Personal Budgets, Personalisation
and Older People’s Housing IGP
Project
Fieldwork Phase
Final Report
May 2009
Alison Macadam
Kalyani Gandhi
Gillian Granville
Helen Bowers
Sarah Vallelly
Personal Budgets and Older People’s Housing IGP Project
Fieldwork Phase
Contents
Acknowledgements ........................................................................................ 3
Chapter 1: Summary and Recommendations ............................................. 4
1.1
Introduction to this Project ................................................................... 4
1.2
Key Messages from the Research ....................................................... 5
1.3
Key Themes and Debate ................................................................... 11
1.4
Key Messages for Commissioners and Providers ........................... 14
1.5
Overall Recommendations ................................................................ 15
Chapter 2: Introduction, Context and Background Information .............. 18
2.1
Methodology ........................................................................................ 18
2.2
Limitations of the Research ................................................................. 20
2.3
Terminology .......................................................................................... 20
2.4
Background Information on the Fieldwork Areas ........................... 22
2.5
Background Information from Wider Sources ................................. 25
Chapter 3: Older People's Views ................................................................. 30
3.1
Information on Focus Groups ............................................................ 30
3.2
Key Findings from Focus Groups ....................................................... 31
Chapter 4: Professional Stakeholders' Views ............................................. 42
4.1
Findings from Interviews in West Sussex ............................................ 42
4.2
Findings from Interviews in Oldham .................................................. 56
4.3
A comparison of Findings from Interviews in Each Area ............... 64
Chapter 5: Conclusions ................................................................................ 68
References ...................................................................................................... 73
Appendix 1: Further Information from Focus Groups ................................ 75
Appendix 2: Further Information from Wider Literature/Other Sources ... 79
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Acknowledgements
We thank everyone who took part in this fieldwork – both in Focus Groups
and Interviews - we are very grateful for your time and willingness to share
your views so freely. We would especially like to thank Housing 21 Court
Managers and staff for their considerable help in arranging and setting up
Focus Groups.
About the NDTi
The National Development Team for inclusion (NDTi) was formed in April
2009 when the National Development Team and the Older People’s
Programme joined forces. As a development, research & evaluation
consultancy, the NDTi covers all aspects of public service reform that aim
to improve the life chances and inclusion of older and disabled people.
NDTi aims to increase the voice, inclusion and participation of all
individuals and communities in developing services and supports that
make a difference to their lives.
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Chapter 1: Summary and Recommendations
1.1 Introduction to this Project
This report summarises the main issues from research exploring how
personalisation is impacting on specialist older people’s housing in two
localities (West Sussex and Oldham) which had been Individual Budget
(IB) Pilot Authorities. Views of professional stakeholders and, residents of
older people’s housing (both sheltered and extra care) are outlined here.
This research forms part of a wider project Housing 21 is undertaking which
looks at how personal budgets can work in specialist housing settings
(extra care and sheltered) for older people. The work is funded by the
Tenant Service Authority (TSA) via an Innovation and Good Practice
Grant. The Department of Health Housing Learning and Information
Network (LIN) is also supporting the project.
The project started with a stakeholder workshop in late 2007 where a
range of practitioners, commissioners, policy makers and representative
bodies identified and debated the main issues and challenges that
personalisation presents to older people’s housing. A report which brings
together the main outcomes of this workshop has been published1 and an
on-line discussion forum2 was launched to broaden the debate.
The fieldwork which forms the basis of this report was conducted by the
Older People’s Programme (OPP). In Housing 21’s previous report, Building
Choices, the term Personal Budgets was used. As the fieldwork that forms
the basis of this report was carried out in Individual Budget pilot sites, the
term Individual Budgets (IBs) is used throughout this document.
Aims and objectives of fieldwork project
 To focus on the questions raised in previous phases of the
project.
 To engage a range of stakeholders in both areas and obtain an
overview of current practical issues in implementing Individual /
Personal Budgets in housing settings.
1
2
Vallelly S, Building Choices, Housing 21, 2008
See www.housing21.org.uk/db
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To test out some of the ideas raised in the workshop with older
people, service providers and commissioners.
To consult older people in specialist housing settings.
To gather intelligence on how services are changing in the two
localities; the provision of brokerage, role of advice
organisations, how local specialist housing providers are
engaging in the IB agenda.
Methodology
 The two main elements of the fieldwork involved telephone
interviews with a range of professional stakeholders in each
locality and Focus Groups, with residents of extra care and
sheltered housing. Overall, 11 interviews took place and 4 focus
groups were held Involving a total of 30 older people.
 Additional desk research was undertaken to obtain background
area information on each locality with a specific emphasis on
personalisation.
 Limitations - The study was small-scale and 90% of residents who
took part were female. All were White British. Only one focus
group participant was an IB recipient and few people had any
prior understanding or awareness of IBs.
1.2 Key Messages from the Research
The key messages from this work are shown within this section; first the
views of residents of specialist housing settings, then those of various
professionals. Finally key themes of debate are highlighted.
Resident Views
Few older people were aware of IBs and when information on the
concept was given at focus groups, much of the discussion amongst
participants was around how these related to and would affect benefits.
A lack of clarity of the concept generated some confusion and responses
to the idea were generally (but not all) negative. Where views were
given, these varied:
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Nervousness and distrust
Some feeling that it(IBs) would be ‘frightening’, ‘too much to sort out’ or
the level of change required by the person themselves would be too
great (especially if traditional systems were working well). This was
particularly the case in extra care housing, where it also proved to be
difficult to engage residents initially in the research.
Improving choice and control
Some residents were positive about the idea of IBs as they saw it as
increasing choice and control; this was especially the view amongst
people who are currently self funders (and therefore likely not to be
eligible for IBs) who often saw similarities between the concept of IBs and
how they currently manage their budgets.
Practical realities of choice
It was often difficult for older people to envisage how choice over some
services (such as central alarm providers), which are currently provided as
part of a core package, could be opened up. However, choice in how
some of these services are designed and delivered (such as having the
option of wrist bands rather than pendants for alarm services) was
appreciated.
There was also a feeling articulated by some participants (particularly in
extra care housing) that the move into specialist housing had involved the
choice in itself to ‘buy into’ the range of services on offer, as illustrated by
the following quote. ‘But why go into a sheltered housing scheme if you
don’t want these services? If you want to opt out of services you shouldn’t
be there. It means people taking up spaces who don’t need supported
housing. If you are going to opt out, why not just go into a council house?
Commitment to choice does not necessarily lead to IBs
Many of the older people involved in this research wanted a greater
voice in and choice over a range of issues from more say in when and
how resident meetings are run to the provision of a wider spectrum of
opportunities for social activities. However, it was emphasised that not
everyone wants to be involved in running things and some people
(particularly those with high support needs) often find it difficult to get
involved.
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Difficult to set up and manage
Most residents considered that some older people may need a lot of help
and support, especially in the early stages of setting up an IB if it was to be
as a Direct Payment – although a few were clear that they would rather
manage things themselves.
Navigating the system: advice, information and brokerage
The whole infrastructure of support services (including information, advice,
advocacy and brokerage) needs to be much more developed and
made more accessible to older people. One resident who had received
an IB felt that there was a significant lack of information and support on
offer to manage it. Residents often referred to pensions and benefits when
discussing IBs and this was a crucial area where older people felt they
needed clear advice both in general and on the specific impact of IBs on
eligibility or entitlement to a range of benefits.
Trusted support
A clear hierarchy of who older people would seek support from (if they
had an IB) emerged from all of the discussions – the emphasis was placed
on who people felt they would trust most. Family (If available) were the
preferred option by most people, followed by friends. There was mixed
reaction about receiving support from Housing 21 Court Managers (these
were the only Housing 21 staff which some people felt they would
approach) and about using external, independent organisations. Social
Workers seemed to be the least popular source of support.
Where to get care?
Residents of extra care with care packages described a strong
preference for the on-site care provider and didn’t discuss benefits or
issues related to having separate providers for care and housing services
(which was the situation at one of the courts where a focus group was
held).
Managing risks
Residents involved in the focus group at the extra care court were
particularly concerned about security and the risks involved in increasing
the numbers of people who had access to their court.
Risk and choice
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Issues related to risk and risk management were described by some
residents as curtailing choice – eg. rules imposed in communal areas in
the name of ‘health and safety’ (sometimes felt by residents to be related
to insurance) or changes made which affect residents without their
involvement in the decisions or where they have no knowledge of the
reasons behind the changes. Such situations were described by residents
as making them feel patronised – ‘treated like children’ and provided
examples of how regulations designed to safeguard can mitigate against
the personalisation/ choice agenda
Ageism
The issue of Ageism wasn’t directly discussed by residents, however it was
an area which arose indirectly, both in the situations described in the
above point and in a poignant quote given by one focus group
participant : ‘‘Sheltered housing is a form of independent living, it is not an
old people’s home, but people in the community don’t understand that.
They think we are put to bed at a certain time etc’.
Independence and security
The benefits of a combination of independence with security in specialist
housing for older people were widely acknowledged, with the peace of
mind of knowing that help is on hand if and when needed being much
appreciated. This seemed particularly important to extra care residents
who felt that knowing on-site care and support staff also played an
important part in ensuring peace of mind.
Professional (stakeholder) views
Generally, and in contrast to the findings from focus groups with residents,
professionals expressed a great deal of support for IBs and felt that their
organisations were committed to their development and implementation
despite initial (and in some cases ongoing) scepticism about their
fundamental suitability for older people. IBs were felt to be really starting
to work for some older people, with positive changes evident. However, it
was recognised that it is still early days, and the depth and scale of the
changes required to make personalisation work for older people is
massive.
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The models and mechanics of the system which would enable more older
people to realise the potential benefits were still seen as being in the
embryonic phase. A significant number of older people (including those
who were directing their own support) are currently perceived as not
wanting to change or move away from traditional services.
Most support for older people around IBs still comes from professionals in
‘traditional roles’, such as Social Worker or Care Manager. It was felt that
some people within these roles may be hanging onto traditional attitudes,
although the situation is changing gradually.
A move away from block contracts (for care services) seems likely,
however this would take a considerable time and be dependent on the
rate of progress of the development of more flexible, ‘pay as you go’ type
services within the market and on the balance between choice and
economies of scale in the provision of different services.
The contribution of housing to personalisation
Significantly, none of the professionals interviewed could point to any
examples where housing providers were active in developing or
implementing IBs. Within the fieldwork areas, housing and related care
and support service providers did not appear to have been involved in
the IB Pilots and the implications for Housing Providers had not yet been
fully understood.
At the newer extra care housing courts (schemes) professionals
perceived that personalisation was being considered more seriously, with
adaptable facilities (such as treatment rooms) being included more
frequently in the original design and Court Managers being more
responsive to residents’ requests (eg. in setting up new activities).
Housing providers were felt to face considerable challenges, including:
 The threat of destabilisation of the market, including loss of
business by individual providers.
 Changes to funding (eg. Supporting People Funding which
ceases to be ring fenced as of April 2009).
 Balancing individual needs in a supported living, often shared,
environment.
 Retaining the positive aspects of specialist housing in the new
agenda.
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Managing or helping others to manage ‘new’ risks – e.g.
financial abuse by families and the risks associated with
increased ‘traffic’ in Housing settings.
However, opportunities were also believed to exist:
 Older people’s Housing Providers have long lasting and often
deep and trusting relationships with residents. This places them in
a unique position to promote and support personalisation for
older people and potentially introduce new types of services to
them.
 On a practical level, specialist housing often provides
opportunities and facilities to communicate and work with large
groups of older people.
Advice, advocacy and brokerage
The provision of support, advocacy and brokerage by housing providers is
an area which generated a considerable split in opinion. On one hand,
the potential for conflict of interest was felt to be too strong – particularly
in brokerage. On the other hand, there was significant support for
Housing organisations developing and providing these services, which
were badly needed. Alongside this was some recognition that housing
providers were in a good position (re their relationships with residents) to
offer advice and guidance. However, conflict of interest would have to
be carefully managed if housing providers developed these services.
Responsibility or Duty of Care
Opinion was divided on this issue with views ranging from duty of care
being the responsibility of statutory providers, to a perception that it
should be shared between local authorities and providers. Overall the
Duty of Care is an area which merits further discussion and development,
with risk enablement and more confidence and creativity around the
assessment and management of risk being required.
Reputation Issues
The challenge of having an increased number of support and service
‘providers’ (both formal and informal) within buildings was highlighted.
Some of the participants felt that bodies such as Risk Panels should be
able to deal with potential neglect and abuse of older people on
Individual Budgets.
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Challenging Ageism
The perception of low expectations and aspirations both amongst and for
older people was recognised, and it was acknowledged that this
represents a significant barrier to the whole area of personalisation.
The lower level of funding available to older people compared to
younger disabled people, emerged as an issue which was likely to limit
the potential positive impact of IBs for older people. However, it was also
felt that small changes, which often do not require substantial spend, can
make a big difference to older people’s lives.
1.3 Key themes and debate
Sustainability of Extra Care
Specialist housing for older people is felt to have an important role to play
in personalisation :
 The demand from older people (particularly for Extra Care) is
stronger than ever and the provision needs to increase to open
up choice. This was articulated by professionals and supported
by the views of participants in a new extra care facility who felt
‘lucky to be here’.
 The risk that extra care may be threatened by the
personalisation agenda was recognised by professionals,
specifically issues concerning 24 hour on-site care. However, it
was felt that losing the essence and benefits of extra care must
not be allowed to happen.
 Housing providers are widely viewed as having the potential to
become key players in ‘opening up the market’ as providers of
‘tangible’ services and support, advocacy and brokerage
services to both residents and non residents within their
communities.
Core Service Model
One of the ideas from Housing 21’s earlier work on personal budgets and
in response to perceived threats to the long term sustainability of specialist
housing was to look at developing a core and add-on service model
On the whole, professionals interviewed felt that this was a useful and
workable approach although there were some concerns over making
things too complicated, costing issues for short and long term services and
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longer term implications of possible moves towards only people with
‘core’ needs being able to stay in some locations.
Perhaps unsurprisingly, given the lack of awareness of IBs and subsequent
confusion that discussions about the concept elicited for some people,
there was less engagement on this area amongst residents. It seemed to
be difficult to envisage how this concept would work and to distinguish
between what would be core and optional. It was also quite removed
from current arrangements where a set range of facilities and services is
most often provided.
Safety Issues and Risk
The safety of residents was the main area of risk discussed amongst
residents – with the implications of increased ‘traffic’ in buildings
recognised. This was an area of considerable discussion amongst
residents at an extra care only setting who were already concerned and
had considered hiring a security person, despite no one yet being on an
IB at that location.
Professionals mentioned areas of concern around risk and possible
solutions (such as risk panels), however specific ways of dealing with
different elements of risk were not highlighted. Some of the professionals
interviewed did however emphasise the need for a shift in overall
attitudes to risk amongst professionals and organisations, with a need to
focus on how people can be enabled and supported to do the things
they want to, whilst managing the risks involved.
Costs and resource pressures
Numerous issues were highlighted in bringing together different funding
streams involved in Individual Budgets, with varying criteria, objectives
and eligibility rules. Supporting People funding was discussed extensively
as a key area related to funding for Housing. Future changes were felt to
call into question how some services will be funded.
Some of the participants in the focus groups described a reluctance
(amongst some older people) to pay for services and activities. People
interviewed expressed uncertainty over how support (information, advice,
advocacy and brokerage) services would be funded and whether
individuals would be willing to pay for these.
