Introduction

This briefing examines some of the recent UK and international literature relating to the development of personal budget schemes for adults eligible for support from social care services. These include older people, people with physical or sensory disabilities, people with learning disabilities and people with mental health problems

The briefing is an update of Research briefing 20: Choice, control and individual budgets: emerging themes (2007) and incorporates some new findings from research published between 2006 and 2008. It includes highlights from the In Control evaluation, the UK Direct Payments survey and the Department of Health Individual Budgets pilot.

The briefing is intended to provide an outline of – and signpost to – some of the most recent research for all those interested in the role of individual budget schemes for the development of personalised adult social care in England. The findings presented here are not comprehensive or conclusive, but give a brief indication of how personal or individual budgets have been working to date.
Key messages

The international evidence to date is based on many relatively small examples, but given the right level of support, user views are very positive and they report improvements.
All schemes are still working to balance safeguarding and registration of the workforce with individual choice and control. There are emerging risks to be overcome at the level of the organisation and the individual.
There are both advantages and disadvantages for carers and families. Support arrangements are needed to ensure successful implementation.
Older people and people with complex needs may need greater time and support to help them get the most from individual budget schemes, particularly the cash direct payment option.
Brokerage and support is needed but the support infrastructure is not yet sufficiently well developed in the UK. Emerging evidence indicates that support is more successful when it is independent of the service system. Support brokers should provide a task-focused service and be trained and regulated.
Early studies of personal assistants (PAs) paint a mixed picture of poorer pay and conditions but higher job satisfaction.
Most schemes share the same goals of improving freedom of choice, independence and autonomy and using public funds more efficiently.
Schemes still vary to take account of national context, but central government leadership is always a vital component.
All schemes have taken time to embed and have needed strong local leadership and investment in targeted training and support for frontline staff.
In the UK, IBSEN claims that individual budgets have ‘the potential’ to be more cost effective and there is improved satisfaction for people who use services.
Reliable evidence on the long-term social care cost implications is not yet available. This is an area which needs urgent attention to sustain confidence. There is emerging international evidence that self-directed care can lead to health gains and consequent efficiency gains