of personal budget allocations, often left little flexibility to pay for support beyond personal care needs. Cuts in local services were also reported to have restricted the choices available to older people, while a restructuring of local authority services created challenges for partnership working. Many of the projects adopted a pragmatic response to these challenges, developing a range of referral mechanisms and adopting a broad definition of personal budgets which included self-funders.
Overall, the success of the scheme is perhaps best judged not as maximising older people's use of personal budgets, but more as enabling personalisation through providing specialist information and advice or a specialist brokerage and befriending service, which contributed to feelings of well-being and supported people in accessing a wide range of local services. In the end, it seemed to be more about the time and the relationships than it was about the money.