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The implications for funding IBs emerged as an area of concern for some
older people with one or two expressing cynicism and viewing this area as
a ‘Cost Cutting Exercise’ and others questioning how this would be paid
for. Professionals, however, did not view the personalisation agenda in
itself as ‘cost cutting’. The impact of changes to certain funding streams
such as Supporting People was acknowledged although it did appear to
be too early to predict what these impacts would be. Overall there was
an emphasis on getting value for money partly through better outcomes
of IBs.
Choice over service provision
It was difficult for older people to envisage how choice over some
services (such as central alarms), currently provided as part of a package,
could be opened up. A view did emerge from professionals that there
would be a strong preference to buy from on site providers, as long these
were of the right quality and offered value for money. This was also
backed up by residents:
“It’s better the devil you know” (resident)
Equality and Diversity
It proved more difficult to engage residents within extra care settings (and
who consequently are likely to have higher support needs) in discussions
on IBs. This leads to the question, for frailer people (in Extra Care) is the
decision to move into an extra care setting the main aspect of choice?
This was apparent in the small number of discussions with extra care
residents
The challenges of supporting people with mental capacity issues, such as
those arising from dementia, were widely recognised, along with likely
significant needs for ongoing and specialist support, however examples of
how this might happen did not emerge during discussions.
Inclusive Services
An overwhelming message from this work is that the markets for services
and support to enable IBs to be widely adopted by older people are still
very immature. Developing markets may help to ensure that services
become more inclusive, however there is still a very long way to go in
most areas.
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Much greater and more effective involvement of a diverse range of older
people will be an essential factor in the successful development of
inclusive services and support. Making what can seem to be very
abstract concepts (ie. Personalisation and IBs) real for people, partly
through realistic examples of how people have moved to IBs and how
their lives have changed as a result will play a key role in developing this
area.
Within specialist Housing settings for older people, a significant number
(particularly those with high support needs) may be excluded from certain
(particularly social) areas of life. The development of services and support
which enable greater inclusion of both residents and (with the likelihood
of more services opening up to non-residents) other local older people
who are currently facing exclusion is a key area within the personalisation
agenda for Housing and Housing Support providers.
1.4 Key Messages for Commissioners and Providers
For commissioners
The role of commissioners in this agenda was felt to be difficult and
emerging. Nonetheless, the following actions and issues were believed to
be crucial:
 Choice is the key issue – rather than IBs per se.
 Recognise the increasing need for extra care Housing, and a
range of models, not just schemes for people with high support
needs.
 Develop more joint commissioning across health, housing and
social care.
 Understand the tensions between personalisation and
economies of scale.
 Manage the move away from block contracts (although hese
may continue for some time in some areas).
For housing and support providers
 Develop a more commercial approach through marketing
services which older people actually want and are involved in
designing / delivering.
 Promote services to non residents. Housing providers are well
placed to do this and this should really help to stimulate the
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market, provide much needed services and promote inclusion.
However, carefully consider and plan the types of services and
support which should be offered and the ways in which these
should be offered and managed.
Increase partnership working to develop new services and agree
joint responsibility – e.g. with local authorities around risk sharing.
Invest in staff training, skills and knowledge development
including the personalisation agenda, engaging with and
empowering older people, responding to / meeting individual
needs and risk assessment / enablement.
Focus on working with people at an individual not ‘macro’ level.
Change culture and attitudes – ‘treating customers (residents)
as stakeholders and shareholders’.
Empower staff – and ensure appropriate staffing levels,
acknowledging this is a challenge at a time of economic
recession.
1.5 Overall Recommendations
For housing and support providers

Housing 21 and other specialist housing and support providers need
to ‘take the agenda’ for specialist housing for older people to
statutory and other organisations to really get involved in
developments within Personalisation. This may be most effectively
achieved in partnership with other providers. As part of this,
developing Personalisation or Individual Budget pilots within specialist
housing settings would really provide focus and help to identify and
clarify the challenges faced. Issues and stories which emerge will
also really help to ‘make it real’ for older people, professionals and
providers and help to develop the ‘mechanics’ of how this might
actually work.

A key area that has emerged from this work is the widely agreed
need for extensive development of the markets which can provide
flexible support and services for people, opening up choice and
enabling increased personal control. Housing and Housing support
providers are viewed widely as organisations which have an
important role in developing in the following key ways :
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o Offering services and support to non residents, within the
wider community.
o Exploring the development of services (perhaps in
partnership with other providers) which help people to
plan and manage the support they want to receive, from
advice and information through to support planning and
brokerage.
o Developing partnerships – with residents and other clients,
with statutory organisations and with other providers to
ensure a holistic and joined up approach.

Personalisation is becoming an increasingly important area for all
organisations who work with older people. Continued development of
this area within Housing organisations (Housing and Housing Support
providers) such as Housing 21 is vital and all parts of the organisation,
particularly residents, must be fully involved. It is also vital to recognise
that Individual Budgets are only one part of personalisation and
although it is important to ensure that people who are moving to IBs
are fully supported and enabled to make best use of them, the scope
for developing personalisation goes far beyond this. The following
areas of discussion need to happen in all areas and at all levels):
o What can be done to increase the voice of customers
(residents and service users) to make sure that everyone is
able to express their views and feel confident that they will
be listened to?
o What can be done to develop and improve choice in a
meaningful way, which would be welcomed by Housing
customers?
o How can control be increased for Housing customers –
what support could Housing organisations provide to help
this happen either directly or in partnership with others?
For further research :
 A few carers were involved in the focus groups, however this needs to
be expanded upon and the specific views of a wider group of carers
on personalisation and IBs sought.
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Purposeful sampling is required to involve and hear the views of a
much more diverse range of older people who live in specialist Housing
settings. Specifically :
o More people on IBs who live in specialist housing settings
o More Men
o People from different BME groups
o People with a diverse range of support needs as a result of
disabilities, impairments or ongoing health needs
o Lesbian and Gay people
This may be best achieved through linking with specialist housing
providers whose services are aimed at particular groups of older
people. This is a particularly important area within the context of
Personalisation and IBs as one of the fundamental benefits of people
directing their own support is believed to be that the needs of a
diverse range of individuals will be met more appropriately and
effectively.

The views and experiences of specialist Housing and Housing support
providers for older people, and staff working within these settings, on
personalisation and IBs for older people need to be gathered. Given
the low level of involvement apparent for Housing organisations within
the IB pilot stages, it is likely that this is an area which is still very new for
many providers, therefore large scale research (such as surveys) is likely
to be inappropriate, rather smaller scale activity such as calls for
information targeted at providers who have been changing their
services and discussion forums may be better suited to gathering this
type of information.
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Chapter 2: Introduction, Context and
Background Information
This report is one component of a wider project Housing 21 is undertaking
which looks at how personal budgets can work in specialist housing
settings (extra care and sheltered) for older people. The work is funded by
the Tenant Service Authority (TSA) via an Innovation and Good Practice
Grant. The Department of Health Housing Learning and Information
Network (LIN) is also supporting the project.
This report summarises the main issues from research exploring how
personalisation is impacting on specialist older people’s housing in two
localities (West Sussex and Oldham) which had been Individual Budget
(IB) Pilot Authorities. Views of professional stakeholders and, residents of
older people’s housing (both sheltered and extra care) are outlined here.
This chapter gives an overview of the methodology deployed for the
fieldwork and offers some background contextual information on the two
localities selected.
2.1 Methodology
The overall objectives of the fieldwork were as follows:
 To focus on the questions and issues raised in the previous phases
of Housing 21’s project
 To engage a range of stakeholders in the two key areas and
obtain an overview of current practical issues in implementing
Individual / Personal Budgets in housing settings.
 To test out some of the ideas raised in the workshop and
consultation with service providers, commissioners and older
people.
 To consult older people in specialist housing settings.
 To gather intelligence on how services are changing in the two
localities; the provision of brokerage3, role of advice
organisations, how local specialist housing providers are
engaging in the IB agenda.
3
Please see the section on terminology in this chapter for an explanation of brokerage within this context.
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To gather information from a wider range of sources and
literature, which is particularly pertinent to personalisation for
older people within specialist housing settings.
A team of Researchers and other staff from OPP planned and carried out
the fieldwork, working closely with Housing 21. One researcher focused
on the Oldham area and the other on the West Sussex area. The two
main elements involved, Interviews and Focus Groups were planned and
implemented in the following ways:
 Interviews – in each area, a range of stakeholders (from a
number of different types of organisation across the voluntary
and statutory sectors) were identified and approached with a
request to take part in a telephone interview with an OPP
Researcher. During this process background information was
also provided to potential participants on the project and its
aims. Overall 11 interviews took place, 5 in Oldham and 6 in
West Sussex.
 Focus Groups – The Research Manager at Housing 21
approached a number of Housing 21 Court Managers with a
request to host focus group discussions amongst residents, which
would be run by an OPP Researcher. 4 Managers agreed to
help arrange focus group discussions at their Courts – 2 in
Oldham and 2 in West Sussex. Posters advertising the group
discussions and individual letters inviting residents to take part
were prepared and distributed, along with background
information on the project and its aims. Potential participants
were also advised that they could take part in one to one
discussions with an OPP researcher, if they would prefer to do this
rather than join in a group discussion. 3 of the 4 Focus Groups
which were initially planned took place – 2 in Oldham and 1 in
West Sussex. The 4th discussion was cancelled as the Court
Manager advised that none of the residents wanted to take part
either in a group or individual discussion at this venue. A 4th
Focus Group discussion did take place at a later date at a court
which was not in the fieldwork areas (in Greater London).
Overall 30 people took part in the 4 Focus Group Discussions and
2 people took part in one to one discussions with OPP
Researchers.
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In addition to the fieldwork, desk research was undertaken to provide
further information on:
 The background within each fieldwork area.
 The developments around personalisation / IBs for older people
in each fieldwork area.
 The messages from work relating to personalisation which has
been carried out on specialist housing for older people.
 The findings from wider literature on personalisation and self
directed support for older people.
2.2 Limitations of the Research
This was a small-scale project. The team carrying out the work feel that it
is important to clarify what the limitations are:
 The majority of focus group participants (29/32) were women
and all of the participants were White British which meant the
sample was limited in terms of diversity considerations. Whilst this
group may have been representative of tenants in Housing 21,
the research was unable to hear the views of potentially more
excluded groups of older people.
 Only one person across the 4 focus groups had experience of an
IB which made it difficult to engage the groups in meaningful
discussion about the implications of IBs.
 In spite of information, examples etc the concept of IBs was
difficult for residents and staff to fully grasp.
 There was some difficulty in finding schemes to take part in the
focus groups. The schemes that did immediately agree to be
involved were particularly enthusiastic and therefore may not
have been representative of all Housing 21 schemes.
 There was difficulty in recruiting stakeholders for the telephone
interviews. This may have been due to other commitments. Those
that were interviewed tended to be already involved and well
informed about IBs, which meant we were unable to capture a
wide range of stakeholder views.
2.3 Terminology
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The following provides an explanation of some of the terminology used in
the context of this report. For further information please see Building
Choices which contains a glossary of terms and SCIE’s recent publication
Personalisation : a rough guide4.
Individual Budgets (IBs)
An IB is described as setting an overall budget for a range of services, not
just from social care, from which the individual may choose to receive as
cash or services or a mixture of both. IBs combine resources from the
different funding streams to which an assessed individual is entitled.5
Personalisation
This refers to the overall agenda for transforming public services6.
Personalisation means starting with the individual as a person with
strengths and preferences who may have a network of support and
resources, which can include family and friends. It reinforces the idea that
the individual is best placed to know what they need and how those
needs can be best met. Personalisation is about giving people much
more choice and control over their lives7.
Personal Assistant (PA)
A personal assistant (PA) is someone employed by an individual to
provide some of the personal help and support they require both at home
and in the community.
Self Directed Support (SDS)
SDS is a term that originated with the in Control project and relates to a
variety of approaches to creating personalised social care8.
Resource Allocation System
A system used by Local Authorities to distribute funds transparently,
according to assessed need, so that an individual knows what resources
are in their individual budget.
Brokerage
4
Carr, S.(2008) Personalisation : a rough goude, SCIE London
Carr, S.(2008) Personalisation : a rough goude, SCIE London
6
Vallelly S, Building Choices, Housing 21, 2008
7
Carr, S.(2008) Personalisation : a rough goude, SCIE London
8
Carr, S.(2008) Personalisation : a rough goude, SCIE London
5
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In this context, a broker or support broker is someone who helps to plan
and organise appropriate care and support to enable someone to be
independent. They ensure that the person is fully involved and in control
throughout the process of choosing a care and support package and its
delivery9
Court and Court Manager
Housing 21 refers to its housing schemes as ‘courts’ and the ‘Court
Manager’ as the person who manages the facility. Court Managers are
often called wardens, scheme or estate managers in other organisations.
2.4 Background Information on the Fieldwork Areas
This section gives an overview of the two local authority areas which were
used as the basis for the fieldwork in this report. They were selected as
both were Individual Budget pilot authorities where Housing 21 has a
considerable presence. Each area has strongly contrasting
characteristics – West Sussex is affluent, semi-rural and has a high
percentage of older people. Oldham is an urban area with high levels of
deprivation and a diverse population. West Sussex was the only IB Pilot to
focus exclusively on older people, and has a broader Fair Access to Care
(FACS) criteria than Oldham. The table overleaf provides a summary of
key background information and statistics for each area.
9
Vallelly S, Building Choices, Housing 21, 2008
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Summary table – Key Background Information by Fieldwork Area
Key characteristics
Total Population10
% of Older People
% of people living in
20% most deprived
areas
Health
West Sussex
780,000 for 2008
20.5% over 65 (England
ave 16.1%)
3.3% over 85 (England
ave 2.2%)
3.6% (England ave
19.9%) - but variation,
Adur area near Eng.
ave.
Better than England
average but inequalities
through county
Ethnicity (from 2001
census data)
93.5% White British
(England ave 86.8%)
Availability of specialist
housing for older
people
697 units 22 extra care
schemes, Jan 0811
4.6 per 1,000 over 65
(Eng ave. 5 per 000)
308 sheltered and
retirement schemes12
695 Total
485 Older People
Number registered as
having an Individual
Budget15
Oldham
221,000 for 2008
14.5% over 65
(England ave 16.1%)
1.9% over 85
(England ave 2.2%)
40% (England ave
19.9%)
Worse than England
average with
inequalities in
gender, level of
deprivation and
ethnicity
84.3% White British
(England ave 86.8%)
11.9% Asian (England
ave 4.6%)
No extra care
schemes, Jan 0813
95 sheltered and
retirement schemes14
1800 Total
No info on % who are
older people
10
2006 Based sub national population projections, ONS
Statistics on Housing with Care in England, EAC January 2008
12
The EAC database (http://www.housingcare.org/sheltered-housing)
13
Statistics on Housing with Care in England, EAC January 2008
14
The EAC database (http://www.housingcare.org/sheltered-housing)
15
From the In Control website www.in-control.org.uk
11
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FACS Eligibility Criteria
Critical, Substantial and
Moderate need
Critical and
Substantial need
In addition, a summary of other key information obtained from published
sources on Individual Budgets / Personalisation in each area is shown
below.
West Sussex
 One of the 13 sites which took part in the IB Pilot Programme
from November 2005 until December 2007 and the only one
focused on older people.
 One of the 6 original Local Authority pilot sites for in Control,
which began in 2003.
 3 core teams worked as part of the pilot with other stakeholders
– including voluntary and independent sector providers.
 Scoping the different funding streams involved and streamlining
self assessment were among the difficulties reported.
