Partnerships and
personalisation: the
implications of direct
payments and personal
budgets
Prof. Jon Glasby
Co-Director, Health Services Management Centre
Outline

Background
 Advantages/barriers
 Personal budgets
 Implications for social care
 (Tentative) implications for health care
1. Background
“The potential for the most fundamental
reorganisation of welfare for half a century”
 Cash payments to service users aged 18-65
in lieu of direct service provision
 Extended to include older people, younger
people aged 16 and 17, carers and the
parents of disabled children
 Now mandatory rather than discretionary
1. Background

Illegal under 1948 legislation
 Indirect payments (pioneered by disabled
people)
 ILF
 1990 NHS and Community Care Act
 Lobbying and research by disabled people
 Disabled people involved in
implementing direct payments
1. Direct Payments are very simple
– it’s not hard
Direct Payments = a means to an end
(of independent living)
Choice and control are central
2. Advantages

More responsive services and increased
choice and control
 Improved morale and mental/psychological
wellbeing
 A more creative use of resources which may
sometimes reduce costs, but which certainly
ensures better value for money
 A blurring of the boundary between
health and social care
2. Barriers

Perceived focus on physical impairment
 ‘Willing and able’
 Complexity of monitoring arrangements
 Staff attitudes and knowledge
 Political concerns in some authorities:
‘privatisation by the backdoor’?
 Boundaries with NHS and housing
3. Personal budgets

Rights-based approach (more like social
security than traditional social care)
 Links to PCP and circles of support
 Sees DPs/PBs as a means to an end
 Can use same resources much more
effectively
 Emphasised in the White Paper and being
rolled out
3. Seven steps to Self-directed Support
 Set
PB (using in Control’s RAS)
 Plan support – with support as needed
 Agree plan
 Manage PB (currently 6 distinct degrees
of control)
 Organise support – complete flexibility
 Live life - people use their PBs to
achieve outcomes important to them
 Review and learn
4. Implications for social care
“In the future, all individuals eligible for publiclyfunded adult social care will have a personal
budget (other than in circumstances where
people require emergency access to
provision): a clear, upfront allocation of
funding to enable them to make informed
choices about how best to meet their needs.”
(Transforming social care 2008 circular)
4. Implications for social care





Not a matter of ‘whether’ but of ‘how’ and ‘how
quickly’
Significant cultural challenges for whole of social care
Key test will be not regulating/scrutinising the new
system to death
Focus shifts from assessment and from services to
planning/review/outcomes
Holds out the potential for reforming the system as a
whole – not just bolting on to the existing system
5. (Tentative) implications for health

People do use DP/PB for health care
 Separating health and social care rarely
makes sense to the individual (or workers)
 DP/PB for social care and not health flies in
the face of the partnership agenda
 DP/PB could help the NHS deliver key
priorities
 Growing sense of momentum
5. What could the world be like? –
HSMC’s expert seminar, 2004

How can we make direct payments work
better in integrated health and social care
settings?
 Could/should direct payments be extended to
health care and in which areas of health
care? What implications might this have?
 Could we learn from the choice and control of
direct payments to improve health care?
5. What could the world be like? –
HSMC’s expert seminar, 2004

Would fit well with long-term conditions
agenda
 Scope to extend to specific groups
 Wide concerns about a broader roll out
(equity, supply, cost etc)
 Scope to learn DP lessons in health care
 Need to repeat the 1990s battle for ‘hearts
and minds’
5. Key questions for health care?

When might it improve outcomes if people
know upfront how much is available to meet
their needs?
 When could the person/those close to them/a
worker achieve better outcomes by having
the flexibility to be creative?
 Where is it really important that support is
truly personalised?
5. Possible areas for an integrated PB?







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LTC (admission avoidance)?
Mental health (recovery budget)?
Continuing care?
Maternity services?
Expensive out-of-area placements?
Learning difficulty services?
Disabled children?
End of life care?
Etc etc
5. How could this work for LTCs?

Scope for an admission avoidance scheme
(with IB set at a % of the tariff)?
 Scope to compare community matron v
budget-holding professional v CIL/peer
support model?
 Scope to work with LA to make money
available (similar to Pointon case)?
 Scope to encourage Independent Living
Trusts?
Further information

Alakeson, V. (2008) Let patients control the purse
strings, BMJ, 12 April, 807-809
 Glasby, J. and Duffy, S. (2007) – policy paper on
direct payments and health (www.bham.ac.uk/hsmc)
 Glasby and Littlechild (2009) Direct payments and
personal budgets. Policy Press
 In Control (www.in-control.org.uk)
 National Centre for Independent Living
(www.ncil.org.uk)
See also, the partnerships and personalisation section
of the HSMC website