Publication Health and Care Social security 28 February, 2019

Proceed with caution: What makes personal budgets work?

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This report provides a critical examination of how personal budgets have been used to deliver public services in the UK. It suggests where personal budgets show potential to deliver more effective, personalised public services, whilst also highlighting and suggesting solutions to the key challenges raised by their implementation so far.

Personalised Public Services

By allocating an agreed upon sum of money to an individual to spend on their support needs, personal budgets represent the ultimate expression of public services centred around the person and not the system. Proponents argue this devolved approach can provide greater control and increased outcomes for citizens, particularly those with complex needs, whilst also reducing burdens on reactive elements of the system. Critics are quick to point out the lack of evidence showing that personal budgets are cost-effective or produce better outcomes for recipients.

How far could personal budgets go?

The expansion of personal budgets across UK public services has been cautious. Whilst over 500,000 adults in social care already receive a personal budget from their local authority, the NHS has only recently begun to utilise personal health budgets (PHBs) for individuals with complex needs. The use of PHBs is likely to increase in keeping with the NHS Long Term Plan, particularly around mental health and maternity care. Education, ex-offender rehabilitation, and long-term unemployment also offer potential areas for personal budgets to have a significant impact, particularly if existing funding like the Pupil Premium and Flexible Support Fund are repurposed in the form of personal budgets.

Weighing the evidence

A better evidence base for personal budgets in achieving improved outcomes and value-for-money is needed before they can be scaled-up. Most data collected from existing schemes has been focused on principles (such as empowerment and autonomy) more so than the financial or value-based assessments which are key to securing the buy-in of local authority commissioners and procurement officers. Personal budget schemes need to be trialled or scaled-up in areas such as employment, education, and rehabilitation, and these programmes evaluated to consider the impact on both the service users and the commissioning bodies.

Laying the groundwork

It is necessary to get the fundamentals of personal budgets right before deploying them more broadly in public services. Efforts need to be made to ensure a healthy provider market, and challenging siloed public services by integrating, aligning, or co-ordinating services around the budget holder. Local authorities also have an obligation to ensuring personal budget holders can make informed decisions about their service needs. This should include consistently providing the right information (enforced by a digital standard) and working collaboratively with third-sector and peer-to-peer advocacy groups to improve the support and guidance available.

Data-driven personal budgets

Good data practices are needed to ensure that personal budgets are designed correctly and evaluated appropriately. The emphasis on co-production between the budget holder and professionals requires both parties to be able to draw upon accurate assessments of an individual’s needs and capabilities. A data-driven approach to monitoring and evaluating personal budgets is also required; lessons should be learnt from good examples such as the Education, Health, and Care Plans, and applied elsewhere.