 A quote from West Sussex’s Executive director of Adults and
Children’s Services highlights the scope of the changes - ‘The
enormous cultural shift required to reform social care into an
enabling system away from one of paternalism cannot be
underestimated and is something that we have given a high
priority’.
 The transforming and empowering potential of IBs for individuals
is emphasized and the following areas were felt to work in the
pilot : Sharing stories of success and examples of potential uses;
enthusiastic and empowered champions; development of the
market in line with the project and an open, learning culture.
Oldham
 Another of the 13 sites which took part in the IB Pilot Programme
from November 2005 until December 2007.
 The pilot in this area involved all groups of service users, rather
than focusing on a particular area.
 Oldham joined in Control in 2005 and became part of the
second phase of the in Control programme, developing self
directed support within social care.
 The scale of the changes required was again highlighted.
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Challenges experienced include – tackling ingrained attitudes
and cultures amongst staff and replacing ‘professional knows
best’ with a partnership approach.
Areas felt to be working are real stories and examples, openness,
honesty and transparency, clear and ongoing communication.
IBs are strongly believed to be the way forward – allowing
greater equality, citizenship and job satisfaction.
Small changes are believed to have the potential to make a big
difference to people’s lives, in Oldham the example was given
of an older woman who changed her services to enable her to
go to church and have her curtains changed.
It is believed that good providers will view IBs as a good
opportunity to develop new and different services.
Partnership working is considered vital – eg. to ensure the market
is not destabilised.
Block contracts which can respond to IBs have ‘yet to be seen’.
In Oldham there is a firm belief that better, more holistic,
outcomes have been achieved for people at no extra cost.
Respite care is a particular area where increased levels of
satisfaction have been seen.
2.5 Background Information from Wider Sources
As part of this project, some of the key findings from previous research on
specialist housing and personalisation for older people were gathered to
add further background to the fieldwork and help to guide and structure
it. This is not intended to be a full review of the literature within these
areas, rather a very short summary of some of the key messages which
have emerged from some of the work undertaken recently in these areas.
This information is summarised in the report, more detail is provided in
Appendix 2.
Messages from Literature on Supported Housing
Key aspects relating to social wellbeing within specialist housing settings
for older people include:
 Having a range of activities for different interests and abilities.
 Opportunities to develop and maintain a social life that is
independent of the housing scheme.
 Integration of housing schemes with the local community.
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Social areas such as restaurants and shops as venues for social
interaction.
The provision of care and support services outside of core hours
of work.
Location and design features having significant impacts on
residents’ quality of life.
Informal support from families and volunteers often playing a
crucial role for residents – supporting their quality of life.
The importance of not underestimating the housing
considerations of residents with care needs.
The aspects of specialist housing which appear to be most appreciated
by older people are as follows:
 The combination of independence with security, which models
such as extra care Housing offer being attractive to a wide
range of older people.
 The social benefits seen in some (particularly the larger)
schemes.
Information and Messages from Literature on Personalisation
The following figures illustrate the numbers of people in England who have
been in receipt of Direct Payments (DP’s), over the latest 3 years.
People Receiving Direct Payments in England (to the nearest ‘000)
Over
Under
% of
% of
% of
% of
65’s
65’s
O65’s
U65’s
O65’s
U65’s
rec. all
rec. all
rec.
rec.
services services Comm.
Comm.
Based
Based
Year
services services
2004/5
7,000
17,000
0.57%
3.46%
0.69%
3.82%
2005/6
13,000
24,000
1.06%
4.64%
1.27%
5.08%
2007/8
17,000
31,000
1.38%
5.71%
1.66%
6.24%
Source – Community Care Statistics 2006-7 : Referrals, Assessments and Packages of
Care for Adults, England :National Summary, The Information Centre, NHS / National
Statistics (2007)
Although the numbers of older people (and percentages of those
receiving services) who are in receipt of direct payments have grown
significantly in recent years, the overall proportions of older people
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receiving services remain very low, particularly when compared to
younger adults.
Official data on Individual Budget (IB) holders will be available from April
2009. Prior to that, some Local Authorities who are involved on the in
Control programme are reporting their figures on the in Control website.
Some of the latest figures are shown below.
 Overall, 10,048 people are registered as having an Individual
Budget on the in Control website.
 2,638 of these are identifiable as older people, the biggest single
group registered.
 Although absolute numbers are still very low, there has been
considerable growth over 2008, with numbers rising from around
2,000 to over 10,000 over the year.
 At the beginning of the year, younger adults with physical
disability were the largest group of people with an IB, by the year
end this was older people.
Source –in Control website, www.in-control.org.uk/PB_LIVE.html
Many councils are expected to mainstream Individual Budgets and the
number of older people receiving both direct payments and IBs is
expected to rise quickly as this group makes up around ¾’s of all new
assessments.
The results of the evaluation of the Individual Budget pilot programme
have been recently published. Although feelings of a greater level of
control have been reported, and some examples have emerged of older
people using their IBs to significantly change the type of support they
receive, IBs appear to have had less of a positive impact for older people
involved in the pilot programmes – compared to younger people
involved. There are believed to be a number of factors which have
influenced this including :
 Early concerns about taking more responsibility over support
arrangements, especially related to employing support workers,
particularly during a crisis when many older people access social
care.
 Reduced scope for many older people to make improvements
due to IBs often being of a much lower value than those
received by younger people, which can be caused by older
people frequently underestimating their own level of need
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(partly it is felt due to lower expectations) and not being eligible
for elements which are available to some younger IB holders
such as Access to Work payments.
Older people’s support plans often focusing strongly on personal
care needs rather than areas such as social activity, restricting
the scope for improvements in well being. This is supported by a
finding of the IB Pilot Programme Evaluation which found that
overall older people used only 15% of their budgets for leisure
activities compared to up to 66% for some younger adults.
Some of the key points which have emerged from other literature
related to self directed support / personalisation for older people
include :
 Support and knowledge of key professionals (Social Workers /
Care Managers / Specialist IB / DP teams) is vital for individuals
on an ongoing basis.
 Organisations need to prepare through staff training and buy in
ensuring systems and the ‘market’ is developing in local areas.
 Everything must support and encourage user involvement at
every stage, eg. use of language everyone can understand,
simple processes and commitment to true partnership with users.
 Champions of IBs and other approaches which promote
personalisation really appear to help their development and
spread in areas.
 The involvement of well established and active user-led
organisations and resources really helps. In areas where these
organisations are less developed and engaged, SDS seems to
be developing more slowly. Groups and networks can help
people who are directing their own support to unite, sometimes
pool their resources and achieve more bargaining power.
 If Health and Social Care funding (and other streams)can be
pooled, this can lead to significant benefits and increased
flexibility for people – and remove barriers between types of
provisions which users have long considered to be ‘absurd’, eg.
not being able to access podiatry services through social care
funding.
 Development of a diverse and accessible local ‘market’ of
support options is crucial.
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Small changes can make a huge difference to someone’s life
and a step by step approach of small changes can lead to
significant improvements over time.
Flexibility is key. Older people appreciate being able to mix and
match different options (eg. more traditional services with newer
approaches). People (including some from BME groups) have
appreciated the flexibility to meet their needs in a more
appropriate way – although it was recognised that there is more
likelihood of a language barrier existing for some older BME
people in trying to set up and manage their own support.
Service users don’t just need their budget allocation – they need
in some cases to be supported to develop the confidence and
skills to direct their own support ‘You don’t just become a
manager overnight’. It is also important to remember that
money is not the only tool – often discussion within this area
revolves around Personal Budgets, yet money is only one asset
which is available to people in directing their own support.
A range of examples of how others have used DP’s and /or IBs is
very helpful – for both the potential recipients and people who
are working to support them.
It is vital to start ‘where older people are’ – individually - and
work from there.
For many older people, their first contact with ‘services’ is often
at a time of crisis, therefore finding the right time to introduce
SDS options can be a tricky balancing act between avoiding a
time of urgent need and introducing these options early enough
before more traditional options become ‘embedded’ and
perceived to be too difficult to change.
It is vital that organisations and professionals recognise that
personalisation is not another box to tick or another part of the
job – ‘this is the job’.
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Chapter 3 Older People’s Views
3.1Information on Focus Groups
This chapter documents the views of residents of retirement housing who
took part in the research. 4 focus group meetings took place in Housing 21
Courts – further details are shown in the table below.
Focus Groups
Location
1
West Sussex
2
Oldham
3
Oldham
No. of residents
involved - group
discussion
Type of housing
8
8
6*
4
London
area
8
Remodeled
– part
sheltered,
part extra
care
2
sheltered
sheltered
extra care
8
2
8
No of residents
involved – 121
meetings
No of Women
No of Men
People who are /
were carers for
partners
No in sheltered
housing
No in extra care
housing
Length of time
resident
TOTAL
30
2
6
8
3
30
2
3
9
8
6
0
23
1
0
0
8
9
3-29 years
7 months – 24
years
4-22 years
4 months –
22 years
* 2 of this group were “Court Voice” tenant representatives, resident at other Housing 21 Courts
The meetings were facilitated by an OPP Researcher. In some cases
Housing 21 Court Managers (and in one case 1 other Housing 21
Manager) also attended for all or part of the meeting. The collective
feedback from participants involved in these discussions is summarised
below. This is structured to show the feedback specifically on IBs first,
followed by wider areas related to personalisation (ie voice, choice and
control). Focus group participants also talked about a range of broader
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issues concerned with life in retirement housing. This information is
summarised in the report but more detail is provided in Appendix 1.
3.2 Key Findings from Focus Groups
Knowledge of Individual Budgets
Overall, knowledge of IBs was very low. A considerable amount of
confusion appears to exist on the subject of IBs. This is likely to be due to a
number of issues, primarily a lack of direct or indirect experience of IBs but
also notably, a lack of appropriately targeted information for older
people and some confusing, overlapping terminology which makes it
difficult in some cases to understand and communicate.
 In two groups, no one had heard of IBs at all.
 In another group, one person (who was a younger disabled
person) asked if it was the same as in Control and advised that
they had a friend who had applied for this, but it was taking a
long time for this person to get it.
 In another group, one participant advised that they had heard
of IBs prior to the information sent out related to this project.
There were questions from other participants including whether
direct payments were the same as direct debits, whether this
would be means tested, if it was the same as Attendance
Allowance and whether this meant money from one’s own
personal savings.
The only resident with prior knowledge was actually in receipt of an IB. The
focus group which had an IB holder participant generated more debate
as the participants seemed able to engage with practical realities rather
than just abstract concepts. The experience of this resident was shared as
follows:
 When discharged from hospital, assessment for an IB took place
but s/he did not feel fully informed of what this entailed.
 The IB was topped up with some of his/ her own money as they
needed/wanted a high level of care.
 S/he did not feel adequately informed of how to manage the
allocated spend and found out at Review that there had been
an under spend of the allocated amount (although top ups with
own funds had also taken place) and some of the money
allocated had to be taken back. This caused considerable
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upset, as did the apparent lack of information and support
available to help with managing an IB
S/he received care from the Housing 21 on site care team and
was unaware that there may be any choice to ‘contract out’.
Reactions to the Concept of IBs
The OPP Researchers gave an explanation of the concept of Individual /
Personal Budgets at each group. This was supported by an information
sheet which was available to participants at the meeting and had been
sent to them with their invitations. Discussions on the concept then took
place and people were also asked to think about how they might use a
personal budget if they had one themselves.
In one of the groups where there had been no prior knowledge of IBs, an
extreme negative reaction by one participant was expressed. This person
felt that IBs were a money saving exercise related to central Government
acting like ‘Big Brother’. However this passionate viewpoint was not
representative of the whole group.
There was a tendency across the focus groups to conflate discussion of IBs
with welfare benefits in general. In some cases, residents felt that they did
not know their entitlement to benefits and had trouble in finding
assistance and information on this subject.
A general desire expressed amongst participants was for some ‘extra’ to
enable people to choose what they wanted to do – but there was no
specific mention of this being instead of something which was already
received.
In two of the focus groups, worries about how the budget would be
‘handled’ and who would look after it were expressed:
 In one (the extra care) group there was a strong consensus that
the situation was best left as it is now, ‘the devil you know’. All
said they wouldn’t want an IB ‘it’s all settled here, you have
piece of mind’ ‘we can go to Housing 21 if we have a problem,
and they sort it out for you’.
 It was felt that taking on responsibility of managing your own
budget could be very frightening for a lot of older (especially the
oldest) people. ‘We had money worries when we were
youngsters, we don’t want it now’.
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Worries about people abusing IBs were expressed
Some participants mentioned that they have to tell ‘Benefits’ if
there are any changes in their circumstances, and the question
was asked whether they would need to declare whether they
were on an IB.
‘Benefits system now is much simpler’.
A negative reaction to change in general was also found ‘I
can’t see there will be many takers because when they
changed from pension books…….. people did not want it, but
they had to get on with it, and now they have got used to it’.
One person felt that choice is already there at the moment
(albeit - take it or leave it) – ‘There is choice now, no-one says
you have to have a service’.
In the extra care court, there were also significant concerns expressed
about the effect of bringing in ‘other’ care staff :
 ‘We wouldn’t want to bring in other carers, very satisfied’.
 There were concerns that if one had a carer from outside all the
problems of paying for their tax etc, employment issues etc
would also be encountered.
 ‘The carers here would not like it at all. If you weren’t satisfied
you would complain to the extra care manager’.
 ‘Wouldn’t work here. There would be too many carers coming in,
if they don’t come the ‘core’ services would be approached. It
would cause a lot of confusion’.
This discussion was interesting in the light of earlier comments made by
participants in this group who felt that one of the disadvantages was the
frequency with which their carers changed (through the use of agency
staff), especially at the weekend.
In the group where one person had direct experience of an IB, there was
much more extensive and constructive discussion around this area.
General questions and points of discussion included whether existing
benefits would be lost if people had an IB, and questions around
affordability of IBs for ‘the state’ as the perception of some people was
that this approach was bound to be more expensive than providing
existing services. On the positive side:
 Many of the participants in this group agreed that it was a good
idea to be able to sort out one’s own care.
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There was a general feeling that this would work well for people
who are able to remain in control, both physically and mentally
however if people lose their mental/physical faculties, it would
be a huge challenge to maintain choice/control.
One person said that ‘success depends on the state of mind of a
person: if a person can cope and is honest enough it can work, if
not, then there could be problems’.
One who had deteriorating health felt she could only use it if it
did not involve too much form filling as her health prevented her
from doing this.
Most felt they would use it if offered but would need proper
guidelines and information on how to use it to get the maximum
benefit.
Those who were self funders felt it was a good idea as they were
already controlling their own money and choosing/purchasing
some services, so were familiar and comfortable with the
concept of choice and control.
However there were also some negative views:
 One person felt that it was not a good idea: ‘why break/change
something hat does not need fixing?’. This person also felt that
the existing system was ‘working ok for older people’.
 Another participant felt they would not use an IB as it was ‘too
much to sort out’. This person was a wheel chair user, had a
range of services already, and expressed that they were happy
with the existing structure/services and did not want to take on
additional work/responsibility.
In terms of the things which people felt they would spend an IB on, the
following were identified:
 Own personal care.
 Paying someone to take one out on activities such as going for a
meal, or to the theatre.
 Having more choice of where to eat, where to get food (eg.
occasional visits to the Harvester).
 Help with shopping.
 Help with transport/getting about town.
 One person questioned whether people would ‘use it properly’
and gave the example of the Heating Allowance where a lot of
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older people do not seem to be using it for heating but for other
essentials.
Help and Support in using an IB
Participants in groups were asked (if they were to have an IB) whether
they felt they would need help and support in planning how to use this
and making arrangements to access different things they may want to
do. Those who felt that they would want support were then asked who
they would prefer to give them this support.
