A personal budget can come in different forms and be managed in different ways. It can be a cash, direct payment or notional budget. Someone can manage a budget themselves, and employ their own staff and directly purchase what they need, or someone else (for example an individual, agency, trust or provider) can do this on their behalf. A personal budget may be funded solely from a local authority or from a combination of sources such as the Independent Living Fund or Supporting People. The NHS can also allocate a notional personal health budget, which, with changes in legislation, may in the future also come as a cash payment. However people choose to manage their personal budget, the idea is that they are encouraged to put together a support plan to meet the personal outcomes they want in their lives, and have maximum control over how the plan is put into action.
I get clear information that tells me what a personal budget is and the different ways of using it.
I get support to decide which is the best option for me.
Making it happen in West Sussex
Lack of information, or confusing information, can stop people taking advantage of opportunities for greater control. For example:
· People are concerned because they believe that having a personal budget means that they have to take on responsibility for employing staff and managing money and they are therefore reluctant to take up the offer
· People are anxious that the change to a personal budget will upset the arrangements they already have that are working well and valued by them
· Language or cultural differences are not taken into account and this leads to misunderstandings.
Examples of things that help with this:
· Clear information that is made available in ways and in places that suit different people
· Information and communication that makes clear:
- the different ways in which it is possible for people to take control over decisions about how money that is allocated to them is managed and spent
- that they do not have to directly manage the money themselves or employ staff if they do not want to and that other people can do this on their behalf
· Training and organisational culture which ensures that care co- coordinators and staff are well informed, supportive, positive and hopeful about what people can do and achieve in their lives
· A partnership between mental health services, the Direct Payments or Individual Budgets team and learning providers to actively promote and support the uptake of personal budgets
· Training courses for people with mental health needs that helps them to understand what is on offer with personal budgets, prepare and gain confidence to use them
I get help with support planning if I want it and this includes support with positive risk taking.
I get the support I need to turn the plan into reality.
When the money has been allocated and people have decided on a way to manage it that suits them, the next stage is to explore how to make best use of it to achieve what they want in their lives. Some people will want to design their own support plans without help. For others, getting the right kind of support to explore options, risks and make decisions will be a vital factor in achieving positive outcomes. Some people will be able to put their plans together quickly and some may want longer to explore options. Support for planning, and for sorting out the things that will make it happen (sometimes called ‘brokerage') can come from a range of people, for example, from family or friends, care co-coordinators, advocates, providers, independent brokers, or voluntary agencies.
Examples of things that help with this:
· Resources that are earmarked and allocated to support planning and brokerage, for example, to make sure information, advice and training is available for people in support planning and brokerage roles
· Capacity for support planning so that people can have a choice of who assists them
· There are a range of options available so that people can choose a way to take control that suits them, and can choose who they want help from
· user-led organisations are developed as an option to provide information, advice, guidance and support
· People are willing to learn from experience how to get the right balance between level of detail and time taken to develop a support plan
· In thinking about how to put a support plan together, people are encouraged to do as much for themselves as possible and to take account of their existing networks of friends and relatives
· There is good communication when the support plan is complete about what people should expect to happen next, and how long it will take.
I can use the money allocated to me in new and creative ways
The IBSEN report highlighted questions raised in the Individual Budget pilots about what was an acceptable use of resources. The DH response to these questions was:
‘As long as authorities ensure that what they are doing is safe and legal and meets the person's needs, taking account of the risks to the individual and the authority, that is legitimate. In this way individuals have been encouraged to develop their own creative solutions to meeting their needs' (DH, 2008).
Personalisation means supporting people to be more in control over decisions about what will help them recover, stay healthy and have a fulfilled life. Sometimes they will benefit, in thinking about this, from the help of their family and friends or an advocate and advice and support from health professionals. Personal budgets provide an opportunity to spend money on things that are unique, personal, creative and custom built. The exercise becomes frustrating and pointless if, at the end of the process, people (individuals and staff) are told ‘I'm sorry but you can't use the resources for that'
Examples of things that help with this:
· Support plans that look as people want them to, rather than need to be in a format that an organization insists people use
· Culture and training that supports care co-coordinators and staff to feel confident about supporting people to come up with creative ways of using resources
· Senior management support for this approach and clear messages for staff
· Access to stories that show how things can be done differently and uniquely
· Focusing on what is important to the person
· Outcome based support planning that helps people be clear about what is important to them. This helps focus on a simple test for the plan: ‘Will this (whatever it is) help me recover, stay healthy and have a fulfilled life?' Focusing on outcomes will also provide essential clinical audit and monitoring information
· Resources for peer support to enable people to benefit from other people's experiences.
