Comment Blog 21 November, 2018

Personal Budgets: Preinventing the Wheel?

In October 2018, the Ministry of Housing, Communities, and Local Government (MHCLG) launched a £7.5 million Local Digital Fund to help local authorities transform their digital services. The response was overwhelming. In just two weeks, almost 45 per cent of all principle English local authorities submitted at least one application.

One of the most popular application subjects was to use digital technology to improve adult social care. Proposed projects ranged from creating a programme to monitor the likely collapses of care providers to inventing a digital application system for home-based palliative care.

Yet the most successful applications revolved around one theme: making it easier for citizens to access information and services to meet their social care needs.

This is not surprising. Unlike other areas such as health care where personal health budgets are just beginning to gain traction, the Care Act 2014 has required local authorities to give all eligible citizens a social care personal budget (i.e. ring-fenced funding that is under the direct control of the budget holder or a nominated third party) since 2015. In 2016-17, 88 per cent of citizens with physical, learning disability or mental health support needs received some form of direct payment or a personal budget, around 550,000 people in total.

Given the independence afforded by personal budgets, holders are dependent upon feeling supported to make the right choice. This is only possible if local authorities and providers make high-quality information easily accessible. However, only half of all personal budget holders believe their local authority had made it ‘easy’ to get the right information and advice. Furthermore, there are no clear guidelines about how to enable this exchange, meaning many local authorities feel unsure how best to meet the needs of their citizens. Of 141 local council directors surveyed, 40 believed their biggest concern in meeting social care statutory duties fell around personal budgets.

Nowhere is this uncertainty more apparent than ensuring a range of accessible information sources are readily available to inform and connect users and providers, including through the use of online portals. Local authorities have adopted a number of approaches, with a distinct lack of consistency. Some, like Durham Locate or Live Well Cheshire, provide a searchable database of providers including detailed information about the provider, recommendations of similar services on offer, and what accreditations each provider holds. Others, like Live Well Kent or Somerset Choices provide only a brief description of what companies are available in different geographic regions.

This inconsistency is particularly problematic when it comes to ensuring a coherent standard of information and assurances of quality across county borders. Rather than learning from others, local authorities have tried to reinvent the wheel by themselves. The result is a jumbled and disorderly “postcode-lottery” of information for their citizens, which leads to a variable of access to the services themselves.

There is a much simpler solution already out there. NHS.UK (formerly NHS choices) is an online, nationwide platform which provides users with “information, advice or data about health and care providers or accessing health and care services”. It includes specific indications of quality, including Care Quality Commission (CQC) inspection ratings and user reviews. Services are broken down by type (for example, Caring for Adults over 65, or Physical Disabilities), and alternative products are offered wherever possible. The site receives 48 million visits per month and won an award in 2018 for the Digital Leaders website project of the year.

Local authorities should look to NHS Digital and existing, successful platforms like Connect to Support to assist them with driving change across local digital services. As with the Local Digital Fund, there needs to be a greater focus on collaboration and cooperation between councils, rather than solely encouraging independent innovation. Whether aimed at creating a national standard for online portals, or simply ensuring all citizens can access appropriate and timely information in a variety of forms, the need for cooperation is especially true when the hard lessons have already been learnt.

Josh is a Researcher at Reform and is currently authoring a paper on personal budgets.