Opinions on this varied. Some people felt that they could manage an IB
themselves, however there was a general recognition that some
individuals (particularly those with dementias) would need considerable
help and support. ‘It’s a big change for people to get the hang of’. It was
also widely felt that everyone would need good information and
‘guidelines’ on the use of an IB with good financial advice being an
‘absolute must’.
In terms of who people would approach for help and support, there
seemed to be a ‘hierarchy’ of preference, with family members being
the first (and usually most trusted) choice, then (e.g. if family were not
available) friends. There was also concern that this could place an
additional burden on families – ‘families have their own lives – it would
give them more to do’.
There was a divergence of opinion over external organisations, some felt
that organizations such as Age Concern or Help the Aged would be
credible and trustworthy and that older people would be likely to benefit
from the advice given by them, however quite a few did not agree
(including one person who felt they had a bad previous experience with
advice given by an organisation).
One group felt that they would ‘confide’ in Court Managers if they ‘had
to’ (but not other Housing 21 staff), while in another it was believed that
Court Managers ‘wouldn’t be allowed’ to get involved. In one discussion
it emerged that people would ‘turn to social workers last’.
Overall, it was stressed that knowing and trusting the person helping you
well would be absolutely vital. Also – in discussions it emerged that this is
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often a difficult area ‘Some older people don’t want others to know what
benefits they are on, what they are paying out etc’. In two groups the
subject of Power of Attorney was discussed and the differences and
similarities with an IB.
Possibilities of Clubbing Together to Buy Services
Participants were asked whether (if they had an IB) they would be likely to
join forces with other residents to buy in services. Given the difficulties in
discussing the general concept of IBs, it is perhaps unsurprising that little
insight on this topic was gained from some of the focus groups.
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
Participants at one court reacted negatively – ‘Not keen on this
idea, best left as it is’.
In another it emerged that participants found it difficult to
reconcile the ideas of ‘clubbing together’ with IBs, the concepts
seemed to be contradictory to them.
In one group however the discussion was much more extensive on this
subject and the main outcomes of this are shown below :
 Many participants felt it was a good idea to club together to
buy some services. Eg. to organise day trips and other group
activities/events.
 Some felt they might consider clubbing together to hire shared
carers as that could ensure better trust of a person and maybe
standards. They also felt that this might lead to them getting a
better price on the service.
 There was a general feeling that it was possible to bargain for a
better price as a group. The example was given of hairdressing
costs: they are cheaper at the court than going individually to
the hairdresser in the village as a group price has been
negotiated.
Disadvantages or Risks of IBs
People were asked to think about the disadvantages and risks which may
be seen with IBs, particularly if people were receiving support and services
from a growing number of providers. Again, little debate ensued in the
majority of cases and in one of these groups the OPP researcher was
advised to ask the Court Managers as ’they know more about it’. In this
group, an opinion was also expressed about the concept of choice within
a specialist housing setting. ‘But why go into a sheltered housing scheme
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if you don’t want these services? If you want to opt out of services you
shouldn’t be there. It means people taking up spaces who don’t need
supported housing. If you are going to opt out, why not just go into a
council house?’.
In the extra care court, the discussion returned again to the issues this may
cause with carers and Housing 21 – ‘Things would change, it would be
different between the carers, the friendliness would have gone, you
would be going behind their backs. It would be more complicated. It is
not fair to Housing 21, they have got it all organised, they know what they
are doing, they are not silly’.
Again, the discussion was more extensive at the group with the IB holder
present and the following disadvantages and risks were given :
 As everyone has different ideas of what they want, choice might
cause arguments /disagreements between residents who
receive all kinds of different services.
 Lack of ‘cover’ staff might be a risk, if enough people opt out of
on site services. Who/how could replacement staff be found?
 Health and safety risk: how/who would carry out checks and
references?
 It might be a problem finding out what’s available for some
older people - if you have family to help ‘all well and good’,
however there may well be a problem for those with no family to
support the person through this process.
 It could be challenging for older people with severe mental
health problems /dementia - who takes power of
attorney/control?
 It could pose a problem to the care team on site if tenants
choose their own care services through family/friends/outside
agencies. However there was a feeling that at least some
people would be likely to continue to choose Housing 21
because of the convenience of having carers on site 24/7.
 One person mentioned the risk of getting into debt and advised
that this was an area which scared them, therefore they
managed their own finances very carefully.
 One particularly frail participant felt that IBs would be difficult to
use unless you were a younger person or a younger older person.
This person felt that they ‘could not be bothered’ and felt it
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should be acknowledged that ‘different people want different
things’.
One felt that lack of information was a big problem/risk, and
found it hard to envisage how IBs could work
Core and Optional Services
Housing 21’s ‘Building Choices’ report refers to the idea of housing
providers offering a core service which older people would sign up to on
moving in and an additional menu of optional add-ons. This idea was
suggested particularly as a way of making the extra care model
sustainable. This idea was discussed with both residents and professionals,
but seemed difficult for residents to conceptualise. A strong contributory
factor seemed to be that residents often tacitly accept that certain
services and support came with the agreement anyway. For example in
one group, all participants had the alarm provided by (or through)
Housing 21 and no one had considered that it may have been possible or
more beneficial to have the choice of alarms from different providers,
even though the alarm was not felt to be working well for some. Another
factor was that some people did not think in terms of ‘packages of
support’.
It seemed to be easier for participants to discuss options which they felt
they should / would like to have access to, although it was still difficult to
identify which should be ‘core’ and which ‘optional’. A list of suggestions
for core and or additional services are incuded in Appendix 1
Voice - Involvement in the Running of Housing 21 Courts
Participants were asked about the opportunities to get involved in running
the Courts where the focus groups were held. This varied between the
locations. In 2 of the courts, there did seem to be more formal and
regular mechanisms for involving the residents in the decisions made, such
as monthly meetings run by the Court Manager, newsletters, choosing
decorations and facilities in flats and communal areas (some of the
Courts had recently been remodeled). Where arrangements were in
place however these definitely seemed to be organised by staff.
In the other 2 no such formal arrangements existed, although there had
been residents groups or ‘committees’ in the past. There was some
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feeling that more formal methods of involvement and representation
were needed here.
Some participants also described getting together with other residents
(eg. in social groups) to raise money and organize events and activities.
Difficulties in ‘getting people involved’, were described – this was felt to
be due to general lack of interest amongst some and practical difficulties
in joining in experienced by people with high support needs. Mixed views
were expressed on whether it was the responsibility of Housing 21 to
stimulate/ facilitate involvement amongst residents – some felt that it was,
others that it was up to residents themselves.
Increasing opportunities for choice and control
There was initial difficulty in all groups in responding to questions around
what areas people might want more or less choice and control over.
Discussion returned to additional services or facilities which people would
like to be offered. In terms of the range of activities offered and facilities
available, suggestions for extending this covered two main areas. On the
social and leisure side these included: art / exercise classes, more evening
entertainment, a wider choice of hairdressers visiting the court, a bar and
a gym. More practical ‘services’ and support requested included,
restaurants, shops, regular financial advice sessions, GP/ Nurse visits,
regular health checks, a consulting room, cleaning services for flats,
maintenance support to manage the garden, more accessible transport
and help for housebound people to get out. One participant made a
specific suggestion for support for new residents who move into well
established schemes –this was described as a daunting time when the
place can seem very unfriendly, therefore it would be helpful if the settling
in process could be eased for new residents.
Further discussion on choice and control was quite extensive at some of
the focus groups when this area was explored further. In terms of the
‘control’ which people are able to exercise, at 2 of the groups the
‘optional’ nature of the Court Manager’s daily visits was given as an
example (although the service still has to be paid for – eg. through the
Supporting People charge – if residents opt out). Some participants with
care packages told how they had recently been asked about their
preferences for timing of care staff visits – having previously been
‘informed’ of timings based on care assessments, this was a change
which was very welcome.
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Suggestions for enabling further development of choice and control
tended to be relate to how residents and staff interact, namely having
someone beyond Court Manager to take complaints to and staff getting
more involved in events with residents such as coffee mornings.
Residents at one meeting gave examples of how choice and control can
be mitigated by ‘regulations’. Residents at this court had requested a
cooker in the communal kitchen area so that they could cook food
together, however this had been refused for health and safety reasons.
They also advised that they were forbidden from taking hot food and
drink from their flats into the communal areas. Participants perceived
that more rules and regulations had crept in over the years. Whether
these had come from Housing 21 or regulatory bodies was unclear,
though some expressed a view this was ‘all to do with insurance’. Some
people described feeling ‘patronized’ and ‘treated like children’ as a
result. This sparked further discussion on the role of a residents’ committee
/ forum, it was felt that without something like this – ‘there’s no way of
standing up to the housing provider’.
Issues of security and safety also arose during these discussions. At the
extra care Court, the desire to limit and control access of people coming
into the Court was described by participants – and it was advised that a
security guard and residents’ rota had been suggested but rejected. At
another meeting, there was some discussion about alarm services, and
participants felt that residents would often rather go and knock on a
neighbour’s door than use the out of hours alarm. There was also praise
for the wrist alarm (as opposed to one which is worn around the neck) – ‘It
is little things like that which make a big difference’.
One participant whose health was deteriorating and could not get out
much, found making choices difficult, as it was not known what was
available in the community. The example was given of shopping through
carers, and not knowing what the shops had to offer. Another participant
made a salient point during this area of discussion (shown below) which
highlights how the wider perception of sheltered housing can be very
different to the ethos. This in turn may also have a negative effect on
community life and choices available.
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‘sheltered housing is a form of independent living, it is not an old people’s
home, but people in the community don’t understand that. They think we
are put to bed at a certain time etc’.
Other Issues
A range of other broader issues were discussed with residents at the focus
groups. Themes covered included reasons for moving into specialist
housing and the advantages and disadvantages of living there. Often
people moved in due to the desire for more security, peace of mind and
to prevent isolation. People who were in sheltered housing were more
likely to have moved in for improved social interaction and security
whereas those in extra care were more likely to site health reasons and
needing more care and support.
Social isolation is a real concern for many older people, and specialist
housing has a preventative role as illustrated by the quote below
‘Having the daily visit from the Court Manager – if you spend a lot of time
on your own, just having someone, perks you up, just that one person
each day – checking you are alive’.
For more information on the further issues explored within the focus
groups, please refer to Appendix 1 of this report.
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Chapter 4: Professional Stakeholders’ Views
4.1 Findings from Interviews in West Sussex
6 people, from a range of different agencies in West Sussex and the South
East completed telephone interviews. All of the organisations represented
(from both the statutory and voluntary sectors) have extensive
involvement in the planning and provision of services for older people.
Involvement in the Individual Budgets Pilot
The level of direct involvement in the pilot itself varied amongst
interviewees, however all were familiar with the work which had taken
place in the area, and with the focus on IBs for older people.
What works well for Older People
5 of the 6 people interviewed thought that IBs were working well (or could
point to positive aspects of the programme for older people. One person
described their own initial scepticism but explained that this had been
overcome by ‘seeing it work in many cases’. Views on what was working
well included:
 Awareness is increasing and older people are getting back in
control.
 The quality of life has improved for those that took part.
 The targets for the number of people involved have been met.
 Possible money savings if IBs are used for preventative measures.
 Working well for older people who were discontent with the
system and were given wider options via the IB.
 Small things in taking control of daily life could make a big
difference. This was supported by the example given at a focus
group where it was felt that wrist alarms were much preferable
to pendants and that a ‘small change’ like this could make a
‘big difference.’
 It was felt that most older people did not want to employ
people, however they still liked at least a little more control.
 The level of choice is greater than under the care management
system.
 IB funding is used in ways that would have not been acceptable
under the previous system.
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What isn’t Working Well for Older People
Most IB packages are lower for older people than other client groups, and
some people had experienced more choice and control, others not.
Some concern was expressed over the fundamental suitability of IBs for
older people, especially those in the older age groups. However most
people interviewed felt that the support and systems for introducing IBs
and helping people to manage them were very underdeveloped,
particularly for older people and reservations were voiced about how this
goes forward and how older people are empowered in this approach :
 ‘There is a need to acknowledge the impact of generational
attitudes of older people being ’grateful’ for services and having
low aspirations’.
 ‘Personalisation isn’t just about holding the money but giving
customers the initiative so that they can drive their care/support
arrangements’.
 ‘There is a need to consider the time factor to put an IB together.
Money is not currently costed against the planning time needed
to put an IB together or the brokerage time needed to support
clients’.
 It was felt that not enough time has been invested to develop
processes that are robust enough to cope with vulnerable
adults, dealing with issues of capacity as well as the possibility of
abuse. However it was acknowledged that this needs to be
balanced by countering the myth that all older people are at
‘high risk’.
 ‘Some older people do not want to take on more work’ - a gap
is seen between those accepting IBs and those ‘looking away’.
 It was believed to be difficult for older people to understand the
IB system and as a result they often came to social services in
crisis. The need to find an easier way towards understanding the
system and managing the transition to using an IB was
highlighted. One contributory factor was felt to be that the
language/terminology used may not be appropriate for the
current generation of older people who sometimes have
difficulty understanding terms like independent living’ and its
broad implications and expectations.
The area of Supporting People (SP) was highlighted in a few cases.
Perceived issues faced were:
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The process of trying to integrate the (SP) funding stream into the
IB pilots encountered difficulties in getting SP into IBs due to issues
around older people needing long term personal/social care not
short term housing related support.
The funding was difficult to integrate as social care and SP have
different drivers, different eligibility criteria and provide different
types of services to vulnerable people, with SP being focused on
short term preventative services or low level maintenance.
In ‘SP land’ the support planning approach is quite different to
the adult social care perspective, also people using SP monies
tend to be younger older people and traditional client groups
using SP monies and adult social care monies are different.
SP philosophy wants to maintain the spirit of SP and support all
client groups and not only work with one particular group (ie.
older people). SP interventions are traditionally short term and
low cost and can differ for adult social care interventions which
are long term, potentially high cost and targeted at people who
cannot necessarily achieve independence with low level
support.
The ring fencing of SP monies and the heavy monitoring
requirements of SP were not believed to integrate well with the
philosophy of IBs – ‘overall the will was there but the system was
a barrier in many cases’.
Nonetheless, it was advised that work on IBs is being taken forward by SP
as self directed support and being offered as the main option for new
adult social care clients in West Sussex. In addition, it was advised that
older people’s SP contracts are being reviewed in a couple of years time
(the review is being done in clusters, it will take some time - estimates
varied from 18 months to 3 years - to get to older people).
The influence and role of social workers was also discussed, particularly in
one case. Views included :
 Social workers traditionally distrusting that anyone can manage
IBs better than them.
 Expectations amongst older people were very low and there
was no encouragement from social workers to increase
expectations.
 ‘Social workers are still stuck in the old system’.
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Although some older people wanted to use some IB money to
use creative respite care routes (not traditional day centres etc),
social workers could not think of other non traditional respite
care options for older people.
Social workers who are acting as brokers (which seems to
happen in many cases) often defaulting to the providers they
know (and like) which aren’t necessarily accredited housing
support providers. A result of this was felt to be that SP
contracted housing support providers’ expertise was being
missed at present in West Sussex.
‘In West Sussex, brokerage services are not well developed so
the default position is that social workers are acting as support
planners, they do not understand the housing sector’.
Enthusiasm and Support for Introducing IBs for Older People in this Area
Generally there was enthusiasm and support for IBs in West Sussex and
recognition that this was the only pilot area which focused on older
people. One person described a lot of support for the principles and
believed that the main issue was getting the mechanics right to make it
work: ‘moving from the hundreds to the thousands’.