· Wide ranging information about what is available in someone's locality, beyond health and social care (See information and advice section)
· Being supported to look beyond health and social care services to understand positive health and social care outcomes from things like being part of a community, employment, leisure, education, faith and culture
· Support for community participation.
Information, support and training is available to help me be a good employer and understand fully what is involved as a personal budget holder I know where to go to get help and advice when I need it as an employer and budget holder and if problems arise
Some people who opt to manage their own budgets and employ their own staff are able and prepared to do so and just want the opportunity to get on with it. Others will need different kinds of help and support to do this confidently and safely
Examples of things that help with this:
· Access to information (see Information and Advice section)
· Access to legal advice
• Local user led organisations that can provide information, peer support and a ‘problem solving' service
· Specific training, workshops, factsheets and sample documents on e.g. advertising, recruitment, making an offer, contracts etc
· Resources planned and available for this kind of help and support
• A person centred culture and the use of person centred thinking tools
SIGNPOSTS
1. Putting us First: A project about direct payments and individual budgets for people who use mental health services. Norah Fry Research Centre university of Bristol Contact: val.williams@bris.ac.uk / pauline.heslop@brisc.ac.uk Tel:0117 331 0982
2. Mersey Care NHS Trust Individual Recovery Budgets Project. This project was established in Early Intervention Services in Liverpool and Sefton, offering a virtual budget to support individuals to secure items and services that enable people achieve recovery outcomes. Contact: Carey Bamber, NW Joint Improvement Partnership: carey.bamber@ northwestjip.nhs.uk or Jenny Robb, Associate Director of Social Care, Mersey Care NHS Trust: jenny.robb@merseycare.nhs.uk
Training
3. A Learning journey to Direct Payments as part of self-directed support: Is it for me? Information and resources for trainers and people in a position to make Direct Payments more accessible for people with mental health needs. Includes workshops to give people the information they need to assess whether or not they want to take up the opportunity and how to prepare themselves if they do. Also training the trainers for people who want to run these courses. NIACE (National Institute of Adult and Continuing Education) Contact: susan.rees@ niace.org.uk 0116 204 4256
Support for managing personal budgets
4. Practical info and publications on National Centre for Independent Living website www.ncil.org.uk re: employing people, using Direct Payments
5. In Control website - for information on employing staff, and for stories www.in-control.org.uk
6. Managing the Money: Resource Development options for personal budgets (DH, 2008) Part of the Personalisation Toolkit Also contains information on user led organisations (In Appendix 1) www.dhcarenetworks.org.uk/Personalisation/Topics/
7. Good practice in support planning and brokerage (DH 2008) Part of the Personalisation Toolkit www.dhcarenetworks.org.uk/Personalisation/Topics/
8. Direct Payments for people with mental health problems: A guide
to action (DH) CSIP 2006 Contact: www.socialinclusion.org.uk/publications/direct_Payments_web.pdf
9. Barnsley Metropolitan Borough Council have developed a useful guide to help people put together their own support plan. www.barnsley.gov. uk/bguk/docs/Social%20Services/Individual%20budgets/Support%20 planning%20guide%20version%203%2002.07.2007.pdf
10. Outcome focused reviews: A practical guide, DH, May 2009 www. dhcarenetworks.org.uk/_library/Resources/Personalisation/ Personalisation_advice/OutcomefocusedReviews2.pdf
11. The independent broker role and training requirements: Summary report, Skills for Care, 2009
www.dhcarenetworks.org.uk/_library/ Resources/Personalisation/Personalisation_advice/Sfc_ISb.pdf
Research
12. The implementation of individual budget schemes in adult social care (2009) Research Briefing 20 Carr, S and Robbins, D Social Care Institute for Excellence www.scie.org.uk
Positive risk taking and risk management
(See section on Helpful person-centred systems)
More information on the Department of Health's personal health budgets pilot programme can be found at
www.dh.gov.uk/en/Healthcare/Highqualitycareforall/Personalhealthbudgets
