Your money and your life: the impact of
self-directed support and personal budgets
John Woolham
The impact of SDS & personal budgets
Structure
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Context of SDS & PBs
Description of local research site
Objectives (& what this presentation will cover)
Methods
Findings
Conclusions
The impact of SDS & personal budgets
Context
– Personal budgets & SDS
– another means of achieving:
• personalisation
• empowerment
• choice
o
Evidence base remains weak at the present time
o
Contested areas – service users as customers or citizens?
The impact of SDS & personal budgets
Context
– Personalisation: an elusive policy aspiration over last
quarter of a century
• Disability rights in USA
• Case /Care Management
• Social model of disability
• Valuing people
• Personhood & Kitwood’s work
• Core social work values
The impact of SDS & personal budgets
Description of local research site
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Shire county, 600,000+ pop
Conservative controlled
Population growing (and ageing) rapidly
Spends more than it should on younger & less on older people
26% of entire SSD budget tied up in residential care
Struggling to manage budgets – expecting the worst
Aspirations for radical change
Decided to use ‘In Control’ to transform local social services
A ‘transformation’ team within Adult Social Services
responsible for driving change.
The impact of SDS & personal budgets
Objectives of research
• Extent to which principles established in the ‘In Control’
approach were being realised in ‘roll-out’
• Satisfaction of recipients with SDS/PBs
• Impact of SDS/PB on lives of recipients.
– This presentation – focus is only on
impact.
The impact of SDS & personal budgets
Design & methods
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Research design
Choice of methods
Questionnaire design
 Choice of questions
 Layout and design
 Piloting
Sampling
REC review
Survey administration
The impact of SDS & personal budgets
Response rates & comparability of samples
The impact of SDS & personal budgets:
health, personal safety, empowerment, isolation & dignity
SDS users were
more likely to say
their health had
improved, and
that they felt
safer in their
homes than
people who used
‘traditional’
services.
The impact of SDS & personal budgets:
health, personal safety, empowerment, isolation & dignity
SDS users were
more likely to
say they felt
safe when they
went out and
that they felt
they had more
control over the
support they
used
The impact of SDS & personal budgets:
health, personal safety, empowerment, isolation & dignity
SDS users were
also more likely
to feel their
social life had
got better, and
that people
treated them
with more
dignity.
The impact of SDS & personal budgets:
care & support
The kinds of
care and
support
purchased were
also different
amongst SDS
users.
The impact of SDS & personal budgets:
impact on ‘areas of life’
On a range of
different ‘areas
of life’ SDS
users felt that
their funding
package or
budget had
been helpful.
However…..
The impact of SDS & personal budgets:
impact on ‘areas of life’
….Substantial
proportions of
people also
felt that SDS
had not made
a difference
to them over
the past year.
The impact of SDS & personal budgets:
impact on ADL (higher scores = higher levels of functioning)
IBSEN service users
had higher scores.
Comparison of
‘traditional’ and
SDS groups showed
little difference: on
some measures
traditional users
had higher levels of
functioning
The impact of SDS & personal budgets:
impact on well-being/ill-being
SDS users had
lower ‘mental
distress’ scores.
Lower aggregate
scores were
evident amongst
SDS users across
all main care
groups
The impact of SDS & personal budgets:
impact on quality of life
Locally,
slightly
more SDS
users
reported
that the
quality of
their life
was ‘good’
on the
whole.
The impact of SDS & personal budgets:
differential impact by care group
Older people
Health has got better
More safe at home
More safe when out
More control over support
Social life has got better
Treated with more dignity
Trad
7 (7%)
30 (29%)
8 (8%)
20 (21%)
9 (9%)
39 (39%)
SDS
3 (6%)
19 (35%)
8 (16%)
16 (31%)
5 (10%)
22 (42%)
Other care groups
<65 yrs
Trad
25 (9%)
70 (26%)
46 (18%)
68 (26%)
80 (30%)
102 (40%)
SDS
24 (19%)
57 (45%)
52 (41%)
88 (70%)
79 (63%)
60 48%)
Margin of
difference
(%)
65+
<65
-1%
10%
6%
19%
8%
23%
10%
44%
1%
33%
3%
8%
The difference between ‘traditional’ and SDS groups was slight
amongst older people, and large amongst people aged under 65
years
The impact of SDS & personal budgets:
costs and cost effectiveness
•It was extremely difficult
to get reliable information
about package costs.