However, this enthusiasm was not unanimous; an alternative view
expressed was that there is not enough support for introducing IBs in West
Sussex and the programme is very much in the developmental stage (in
terms of infrastructure in the Local Authority as well as knowledge and the
availability of training offered to practitioners).
Impact on the General Commissioning of Services
The need for infrastructure and support systems to assist older people to
make choices to spend IBs and manage the processes involved was
emphasised by a number of participants, the following more specific
comments were also given:
 ‘The Personal Assistant market needs to develop more’.
 ‘Support needed would be enabling mechanisms, support that
facilitates contact with Local Authority, allows the older person
to manage the care and support plan, provides information and
advocacy’.
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Use of Housing Related Support Services in the Pilot
No part of the IB pilot in West Sussex was implemented in an extra care
setting as far as participants were aware, it was only piloted in the
community/own home setting. Legal advice in the LA was that the IB
model could not be applied in extra care, however it is understood that
these obstacles are now being overcome. More work is currently being
done by Supporting People Team (SP) on housing support assessment
questions and funding time limited interventions linked to the
achievement of outcomes. This is to help ensure that SP funding is not
used to fund ‘ineligible activity’ and ‘shore up adult social care funding
deficits’.
One person felt that housing related support has not integrated well into
IB pilots for older people, this was believed to have worked better for
Learning Disability clients, yet it was acknowledged that it is still very early
days for older people and there is not enough evidence on housing
related support integration to expand on this point.
Older People’s Housing Providers Adapting in Response to Personalisation
This is perhaps an ‘opportunity stage’ for providers, as one interviewee
stated, but no evidence of what works has been seen as yet. Not much
multi-partner work is evident and it is early days for processes to be in
place. Independent providers seem to be reluctant to share their own
business strategy with others, as they are worried about losing business.
Significantly there was no early recognition in the IB project board of the
need to talk to housing providers to encourage them to innovate and
change service delivery practice. The issue was acknowledged but little
discussion ensued on how to do it.
Some providers were perceived to have adapted in some areas, others
have not. ‘There is a very wide spectrum of providers, some who are
accepting the need to change and are being quite innovative in
response to this and those who feel no need to change’. This was
attributed partly to a continuing lack of adequate information being
given on how money can be spent, in some areas – although it was
acknowledged that in other areas this information is very good.
Learning Disability providers were felt to have worked well with the IB
agenda, but ‘it still seems to be very early days for older people’s
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providers’. An example was given of Housing 21 recently opening a new
extra care facility in Crawley, but with a block contract for the care
instead of implementing a flexible purchase IB approach (the person
interviewed was unsure why this happened as the previous locality
manager was keen to introduce a core contract with optional service
layered on, enabling an IB to work).
Challenges and practical ideas for responding to personalisation
The topics of challenges that personalisation presents to specialist older
people’s housing providers, and ideas for practical responses generated
considerable – and diverse - response from the professionals interviewed
in West Sussex. Issues identified included flexibility, cultural and
organisational change, skills development, adapting costing models,
marketing and provision of information, support and involvement. Views
and comments include:
Flexibility
 As much flexibility as possible is required from providers, ‘many
are still stuck in old care management ways and need a cultural
shift’.
 ‘Providers need to understand personalisation well and cannot
have a purist approach, must be able to work flexibly in
delivering floating and block contracts via IBs’.
Cultural and organisational change
 There is a need to understand that self directed support is about
empowering people and being able to hand over decision
making powers to others, including older people. This can be
hard for professionals to do and they need good training in this
area.
 ‘There needs to be a massive culture change in organisations
from care to enabling to personalisation’.
 Effective leadership is essential to carry through this agenda and
change processes.
 Staff need to develop the understanding that older people are
‘buying’ a service rather than being ‘given’ a service.
 Commissioning challenges: is the market ready to deliver?
Commissioners can’t guarantee block contracts anymore, so this
presents a business viability issue for providers.
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Managing contracts (moving away from block to individual
contracts) – although an example of block contracts continuing
with SP where some block business hours could be offered eg:
daily checks by staff in sheltered schemes was cited.
Information, support and involvement
 Provision of information was described as a crucial area for
improvement – recent focus group work in West Sussex16 (with
65% of the participants being older people) showed that there is
still a lot of confusion around assessment processes, funding
allocations and the integration of funding streams.
 Recognise the skills of older people and develop effective
engagement with them. Not enough engagement work is
believed to be done with older people, especially BME older
people. ‘Rather than relying on good, implementable policies of
engaging with diverse communities, the process still relies on
personalities leading this’.
 Factor in sustainability of services by speaking to older people /
carers / families and developing services based around what
people want, which are attractive to them.
 Provide choices for older people to go to different agencies and
find different services.
 Information to access and manage IBs for older people needs
huge improvements, precise information on how to understand
brokerage, who pays for what etc is required. There is a need to
ensure that information is made available to diverse ethnic
groups appropriately. The BME community in Crawley (which
makes up a relatively high proportion of the population) is not
felt to be adequately connected into the adult social care
world.
 Value older people’s networks as channels though which
information can be provided. Use IT, social cafes, virtual networks
etc.
 Marketing services effectively, considering who and how they
market to. Building relationships with individual prospective
clients, in addition to commissioners.
Self Directed Support Focus Group Consultations in West Sussex, held in 2008 – currently
awaiting the final report which will be forwarded by an interview participant who was
involved in running these groups
16
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Skills development
 Providers need to reassess skills sets of their staff and also their
organisational infrastructure.
 Empower staff, and ensure they are skilled and well paid enough
to do the job properly.
 Training on the transformation agenda, better knowledge of
good practice, and more conferences on the subject.
 Although the provider market in West Sussex was still seen as
being immature, it was felt that ‘providers who are used to
support planning can do a good job if done right’. Possible
developments could include providers being invited to go on a
preferred provider list to deliver support planning.
 ‘Housing providers need to think about their business model, can
it survive with IBs? If services are cross subsidising, this will not
work with the implementation IBs’.
Financial issues, funding contracts and risk
 Housing providers need to know how to cost services so that
older people can buy into some of what is offered and not all of
what is offered. A change to pricing mechanisms is required to
have acceptable hourly rates for services.
 Develop a core contract. eg, a customer can buy into night
support and emergency response cover, with an option for
customers who cannot afford in-house personal care to have a
different provider.
 ‘Both providers and Local Authorities have a role in sharing the
financial risk and costing services so that individual clients can
understand and receive the right information they need to be
able to choose to purchase a service or not’.
 Separate housing support from housing provision and prevent
cross subsidisation between the two streams.
 A particular challenge for SP providers was felt to be that it is
likely they will lose their market share, with domiciliary care
agencies providing both care and support to individuals, possibly
at reduced hourly rates.
 As funding available to older people is a lot less than other client
groups – there is a need to understand the implications of this on
service development, especially regarding the potential
expansion of floating support.
 Building issues - funding investment risks.
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Dealing with having other providers in their building and all the
issues that arise with that on health and safety and risk.
Challenging ageism
 Avoid ‘ghettoising’ old age and ensure that older people’s
services are continually rooted within wider community services.
 Housing design needs to be age friendly and used to ‘build
communities, not dormitories’.
 Treating customers as stakeholders and shareholders.
Other challenges identified
Other challenges and issues included :
 Changes in the housing market.
 Meeting tenure demand for properties: sale or rent..
 The issue of ‘Virtual budgets’ where the service user opts for the
local authority to organise support : perhaps these may not work
where control of the support plan is given without control of
money. ‘I cannot see the point of virtual budgets, why not just
say that having control of your own care/support is one way of
giving people more choice and control?’.
Recognising the range of challenges to be faced, one professional
stressed that housing providers ‘Must not let fear of losing contracts / loss
of income impede new service development. They need to get into the
mindset that some income will come from the Local Authority and some
from customers’.
Duty of Care and Managing Risk
Professionals interviewed in West Sussex considered risk from a number of
different perspectives. There was a feeling that overall attitudes towards
risk would need to change or achieve more of a balance:
 ‘ Yes there will be a shift in the management of risk and a
growing acceptance that we have become risk averse at the
detriment of providing good services. There is a tension
between providing IBs and safeguarding older people, but also
we need to stop infantalising older people and recognise that
they are capable of managing their own life’.
Two different views on where overall responsibility for risk was held were
expressed by two of the people interviewed:
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‘Risk falls on those holding the statutory duty of care as they are
ultimately responsible for IB assessments’.
‘Local authority shares the risk with providers in supporting older
people to take decisions that enable them to use IBs effectively.
This ‘people risk’ needs the right staff skills to manage properly
and is an area which especially needs a lot of work’.
In terms of practical ways of managing risk for individuals, the following
views were shared:
 ‘We need to have good contingency plans that accept a level
of risk as well as robust processes to work with people who have
mental incapacity and cannot easily exercise choice’.
 ‘There is a need to understand the risk (if the person holding the
IB can manage it or not) as part of good assessment processes’.
 ‘I’m not sure if this change in managing risk means going
backwards or forwards. eg: what happens if a family member
paid to provide care does not turn up?’.
 ‘Financial abuse is rife amongst older people by their families,
some accidental, some deliberate. How will this be managed?’.
 ‘Monitoring and review systems need to be far more
sophisticated than they are currently and a balance needs to
be struck between trusting the older person’s own choices and
managing risk’.
 ‘There is a need to make sure that the sign off on the care plan is
meeting legal requirements and IB holders use it appropriately.
Also a need to ensure social workers, advocates and brokers
can work with older people to sustain the right spend’.
 There was concern expressed by older people (at the recent
focus groups held in West Sussex mentioned above) around
Personal Assistants - employment responsibility and worry over
getting qualified people.
 There is a risk that individuals will lead the market and the market
will not be strategic.
 Some businesses will close, especially those that cannot secure
sufficient business and are not equipped to deal with a model of
individual, not block contracts.
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Commissioning services for older people
Despite only one interviewee being directly involved in commissioning 5 of
the 6 did share views on how they felt commissioning is changing (or will
need to change) in response to the personalisation agenda as follows:
 It is absolutely key that SMART/world class commissioning is
applied and commissioners need to be trained and skilled to be
effective, commissioning for quality not just price.
 It is too early to know if commissioners will be risk averse in
commissioning in an extra care setting and also whether they will
look at value for money in terms of long term health gains.
 There is a need to balance SP priorities in commissioning - SP
focuses on prevention and if too much SP money goes into the
IBs, it could leave out customers who are not eligible for adult
social care funding. There has been limited discussion to date in
the Local Authority on the conflict of eligibility criteria between
SP and adult social care. There is currently no adequate
framework that determines how to deal with customers needing
SP but not eligible for adult social care - SP is not able to
administer IBs for clients who are ‘SP only’ as the infrastructure to
support this does not exist. The Department for Communities and
Local Government have not given active guidance in this area
either.
 SP and adult social care are looking at commissioning for
Learning Disability services going forward and the view is that
contracts will be 2/3 block and 1/3 IB.
 Commissioning in extra care will change to potential model of
core service plus floating support plus buffer service for
emergencies.
 Joint commissioning of services needs to improve in West Sussex.
 Uncertainty over exactly know how commissioning will change –
but fear that the role of sheltered housing will be downplayed
and that commissioning will only be for very high-level extra care
schemes.
 Commissioning will be very different in the future. One of the
main issues will include how to stimulate the market without
guaranteeing a block number of customers. This is a big
challenge for providers and commissioners to manage.
 Use of IBs will change past patterns of take up and will need
addressing. Previously those who were not eligible under ‘take it
or leave it’ system will want to take up IBs and get services.
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Commissioning is moving in the direction of
enablement/independent living, and development of extra care
housing is a large part of this agenda. In the future there will be
more commissioning for enabling roles: ie. housing support,
preventative services, advocacy.
Core service model
This idea generally received a positive response from interviewees in West
Sussex and a fairly extensive range of views were expressed and examples
given, including :
Pro core service model
 Envisaging extra care schemes having a core contract and
customers using IB resources to buy additional services. Older
people would be likely to buy from onsite services as it is easier
(research experience was mentioned to back up this view).
 Changes in funding will cause housing providers to move in this
direction in any case.
 An example was shared of an Australian model where some
housing providers went from developing large extra
care/retirement estates to bungalows in communities and
providing a mix and match of services, so clients do not have to
move on.
 The concept of core services layered with other options was felt
to have potential to work well, helping providers cost and also
giving older people a degree of choice.
 Opportunities exist for providers to develop new service models
and expand from their traditional core business models.
 There can be a conflict of interest but if functions are separated
this can be managed. In house core services do not necessarily
need to be provided by provider and can also be delivered
from external sources. It is still early days and there is a lot of
scope for modeling and innovation.
 Ultimately providers will have to see what works best for them
and clients in developing a core plus options service.
Concerns expressed
 One person interviewed expressed concern that with this type of
model there may be a possibility that the optional services
offered (ie those which are not part of the core package) could
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erode over time, meaning that clients who needed anything
more than core services may need to move on.
IBs is don’t lend themselves to short term interventions, they are
more appropriate for clients with long term needs so services will
need to be developed and costed accordingly.
In terms of the split between what should be core and optional services, a
range of opinions were expressed:
Core
 It was felt that alarm services, personal care, housing related
support and daily calls could be core in some cases – however
these did not necessarily have to be provided by the housing
provider.
 Some options for Core SP funding were suggested including
Emergency alarms and a period of ‘resettlement’ help for new
tenants.
Optional
 A range of practical things which enable people to stay in their
own homes as well as support to partake in more social activities
was described, including personalised care, meals, laundry,
cleaning, shopping, gardening, support (including floating),
assistive technology, help in getting out to socialise and go to
leisure activities.
Provision of Support, Advocacy and Brokerage Services and the Role of
Housing Providers in this Area
Some scepticism was expressed about housing providers offering
brokerage services, however most people were more positive about this –
albeit with strong caveats around how this would work.
Housing providers offering services is an underdeveloped area in West
Sussex, some of the advantages of housing providers offering these
services were seen as:
 Scheme managers knowing their tenants well and therefore
being suited to offer this support.
 In the absence of family to support the client, housing providers
are well placed to provide some (‘maybe not all’) advocacy
and brokerage services.
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Some of the disadvantages expressed were:
 Possible conflicts of interest – mentioned by 5 out of 6 people,
however there were differences in the strength of feeling in this
area. One person felt that this was the main reason for housing
providers to avoid providing these types of services, another
viewed this in a very pragmatic way -‘There could be a conflict
of interest for housing providers to provide brokerage/support
planning, but there will also be a conflict of interest if social
workers provide this service’.
 Related to the above - difficulties for housing providers to offer
advice to buy services externally as they have a huge
investment in the scheme and a lot of pressure to get older
people to buy into scheme services.
 Time constraints for scheme managers – which may mean that
they were unable to offer these sorts of services effectively.
 There could be an issue of the relationship between landlord
and tenant getting obscured by getting involved in care and
support planning.
Things which would be required of housing providers offering services in
this area were felt to be :
 Effective methods of managing conflict of interest, avoiding
what may become ‘Preferred Brokerage’ and ensuring
transparency of the advice given. There was some feeling that
that this would require a separate specialist arm of the business,
or at least specialist staff. However not everyone agreed with
this - ‘They do not need separate brokers but it needs to be
someone who can have a trusting relationship with older people
and be able to tell them the truth.’
 Identify the right skills and personal qualities required and
provide the training, procedures and development for staff
needed to deliver this, build on the existing experience. Some of
the most successful brokerage and advocacy is based on good
experience and knowledge of local neighbourhoods. ‘Social
workers and care workers might not have this knowledge but
other staff might’.
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Provision of Services by Housing Providers to non Residents in the wider
Locality
This area generated a mostly positive response in West Sussex, as shown
below:
 ‘Yes, it would work as there is enough current policy to support
this type of development. It has not been done enough and
now providers will almost be forced to do this due to changing
business models’.
 ‘Yes, absolutely, that’s the way W. Sussex wants housing
providers to go and provide wider services in the community. Eg:
floating support in the community, brokerage offered out,
support planning offered to clients in community settings’.
 ‘Yes, they can work to develop providing external services. This
can also help to their business models, not sure if this will
generate enough revenues though’.
 ‘Yes, they have a role, particularly as services are going to be
much more community focused/community delivered, it is
important for providers to understand their local communities
and be able to deliver services beyond their schemes. This can
benefit their knowledge/skills and experience in managing the
expectations of clients within the IB process’.
But support for this idea was not unanimous:
 ‘No, as there are many other agencies in the community that
are skilled in doing this, especially support and brokerage. The
only services they could offer out are meals from their
kitchens/restaurant and some in-house scheme specific services
to make these more economical. They should not do any
additional services that compete directly with other providers
who might be better at doing this’.
 There was one view that advocacy was better placed within the
voluntary sector and that ‘housing providers should stick to doing
what they do best, which is provide good housing’.
4.2 Findings from Interviews in Oldham
5 people, from a range of different organisations in Oldham and the North
West, took part in telephone interviews. All of the organisations
represented (from both the statutory and voluntary sectors) have
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extensive involvement in the planning and provision of services for older
people.
Involvement in the Individual Budgets Pilot
All interviewees were familiar with the Individual Budgets (IB) pilot,
however their level of involvement varied from playing a central role to
being aware of the pilot but not directly involved.
Areas Believed to be Working Well for Older People
A range of mainly positive views were expressed. The ability for older
people to have a choice was the main area which was felt to be working
well and the option for some to stay with or choose traditional services
was welcomed. The potentially life transforming role of personal assistants
(PA’s) was also mentioned by several professionals. Some other key points
are highlighted below:



‘This is not the traditional service that older people historically
expect from care services.’
More older people were slowly going over to PA’s, increasing
their choices and flexibility and it is believed that this process had
been helped by the fact that services no longer had to be
accredited in Oldham.
PA’s were perceived to be becoming more popular, especially
amongst younger older (and middle aged) people who it was
felt generally don’t want to be ‘done to’. Linked to this was a
view that there appears to be more interest in individual
budgets from people whose lives have been suddenly
interrupted by disability rather than amongst those who have
experienced a gradual loss of function through ageing.
Areas Perceived as Not Working for Older People
Getting more information about the pilot/ IBs was highlighted as a need, it
was felt that this was required in order to really understand what has
changed for older people. This included more clarity on how the
packages have been put together, and whether it is the same examples
that are being re-worked and publicised. The need for support (amongst
older people) to get the information to have their choices was also
described.
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A low level of uptake for IBs from older people (compared to other
groups) in Oldham was mentioned and the following explanation was
offered - ‘they appear anxious about it, or do not want to bother’. It was
also felt that some people really do not want to change and are happy
to stay with traditional services – ‘It is not compulsory for people to
change’.
The inequitable levels of funding between older people and younger
people with disabilities was described in one case and there was genuine
shock at how much less was available for older people in the resource
allocation which had led to people raising questions: ‘Why is this the case,
why is it so low?’.
Enthusiasm and Support for Introducing IBs for Older People in this Area
Local Authority Care Managers were initially very sceptical of the
approach, but that this is now changing, with good news about people’s
positive experiences spreading the word.
Another pointed to a lack of convincing evidence that the models of
personalisation used to date are right for older people and gave the
example of the in Control model which it was felt - ‘Could be viewed as a
politicised, North American model which fits around the human rights/
social justice tradition and requires strong lobbying. This does not always fit
so well with older people, and this approach may not always be
welcomed by them.’
Use of Housing Related Support Services in the Pilot
None of the people interviewed could think of any examples of housing
related support services being directly included in the IB pilot programme
in Oldham.
The role of housing providers in adapting to personalisation:
Not everyone was able to comment on this area. It was difficult to
respond to this question because of the lack of information and that there
appears to be a real lack of choice of services generally, therefore there
are limits to what older people can spend their money on. The following
examples and thoughts were also shared:
 One local supported housing provider has remodeled its Care at
Home Warden Service to a Retirement Support Service
(operational for 2 weeks at the time of the interview). The service
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offers low-level support and assistance to any person aged 60+
living or moving into the borough of Oldham (regardless of
tenure) who may be living in isolation. The focus is on housing
support needs, not care needs. The new service is felt to be
designed to take account of personalisation because it enables
people to opt out of what were traditionally core services and
not pay for them if they don’t want them (eg. community alarm
and the warden service). It was also believed that this allows a
better use of resources so that services reach those most in need
and also enables cost benefits to be passed onto tenants.
When the budget is down to the individual, they may choose a
variety of activities, eg. more social activities in the scheme and
low level services such as grab rails and that housing providers
will need to adapt to these different demands, by providing
more individual and varied support. In order to generate
income, it was felt that housing providers may need to open up
their services to people living in the residential area.
At one of the new specialist housing “extra care” facilities being
built in Oldham, there were believed to be indications through
the design that they had been thinking more about
personalisation and offering a greater choice within the scheme
to meet individual needs, for example there was a treatment
room where alternative therapies could be offered. Also it was
felt that Court Managers seemed more keen to set up activities,
eg Tai Chi and exercises, in response to residents’ requests.
Practical suggestions for older people’s housing organisations in
responding to personalisation
The need for greater development of the market and greater choice was
emphasised. Due to a lack of supply and an insufficient range of services,
people were believed to be unable to make choices.
‘Older people do want extra care’ was one view expressed.
Other thoughts shared on this area were as follows:
 The workforce need to build on their skills of engagement with
older people, in order to deliver a more personalised approach.
It requires staff to be responsive to individual needs and focused
on how to meet them.
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One housing and support provider had introduced a
‘personalised’ warden service – it has required ‘warden’s to step
out of their traditional ‘comfort zones’, and embark on an
intensive training scheme shifting their role to a welfare service.
The training includes: understanding basic benefits, applying for
aids and adaptations (which was signaled as an important area
to help older people remain independent) and signposting to
other services.
New and different skills were not likely to be required, rather
people need well developed life skills when it comes to working
with people.
Services need to be more flexible and responsive, rather than
block contracts - more of a ‘pay as you go’ approach. For
example, people do not always need the same level of support
all the time, so they can have services provided for the times
they need them – more ‘spot purchasing’ and rapid response
teams meeting varying needs, eg. ‘can I just purchase the
service for 5 days?’. Housing providers may need to take on
some of these types of care packages.
Housing providers need to work with people at an individual
level, rather than the current perception of operating at a
macro level, where tenants ‘buy in’ to an insurance model. The
core charges cover services that they may not use, and so
tenants may ask ‘why pay for a service that we are not using?’.
Where there has been good practice in housing providers, there
is some tradition of them supporting individual tenants. However,
when IBs and the RAS were first introduced in Oldham, social
care and health colleagues did not traditionally consider that
the landlord may have a view on personalisation. ‘Housing
providers need to proactively engage in personalisation and
take the agenda to health and social care’.
There needs to be enthusiastic ‘risk enablement’ with older
people. This may require staff training, and will require a change
in attitude towards older people. ‘Just because a person is in
their 80’s does not mean that they can’t take risks’. It is about
assessing the risk for individuals through getting to know
individuals, their life story and being flexible. The quality of staff
employed is another very important factor. This will probably also
require an increase in staffing levels as ‘personalisation’ takes
time.
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The Main Challenges Faced by Older People’s Housing Providers in the
Area of Personalisation
Several challenges for providers were highlighted including :
 Anxiety of de-stabilisation of the market, although one person
interviewed felt that ‘There is a view that if there is a good
housing provider with provision that is personalised and focused,
older people will be happy to accept the service and not look
elsewhere.’
 The move away from existing models which can involve ‘quotas’
of people within ‘bands of need’
 Funding – eg. currently the remodeled warden service (at first
Choice Homes) uses Supporting People (SP) money. ‘When SP
changes and becomes part of LAA’s and Independent Budgets,
how will the service be paid for?’
 Working with people at an individual level. ‘The challenge is
how you marry individual needs with supported living
arrangements’.
 ‘Personalisation is one massive challenge!’ A feeling that it is not
easy to understand how it affects housing providers was shared,
due to a lack of available statistics on who has an IB, difficulty in
getting information from the in Control team and a lack of clarity
in the eligibility criteria.
The Main Implications for Housing Providers around Duty of Care and
Managing Risk
Further development was felt to be required around risk assessments
along with more training of the workforce so they develop more
confidence and creativity around the assessment of risk. It was pointed
out that other safeguards are built into the system - eg. people on IBs
have personal care plans which are reviewed. A range of perspectives
came through the interviews:
 The shift to the individual with IBs was believed to necessitate
clear risk assessments by professionals.
 The issue of risk for housing providers would depend on what the
organisation may want to provide, beyond their existing duty of
care to check on well being and keep people safe and well.
 The issue of what may be lost in the new agenda may be a risk
(‘baby out with the bathwater’). There is perhaps a drive now for
sheltered housing to be seen as old fashioned, and a general
view that everyone wants to live at home independently. ‘If
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home is one room, how is that a good thing? The policy
imperative to keep people at home may miss cases when it is
better for someone to live in managed housing.’
At the recently remodeled sheltered housing service some
wardens have already flagged up concerns about older people
who are on IBs and their ability to use them. There are concerns
about what process people go through to get the IB, how much
of an informed choice they can have if they have some degree
of mental incapacity and possible neglect if the level of services
is not available. Some older people are isolated from their
families, or their families do not offer hands-on support, so we
cannot assume that families will help. Also how can available
services be publicised to enable older people to make choices?
Another possible risk for housing providers to consider was the risk
to individuals of financial abuse from families. In one case a
strong belief was expressed that risk panels needed to be in
place. IB was also seen as changing the dynamics within
families, with family members often being seen more and the
subsequent increase in ‘traffic’ possibly impacting on people’s
living arrangements.
It was felt that scheme managers need to know the needs of
their tenants well and to carry out risk enablement, helping
people to reduce the risks involved in something they wish to do
– ‘how can we help you do this?’
Commissioning Services for Older People
Professional participants in Oldham had a variety of roles and areas of
experience, some were or had previously been involved in commissioning
services for older people and some had not – but still expressed views on
developments and changes required within the personalisation agenda,
including:
 A need for commissioners to weigh up the need for
personalisation/ individualised services against economies of
scale and consider which is the best model.
 Providers may need to consider going into partnership for
delivering services, they need to find partners they can work with
and develop new services.
 Choice for older people is the key issue, rather than rather IBs per
se.
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A continuing / increasing need to develop more extra care
housing/ provision.
A feeling that this was a difficult area to comment upon as the
situation is still developing.
Core ‘Package’ idea
Participants were asked their views on housing providers offering a ‘core’
service for support (and care) which residents sign up to on moving in with
a range of optional add ons. This idea received a mostly positive
response from all interviewed in Oldham. It was felt that this could:
 Be a useful way for providers to respond to IBs.
 Help to increase provider services, increase choice and enable
housing providers to compete with other service providers
thereby stimulating the market.
 Give housing providers more control over services available to
their residents as well as other local people.
 Help to develop a more appropriate response to older people’s
needs as housing providers may have a deeper understanding
of the needs of individual older people (through their
relationships with residents, which have often been built up over
a long period).
 Use the position of housing providers to help introduce residents
to new services.
On the negative side :
 ‘Is going down this route necessary?’ (especially if it would make
packages very complex). It was felt that most people entering
supportive housing want the services already provided and that
people would be reluctant to break up care packages.
 The need for a wide variety of services was questioned – the
view was expressed that personalisation was an approach and
a mindset where the quality of relationships between providers
and service users was key. ‘Its about being there for the
individual and continuity, not necessarily providing a complex
range of support services’.
Appropriate ‘optional’ services were felt to be lunches, opportunities for
physical activity, aids and adaptations services and assistive technology.
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Provision of Support, Advocacy and Brokerage Services and the Role of
Housing Providers
Opinions on this area were divided. Some participants voiced concerns
about conflict of interest for housing providers and felt that this should
preclude them developing a brokerage role, however one felt that there
was definitely a role for housing providers in the ‘essential area’ of
advocacy and another voiced a general concern about brokerage and
considered that this was not working well yet.
Conversely, others felt that there is a role for housing organisations in the
provision of brokerage services for older people, the following comments
were given in support of this view :
 ‘Older people want support from people they trust, which is likely
to be their provider’.
 ‘It is not appropriate to have a very purist model, it is about what
works best and we need choice and flexibility in the system’.
 ‘They (housing providers) already do this (act as Brokers) in an ad
hoc way’.
 ‘Scheme managers can be very knowledgeable about their
residents, and could be well placed to offer formal support for
IBs’.
Uncertainties about brokerage were also expressed by one person who
felt that it is difficult to understand at the moment how it will work, eg. will
it be a free service, would older people be prepared to use some of their
budget to have an advice service?
Provision of Services by Housing Providers to non Residents in the Wider
Locality
This area generated very enthusiastic, positive and constructive responses
during all interviews with people in Oldham, as shown below:
 ‘Excellent suggestion, which will stimulate the market and enable
a greater choice of services to older people particularly those
choosing to remain in their own home’.
 ‘Yes, and [local supported housing provider] has built this in to
their remodeled warden service. They have just begun to offer
the service to people regardless of tenure and who may be
living in isolated circumstances. Currently, due to the capacity of
the new service, they are keeping the publicity low key, but it is
clearly an area for development’.
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‘Yes certainly. They may be very simple things such as: hot meals
and more social activities. Housing providers may also be an
access point for other services. A link could be created with
safety services, so the local community can be linked to a safety
scheme. Another service that could be provided is the growing
area of assisted technology, eg. reminding people to take
medication, support for people with earlier dementia by
reminders to close doors, etc. This is seen as a real growth area’.
‘Yes, definitely. Through the RAS, housing providers could be
commissioned to deliver contracts that supplied services in the
local community. However, this will require a culture change, a
different relationship, between housing providers and local
residents’.
‘Yes, a very good idea to expand to other areas. This could
increase choice in the market, and enable older people living
alone to be involved in social activities’.
4.3 A Comparison of Findings from Interviews in Each Area
Differences
Overall, the differences seen between West Sussex and Oldham primarily
relate to contextual and systemic differences, such as type and size of
area, levels of affluence experienced, diversity and age of the
population, the groups of people involved in the IB Pilot phase (with West
Sussex being focused on older people and Oldham open to all client
groups) and differences in FACs criteria in operation in each area. One
difference in the interview findings between areas was opinions on the
use of Personal Assistants (PAs) by older people. This seemed to be an
area which professionals in Oldham viewed more positively than those in
West Sussex, and a feeling that the ‘life transforming role’ of PA’s was
slowly being discovered by more older people was expressed – albeit that
these were more likely to be ‘younger’ older people.
There were a variety of views expressed by individuals within and across
both areas, main differences in opinion seen were in:
 The provision of support, advocacy and brokerage services by
housing organisations, where opinion was fairly evenly divided
amongst people who felt that this would present too much
potential for conflict of interest and those who felt that the
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development of these services would be workable as long as
strong safeguards and appropriate procedures were in place.
 The provision of services by housing providers to non residents.