•SDS users received more
money than traditional
service package users (44%
more overall).
•Differences were much
greater in some care
groups: (111% for older
people).
The impact of SDS & personal budgets:
costs and cost effectiveness
There was
a clear
‘skew’ in
traditional
packages
toward less
expensive
packages.
The impact of SDS & personal budgets:
costs and cost effectiveness
Data above the
horizontal line =
worse than average.
Data to the right of
the vertical line =
more expensive than
average.
Little evidence of
benefit on ADL, but
greater cost.
The impact of SDS & personal budgets:
costs and cost effectiveness
For GHQ,
benefit is
evident,
but so is
cost.
The impact of SDS & personal budgets:
costs and cost effectiveness
IBSEN found
no benefit for
older people.
This study
suggests
limited
benefit but
greater cost.
The impact of SDS & personal budgets:
costs and cost effectiveness
For younger
adults
SDS users (on
left) had better
outcomes than
older people on
both ADL and
GHQ scales.
Costs were also
greater
The impact of SDS & personal budgets
Conclusions
• SDS users were more likely to report improvements in health,
feelings of personal safety, control over their support, being
treated with dignity that their social life had improved, and
less likely to be experiencing mental distress.
However….
The impact of SDS & personal budgets
Conclusions
• There was little evidence that SDS users were any more likely to be
able to perform ADLs
• Substantial numbers of SDS users said their budget hadn’t made a
difference to them in respect of ‘areas of life’
• Impact was differential – younger adults had the best outcomes on
the measures used. For older people differences between traditional
and SDS users were much less marked.
• Transformational impact greatest amongst ‘self completers’ implications.
The impact of SDS & personal budgets
Conclusions
• Costs more for SDS users
o SDS as the ‘means’ not the end. If SDS costs were equivalent to
‘traditional’ packages, would this lead to poorer outcomes for
SDS users?
o If costs of ‘traditional’ packages were increased
commensurately with SDS costs, would this lead to better
outcomes for ‘traditional’ package users?
• Are there better ways of achieving personalised services for some
people than personal budgets and SDS?
The impact of SDS & personal budgets
Conclusions : SDS/Personal budgets: a false prospectus?
•
Are people who use budgets customers or citizens? Is being a
‘customer’ empowering – now and in the longer term?
• What impact will SDS have on people who have impaired
mental capacity?
• Are the improvements in outcome sustainable within a local
care economy based on market principles & values and a
shrinking resource base?
• If SDS isn’t the most effective way of achieving
personalisation for some people – will there be any turning
back from market forces?
References
Carr, S. & Dittrich, R., Personalisation: A Rough Guide (2009) SCIE., London.
Carr, S. Choice, Control & Individual Budgets: Emerging themes (2007) SCIE., London
Clarke, J., Smith, N., & Vidler,E., The Indeterminacy of Choice: Political, Policy and
Organisational Implications (2006) Social Policy & Society 5.3. p 327-336 CUP.
Clarke, J., Newman, J. & Westmarland, L., The Antagonisms of Choice: New Labour and the
Reform of Public Services (2008) Social Policy & Society (7) p 245-253 CUP
Glendinning C., Challis, D., et. al IBSEN Evaluation of the Individual Budgets Pilot Programme
(2008) SPRU, University of York.
Hatton, C., Waters, J. et al. A Report on In Control’s Second Phase Evaluation and Learning 200507 (2008) In Control Publications, London.
Poll, C., Duffy, S., et al A report on In Control’s First Phase 2003-05 (2006) In Control
Publications, London.