Most (but not all) people interviewed in both areas were very
positive about this.
 The fundamental suitability of IBs for older people – where a small
number of professionals expressed ongoing concerns.
 A split in opinion between where responsibility for risk lies with IBs
– one view being that this should be solely with Local Authorities,
another being that this should be shared with providers.
Similarities
Key common areas which emerged from interviews with professional
stakeholders in both West Sussex in Oldham were :
 Very positive views on IBs for older people, including their
potential to open up choice, put the individual back in control
and enable funding to be used in new and innovative ways.
 Concern that levels of IB funding are considerably lower for
older, compared to younger people.
 A recognition that IBs are not suitable for a considerable number
of older people, many of whom have chosen to stay with
‘traditional services’, resulting in a lower uptake for IBs amongst
older age groups.
 Very early days for IBs with the systems and markets for support
and services still in the early stages of development.
 The need for significant ongoing development of these markets.
 The need for more specialist (extra care) housing for older
people.
 An extremely low level of involvement of housing organisations
within the IB pilots – and in discussions generally on
personalisation within each area.
 A need for as much flexibility as possible amongst providers.
 The need for housing providers to really engage with and
respond to personalisation and develop their organisations,
services and staff accordingly.
 A positive view about the suitability of the Core and Optional
services model to enable housing providers to respond
appropriately to IBs and personalisation more widely.
 A view that residents would generally prefer to buy services from
on-site providers.
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Considerable challenges being faced by housing providers
including moves away from established models of
commissioning and operation and uncertainty over future
changes to Supporting People funding.
A move to risk ‘enablement’ being required, whilst ensuring that
clear and strong processes are in place to deal with areas of risk
which are likely to increase with IBs such as financial abuse by
families.
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Chapter 5: Conclusions
This research project, whilst modest in scale and limited in scope has
nonetheless produced some important and strong findings. Previously,
none of the literature on personal budgets has focused specifically on
older people in specialist housing settings. Other research17 on extra care
housing points to the value that older people place on the combination
of independence, peace of mind and security that they have in their
homes. Extra care and sheltered housing models can also maximise the
well-being of residents by providing communal spaces as venues for
social interaction and by hosting a range of activities.
Through this work, we have undertaken to hear the voice of older people
in extra care and sheltered housing and find out their views on the broad
agenda of personalisation and specific concerns about Individual
Budgets. And hearing those voices was challenging, not because older
people in specialist housing settings don’t have anything to say, but
because the concepts and ideas on personalisation are still somewhat
abstract. It is difficult to engage people in an informed debate when
information is so diffuse. For all the many news column inches, policy
papers and practitioner guides produced on personalisation, there is little
that is targeted to older people, so the issue is confused. And yet, there is
a need for clear information so that older people can make informed
decisions to get the right care and support for them in the right place.
Most of the growing literature on personalisation points to the need for a
range of practical examples of how others have used IBs or Direct
Payments. Certainly our evidence from focus groups suggests that having
a participant who has direct experience of an IB is instrumental in terms of
driving the discussion and engaging other older people in the debate. It
was particularly difficult to engage older people with high support needs
in extra care settings in this work, but those who did eventually take part
Croucher et al : Comparative Evaluation of Models of Housing with Care for Later Life,
Joseph Rowntree Foundation (2007)
17
Evans, S. and Vallelly, S: Social Well-Being in Extra Care Housing , Joseph Rowntree
Foundation (2007)
Evans, S. Presentation at Housing with Care : Current Evidence Future Policy, November
2008
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expressed a number of concerns about IBs, particularly related to security
on the schemes (courts) where they live. For them, the choice was moving
into the extra care facility; most did not want the perceived hassle of
having to organise their own care. Primarily we need to learn from older
people as we plan for the future of extra care.
At the time of completion, (spring 2008), the IBSEN report18 concluded that
for older people, there was little evidence that IBs were working any
better, or were more cost effective than other traditional service models,
based on the small numbers of older people who had been involved in
the evaluation sample. The control group comparison showed that older
people who were on IBs experienced more stress and less psychological
well-being than other older people not using IBs. Some of this may be due
to the fact – as other literature points out - that older people often come
into contact with statutory services at a time of crisis, and at this point may
not wish to take on the additional concern of controlling and setting up a
care package via an IB. Similarly, many older people move into extra
care housing following a personal or health crisis event, and this may well
influence their reluctance to explore the possibility of using an IB. It is also
the case that since IBSEN reported, many of the 13 authorities involved in
the IB pilot have continued to adapt and refine their systems of self
directed support underpinning their local arrangements for IBs, and that
older people are now amongst the fastest growth of people accessing,
and reporting satisfaction with, personal budgets.
It has been widely recognised that it is still very early days for IBs. This was
highlighted in the literature and supported by the findings of the fieldwork
for this project. Many of the people involved in the IBSEN research had
only recently moved to IBs and were experiencing a great deal of
change at the time this was carried out, as one older person participating
in a Focus Group said ‘it’s a big change for people to get the hang of’. In
addition, as often described by the professional stakeholders interviewed,
the systems and support for people on IBs are still in the early
development stage in many areas.
Two other areas were also mentioned in IBSEN and by professional
stakeholders which were felt to be influencing the situation and limiting
Glendinning et al (2008) Evaluation of the Individual Budgets Pilot Programme : Final
Report, Individual Budgets Evaluation Network
18
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the scope for improvements in quality of life for older people. The
monetary amount involved in IBs was on average considerably smaller for
older people and their support plans were much more likely to focus on
personal care and less on social activities than those of younger people.
The small number of older people involved in discussion groups and
interviews for this project expressed a number of concerns about IBs. Most
responses to the concept (but not all) were negative. There was a sense
of nervousness and distrust, along with a feeling that IBs may be difficult to
set up and manage. Some were concerned about risk and the potential
for abuse. There was some recognition amongst older people that IBs
could really open up choice and control, however good information,
advice and support were seen as being crucial to enable this to happen.
It was difficult for residents involved in this study to envisage and articulate
how choice could be provided in some of the key services like the
emergency alarm system, though some said they would prefer a wrist
band to a pendant alarm. In that sense, the findings here amplify findings
from other work19 that small things and minor changes can make a big
difference. For some in extra care settings, the move itself was felt to be
the critical choice.
A strong preference was expressed for the on-site care provider; it’s
‘better the devil you know’ as one older person exclaimed. From the
residents’ perspective, it would not matter whether this service was
delivered by the managing organisation (landlord) or not, but what was
important was knowing the staff. As one resident put it, ‘why go into
sheltered housing if you don’t want these services’ However, this type of
comment could also be indicative of the culture of low expectations for
and amongst older people which personalisation seeks to improve.
A clear finding to emerge from this project is that older people do want
more voice, choice and control over a range of issues; in some cases the
running of their court, in others the times when carers visit and the range
of activities provided. But this commitment to choice does not translate
automatically to a commitment to using IBs. Choice and control are vitally
CSIP (2007) Older People’s Services and Individual Budgets. Good Practice - Examples
and Ideas
19
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important to older people. There is evidence that they can feel
‘patronised’ and ‘treated like children’ when this is curtailed, eg. through
what is perceived as ‘health and safety’ and insurance concerns
impinging upon their choices. This is an example of how regulations to
safeguard can sometimes mitigate against the broader personalisation
agenda.
In contrast to findings from the discussions with older people, professionals
interviewed in both West Sussex and Oldham, having been involved with
the IB pilots, all expressed strong support for IBs, though in some cases
concerns about their suitability for older people were expressed. However,
they recognised that personalisation is still in an early phase of its
development. Significantly, no professionals interviewed could point to
examples where housing providers were active in implementing or
developing IBs. However, some local housing and service providers have
adapted their services in response to personalisation. Most participants
recognised that specialist housing settings can have an important role to
play in personalisation, and that it is vital that housing providers are
proactive in ‘taking the agenda’ to local authorities and service
commissioners tasked with the practical implementation of
personalisation. Housing providers face a range of challenges; changes to
funding, block contracts, potential loss of business but there are also
opportunities for service developments. Older people’s housing providers
often have strong and trusting relationships with their residents, and this
places them in a unique position to promote and support personalisation
for older people.
Opinions differed between and across the residents and professionals
interviewed in some aspects. Professional views were split in terms of
whether housing organisations should provide advocacy and brokerage
services. Resident views were clear in that they would initially seek help
from trusted family members and friends. Some may seek the advice of
their court managers, but not other staff. Some professionals suggested
housing providers needed to respond to the increased ‘traffic’ that would
emerge from residents having IBs and managing their own care, whereas
residents were mainly concerned about this due to the negative impact
on security. It was particularly difficult for older people to agree on the
distinctive elements of what would constitute ‘core’ and ‘optional’
services within their housing setting, but most professionals felt this would
be a useful approach in achieving service sustainability. Some older
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people were concerned that IBs represent cost-cutting. In contrast, whilst
professionals recognised that changes to some funding streams like
supporting people would affect specialist housing, they did not see IBs as
cost cutting per se.
However, widespread agreement was reached on some issues. Both
professionals and older people felt that specialist housing has a key role in
the broader agenda of personalisation. Demand for extra care housing is
stronger than ever. Concern on the part of professionals and older people
was expressed in terms of how older people with mental capacity issues or
complex needs associated with dementia could be enabled to use IBs
effectively.
Personalisation is still an emerging agenda. Despite much rhetoric from
the social care media and in policy circles, all the targets have not been
met, and everything is not yet sorted out. Markets for services and support
for older people are still very immature. Greater and more effective
involvement of a diverse range of older people will be necessary to the
successful development of inclusive services and support.
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References
Beresford, P. (2008) Pilot lights : A report drawing on the views of service
users and practitioners illuminates the debate about person-centred care
budgets, The Guardian, (July 23 2008)
Bowler, E. (2008) Individual budgets in West Sussex care services,
Community Care website - www.communitycare.co.uk, 26 June 2008
Boyle, D. Assets that can’t be bought. The Guardian, 16th of July 2008
Clark, H., Gough, H. and Macfarlane, A ( 2004) ‘It pays dividends’: Direct
payments and older people, JRF
Commission for Rural Communities (2008) The personalisation of adult
social care in rural areas
CSIP (2007) Older People’s Services and Individual Budgets. Good
Practice - Examples and Ideas
DH (2004) A toolkit for older people’s champions : A resource for nonexecutive directors, councilors and older people acting as older people's
champions
DH (2005) Improving the Life Chances of Disabled People
Glendinning et al (2008) Evaluation of the Individual Budgets Pilot
Programme : Final Report, Individual Budgets Evaluation Network
Godfrey et al (2003) Supporting People : A guide to user involvement for
organisations providing housing related support services, Nuffield Institute
for Health, Leeds University and ODPM
Hasler, F. and Stewart, A. (2004) Making direct payments work: Identifying
and overcoming barriers to implementation : Developing direct payments
in the North East of England, JRF
Hatton, C. and Waters, J. (2008) A Report on in Control’s Second Phase :
Evaluation and Learning 2005-2007
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Henwood, M. In Control Evaluation : users’ quality of life improves.
Community Care, 8th of May 2008.
Homer, T. and Gilder, P (2008) A Review of Self Directed Support in
Scotland Research Findings No.64/2008, Social Research, Health and
Community Care
in Control website - www.in-control.org.uk
IDeA London (2007)Why Bother? Improving the quality of Life for Older
People (1)
IDeA London (2007) Engaging with older people. Improving the quality of
Life for Older People (2)
Joseph Rowntree Foundation (2000) Strengthening Community Leaders in
Area Regeneration
Joseph Rowntree Foundation (2005) Is Information Power? Older People,
Information, Advice and Advocacy
London Citizens - www.londoncitizens.org.uk
Maynard Campbell et al (2007) Mapping the Capacity and Potential for
User-Led Organisations in England: A Summary of the Main Findings from a
National Research Study, Department of Health
Robbins, D. (2006) Choice, Control and Individual Budgets : Emerging
Themes, www.in-control.org.uk
The Rowan Organisation (2005) Direct Payments Development Fund
Project, www.therowan.org/doh.htm
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Appendix 1: Further Information from Focus
Groups
In addition to the information shown in the main report, further information
which was not directly related to the discussion on IBs, emerged at focus
group discussions with Housing 21 residents. This is shown below for
information.
Participants’ Reasons for Moving to a Housing 21 Court
Reasons for moving to the courts were discussed :
 The desire not to ‘live alone’ and have more company was
mentioned frequently.
 Safety issues were also often given, including:
o A feeling of being less vulnerable to crime.
o Knowing there is someone near to call on in the case of
health problems - ‘peace of mind’.
 The need for ongoing extra support through deteriorating health
and increasing disability was described.
 Moving to be near to family and friends, the convenient location
of the scheme was mentioned by a number of participants.
 Wanting to be on the level to help with keeping mobile was a
consideration for some.
 Two participants mentioned problems which made it necessary
to move out of their previous accommodation (eg. problems
with the lease).
 One described the process of making the decision – ‘Depends
what was on offer – is it suitable for me? Can I live here?’.
Overall, there was a difference seen in the reasons for moving between
people in :
 Sheltered housing units, who were more likely to describe moving
for social or security reasons; and
 Extra care units who were more likely to mention health reasons
and an increasing need for care and support
Advantages of living in older people’s housing
Security and safety was seen as the biggest advantage :
 ‘You are safe here’.
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24 hour alarm systems were much appreciated - ‘Someone on
hand 24/7, that’s a big thing regarding your security as you get
older’.
‘Someone on call if you are ill’.
‘Peace of mind with caring’.
‘You get to know neighbours’ habits – curtains drawn, getting up
at regular times- so you can keep a look out for each other.
Doesn’t happen in the community in the same way, that added
bit of security’.
At the same time, the sense of independence was also mentioned by
many of the participants:
 ‘If you want to be on your own you can’
 ‘You have your own private space’
 ‘We all live our own independent lives. Don’t have to take part in
communal life, no pressure’.
 ‘It’s easy to move around because of the flat levels.’
In one court which is a part extra care scheme (recently remodeled), the
access to on site care and support – if needed - was seen as a
considerable advantage. Following remodeling support staff were
around 24 hours a day, whereas previously warden staff were available
on site from 9-5. The combination of care and housing support staff on
site was also appreciated. A feeling was expressed by some participants
that the combination of facilities and support available meant that this
really could be a ‘home for life’.
Social and community advantages were discussed:
 ‘Having the daily visit from the Court Manager – if you spend a
lot of time on your own, just having someone, perks you up, just
that one person each day – checking you are alive’.
 ‘It is very important to have a Court Manager – worth their
weight in gold. We also support the Court Manager by making
suggestions and offering support – works both ways’.
 Social activities - ‘We play bingo 3 nights a week, play cards,
have do’s’.
 ‘Sometimes the women try and encourage the men to take
part. Some of the men look forward to seeing us, and us
involving them. They like the attention.’
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There were advantages regarding the location for some, eg.:
 Being near to relatives and friends.
 ’10 minute walk (if you are fit) to the town centre’.
 Good views (for some).
Disadvantages of living in a Housing 21 Court
Few disadvantages were expressed but amongst them: .
 Location, being built on a hill.
 Availability and expense of transport (eg. taxis for those who
need them).
 Not enough mixing by residents – ‘some people are not
bothered to mix’.
In the meeting in the recently remodeled, part extra care court the
greatest amount of discussion around disadvantages took place.
Although all participants said they enjoyed living in the scheme, a few
expressed anxiety over the increasing orientation of the scheme towards
meeting the needs of extra care tenants. Many expressed concern that
what began as a sheltered scheme was turning into a ‘care home’ which
was seen as ‘depressing’. Some of the more independent tenants felt that
many of the activities previously enjoyed were now not provided or very
infrequently provided. Other disadvantages given were:
 A feeling that the needs of those with high mental health or
severe frailty could not be met.
 Some felt that as their care needs were likely to increase they
might not be able to get all the support they need: this was only
a part extra care Court. Although, as mentioned above, the
opposite view was also given, ie. that this could be a home for
life.
 Many felt that there was insufficient integration between the two
levels of provision (ie. extra care and sheltered) and not enough
shared living/sense of community. The lack of communal
activities was felt to be a strong contributory factor here.
 It was also felt that the location could be a bit isolating as bus
services had recently reduced in frequency.
In the meeting which was held in a recently built (within the last 3 years)
extra care Court, the participants advised that there was a treatment
room at the court which had never been used. They explained that they
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would appreciate having visits from medical staff who could use this
facility. Disadvantages discussed at this group included:
 Security concerns – with some residents ‘letting people in’ to the
building without knowing why they were visiting
 Frequent changes amongst care staff, particularly at weekends
when agency staff seem to be used more frequently
 Things being very quiet at weekends, partly due to the restaurant
being closed on a Sunday – ‘We just stay in the flats at
weekends’
List of services that residents would like to see provided
 24 hour care and support as needs increase.
 Emergency alarm.
 Meals service/cooked on site or delivered.
 Communal lunches.
 A shop.
 Hairdressing services/a salon space.
 A dedicated health / treatment / consulting room.
 More qualified medical staff on site / visiting - including doctors,
nurses, chiropodists, opticians.
 Cleaning of communal areas(this arose because one court did
not currently have a communal cleaner and this was causing
some problems).
 Domestic help in people’s own flats.
 Good and regular advice: eg. regular visits of a fire safety officer
to talk of first aid and fire safety.
 A transport/minibus service dedicated to the scheme in the
absence of good available public transport.
 Shopping services (in one court a service provided by Age
Concern is available).
 Ring and Ride services – which were found to be available at
two courts, arranged and paid for individually, however this was
not felt to be a good service at one court.
 Personal Assistants – it was advised by one participant that they
believed Housing 21 provide this service now, which people can
‘buy’ for a variable time period.
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Appendix 2: Further Information from Wider
Literature / Other Sources
Further information obtained during literature and other searches for
background information during this project is shown below for information.
Information (from published sources) on Individual Budgets /
Personalisation in West Sussex
In an article in Community Care in June 200820, the following was reported
on Individual Budgets in West Sussex:
 There are more than 700 people in West Sussex on self directed
support packages (at the time of writing), with around 100 of
these on IBs.
 Project Management staff described strong support from CSIP as
being essential in the initiation and development of the IB pilot.
 Three core operational teams worked as part of the pilot with
other stakeholders – including voluntary and independent sector
providers.
 A lot of effort was required to scope the different funding
streams involved in IBs.
 Difficulties were seen in streamlining self assessment through the
complexities encountered in the range of funding streams.
 The West Sussex pilot began by testing the in Control model with
older people and found that ongoing adaptations and
developments were required.
 Key factors which contributed to success were seen as :
o Frequent small team meetings to discuss issues and challenge
thinking
o Supporting frontline staff, eg. through regular briefing sessions
throughout the course of the pilot
o Gathering views of users, staff, carers and stakeholders on an
ongoing basis
 The significance and scope of the work is highlighted within the
article and summed up in the following quotation by West
Sussex’s Executive director of Adults and Children’s Services ‘The enormous cultural shift required to reform social care into an
20
Bowler, E. (2008) Individual Budgets in West Sussex Care Services communitycare.co.uk, posted 26 th of
June 2008
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enabling system away from one of paternalism cannot be
underestimated and is something that we have given a high
priority’.
The transforming and empowering potential of IBs are illustrated
within this article through quotations from people using them.
The following areas were give as those which have been found
to work in West Sussex :
o Sharing stories of success and examples of potential uses
o Champions who are enthusiastic about the possibilities and
empowered to effect change
o Development of the market, in line with the project
o A culture which is open to learning, change and sharing
results
Jane Goldingham, Individual Budgets Project Lead in West Sussex,
reported the following information and findings from on this project in a
presentation given in June 2008:
 The overriding vision of West Sussex County Council for Adults
Services providing a backdrop for this project. This includes:
o transformation of social care into a system of self directed
support
o the creation of a high quality, customer focused and efficient
model, which accounts for the needs of partners
o supporting people to achieve wellbeing through reducing
barriers to access in key areas of life.
 The principles of self directed support are described as follows :
o Right to independent living
o Right to an individual budget
o Right to self determination
o Right to flexible funding
o Accountability and responsibility principle
o Capacity principle.
 Background and essential building blocks are given as follows for
West Sussex:
o A large population of older people
o Well established Direct Payments scheme and ILA support
service
o Self Directed Support Programme Board (In Control, IB Pilot,
Direct and Indirect Payments)
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21
o In Control (LD) pilot methodology tried and tested
successfully
o Indirect payments policy in place
o Supporting People – initial work undertaken on aligning
funding with social care funding via Direct Payments.
Tools developed as part of the pilot included :
o Self / supported assessment
o Resource Allocation System
o Different funding streams
o Development, agreement and implementation of support
plans
o Review and monitoring.
Five funding streams were involved – social care funding
(including carer’s grant); Supporting People; Integrated
Community Equipment Service; Disabled Facilities Grant and
Independent Living Fund (65-75 years)
Positives seen (from the older person’s viewpoint) :
o People appreciated being asked their opinion
o A strong desire was seen amongst people wanting to be in
control of decisions on their own care
o Wider choice of equipment given
o Family involvement
o Carers were taken into account
o Increased flexibility.
Challenges seen (from the older person’s viewpoint) :
o People often need the ‘expert’ (ie. social worker) to lead
them
o Having enough knowledge to make choices
o Knowing what is available and appropriate
o The potential for abuse by families
o A lack of acknowledgement of the value of carers
o Having the mental capacity to make decisions.
Quotations from older people and carers reflect the
appreciation of flexibility and acknowledgement of a change in
attitudes amongst Adults Services staff – leading to improved
outcomes and quality of life.
The benefits of Individual budgets were listed (from a document
by Jane Weston21):
Weston, J. : Individual Budgets – the Carer’s View
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o Choice and flexibility enabling creative solutions
o Increased customer satisfaction
o Reduced feelings of exclusion from society
o Improved psychological wellbeing.
Challenges listed included :
o Moving from a service to outcomes focus
o Developing effective tools – eg. assessment / RAS
o Support planning
o Engaging / enthusing staff and stakeholders
o Developing the market
o Combating mistrust – ie it’s not about saving money
o Choice & Control vs Responsibility & Risk
o Aligning funding streams – charging / managing rules.
The situation now in West Sussex was described as:
o IB and in Control pilots now complete
o Lessons Learned complete
o Combining learning from the above and experiences of
Direct Payments
o The Mental Health (working age) pilot is ongoing
o End to end process workshops are complete, which involved
mapping of gaps / additional processes
o There are 800 people with a personal budget in place
o Single self or supported assessment is in place
o Progress is being made towards single RAS
o Self Directed Support Terminology has been agreed and
published.
The Future is seen as involving :
o A rollout of Self Directed Support across all client groups
o The development of customer and carer reference groups
o Continuing to collect stories
o Ongoing staff training and engagement
o Ongoing work on systems and processes, including new Self
Directed Support IT solutions
o Developing joint work on personalisation with Health
o Developing the market focusing on outcome based
contracting.
Information (from published sources) on Individual Budgets /
Personalisation in Oldham
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In an interview with Karen Saville, Oldham MBC, in March 2007 which was
reported on by DH / CSIP, the implications of working with Self Directed
Support approaches for Care Managers are discussed. The following
points emerged from this interview :
 The Individual Budgets (IB) pilot is representing
transformational change in social care in Oldham, in a
proactive not a reactive way.
 Challenges have been experienced in getting care
managers to release power and control, but opportunities
have been seen in this being a positive way to reestablish
‘real social work’, what people originally got into the job to
do.
 Openness, honesty and transparency are key.
 Two big challenges have been experienced – tackling
ingrained attitudes amongst staff and replacing ‘professional
knows best’ with a partnership approach.
 Care managers have been involved through information
sessions, team briefings and presentations which have
allowed them to ask questions, discuss concerns and develop
an understanding of how roles need to change.
 Care managers have also been involved in designing and
implementing the IB pilot.
 An inclusive, top down and bottom up approach has also
been developed and everyone has been viewed as having
a part to play.
 The Resource Allocation System and the Risk Enablement
Panel have both provided opportunities for shared decision
making and illustrated the balance of areas such as rights to
take risks with duty of care.
 Embedding this as everyday business (not something different
or transient) has helped to develop trust in the processes.
Ratifying RAS policy at council level and ensuring cost
neutrality have helped in this process.
 Changing culture to enable people to let go of bureaucratic
processes which have no obvious point has been one of the
biggest challenges.
 Real stories and examples with positive outcomes are making
a huge difference in helping people to see how changes can
be made. Seeing outcomes for users makes a huge
difference.
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Clear and ongoing communication with care managers is
vital.
IBs are strongly believed to be the way forward – allowing
greater equality, citizenship and job satisfaction.
A once resistant care manager has been proactive and set
up a support group for parents, which helps to promote the
new approaches.
The example was given of an older woman who changed
her services to enable her to go to church and have her
curtains changed.
There is a strong belief that change should be attempted on
a large scale and that IBs can work for everyone.
Bev Maybury, Head of Modernisation and the Individual Budgets lead in
Oldham MBC was interviewed about the IB Pilot and in Control
programmes and the interview was subsequently added to the Talk
website (www.talknet.eu/confidence/display/TALKOIC). Some points
which emerged from the interview which have implications for this project
are listed below:
 A co-operative of former Local Authority staff who are now
Personal Assistants is emerging within the area.
 It is believed that good providers will view IBs as a good
opportunity to develop new and different services.
 Partnership working is considered vital – eg. to ensure the market
is not destabalised.
 Most people do have fluctuating needs and conditions and it is
believed that IBs can respond to these and also facilitate
support that is appropriate and proportionate to the needs of
that person. Self assessment is the beginning of a process which
helps to do this, moving away from the paternalistic approach of
the past.
 Increased efficiencies and greater levels of client satisfaction
have been seen through the IB programmes.
 Massive, whole systems changes have been seen in Oldham.
 Block contracts which can respond to IBs have yet to be seen.
 This is not just about changing processes – it’s about changing
hearts and minds.
 Leadership is vital, but this area can be subtle and hard to
quantify / replicate.
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The Risk Enablement Panel in Oldham is also open to providers of
services.
A presentation by Viv Slater, Assistant Team Manager, Oldham in Control
also appears on the above website. Some key points from the
presentation include:
 Around 5,000 referrals are received by Oldham Social Services
for adults every year, around 4,000 cases are open at any one
time and approximately 3,000 referrals are carried out annually.
 Oldham joined in Control in 2005.
 Much inequality was felt to exist within the system, eg. older
people were often subject to a best value limit of £250 per week,
while funding for some individuals ran to £250k per year.
 The cost of service provision was not always clear and the
decision to provide services could be based on subjective views
– more transparency was believed to be needed.
 Few block contracts were believed to work in the council’s or
citizen’s favour and much of the provision was in house.
 Radical change has been initiated through a new senior
management team.
 There was a recognised need for a large scale culture change,
which fuelled the decision to involve all service users in the IB
pilot – rather than a sample. One Resource Allocation System is
used for everyone, its development and implementation has
been a considerable challenge.
 Older people have been found to often underestimate their own
needs.
 In Oldham there is a firm belief that better, more holistic,
outcomes have been achieved for people at no extra cost.
 Respite care is a particular area where increased levels of
satisfaction have been seen.
Messages Related to Personalisation / Self Directed Support from Literature
on Specialist Housing for Older People
The following were found to be important areas relating to social
wellbeing for tenants in extra care housing (from a JRF research study22):
Evans, S. and Vallelly, S: Social Well-Being in Extra care Housing , Joseph Rowntree
Foundation (2007)
22
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Having a range of activities for different interests and abilities.
Opportunities to develop and maintain a social life that is
independent of the housing scheme.
 Integration of housing schemes with the local community.
 Social areas such as restaurants and shops as venues for social
interaction.
 The provision of care and support services outside of core hours
of work.
Other findings of the study included:
 A person-centred approach to care provision can contribute
towards social well-being.
 An understanding and toleration of diversity by a range of
stakeholders is needed including tenants, family carers and
professionals across housing, health and social care.
 Information on supporting social well-being should be included
in profiles of extra care housing and other long-term care
options.
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In another JRF study23 an evaluation of a number of different models of
housing with care for older people was carried out. Key findings which
can be related to personalisation included:
 The combination of independence with security, which models
such as extra care housing offer being attractive to a wide
range of older people.
 Larger schemes seeming to offer some social benefits.
 Location and design features having significant impacts on
residents’ quality of life.
 The importance of not underestimating the housing
considerations of residents with care needs.
 Informal support from families and volunteers often playing a
crucial role for residents – supporting their quality of life.
 In some schemes, not all care needs were able to be met on
site, especially for people with mental health needs.
Croucher et al : Comparative Evaluation of Models of Housing with Care for Later Life,
Joseph Rowntree Foundation (2007)
23
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In a review of some of the evidence on housing with care presented by
Simon Evans in November 200824, 3 themes for housing with care for Older
People were explored :
 The Promotion of Independence and Wellbeing
 Housing with care as Sustainable Communities
 Supporting older people with dementias
The importance of many of the areas highlighted in the studies mentioned
above were also emphasised. In addition, the following points were
made / emphasised which relate to personalisation:
 Opportunities for resident involvement (eg. residents
committees) often need to be developed / go further than seen
at present.
 Flexibility of Care is key.
 Accessible Information is vital.
 There is potential to improve connections with wider
communities in many schemes – issues of location and transport
need to be considered.
 If support is provided in the right way, people with dementia can
be successfully supported in these settings.
 Questions of diversity – and prejudice – often arise,
encompassing areas such as ethnicity, health, tenure and age.
Messages related to Personalisation / Self Directed Support for Older
People from Wider Literature / Sources
Several studies related to older people’s experience of self directed
support (including Direct Payments and personalisation more widely)
were reviewed as part of this project. A summary of key messages
which have emerged from this literature is shown below.
 Support and knowledge of key professionals (Social Workers /
Care Managers / Specialist IB / DP teams) is vital for individuals
embarking on Self Directed Support (SDS) – on an ongoing basis,
particularly in the area of employing Personal Assistants.
 Organisations need to prepare for SDS through staff training and
buy in (knowledge / confidence building), ensuring systems
(including financial) support SDS, and that ‘the market’ to
support SDS is developing in local areas. Everything must support
Evans, S. Presentation at Housing with Care : Current Evidence Future Policy, November
2008
24
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user involvement, eg use of language everyone can understand,
processes which are as simple as possible, a commitment to true
partnership with users – including involving users as much as
possible at every stage of development, from as early a stage as
possible.
Champions of DPs / IBs / SDS / Person centred approaches really
appear to help their development and spread in areas.
The involvement of well established and active user-led
organisations and resources really helps. In areas where these
organisations are less developed and engaged, SDS seems to
be developing more slowly.
Peer support networks are also believed to be very important.
The above groups and networks can help people who are
directing their own support to unite, sometimes pool their
resources and achieve more bargaining power.
Giving people information on their total ‘budget allocation’ (for
IBs / DP’s) helps it to become more real and encourages people
to start thinking about alternatives. The Department of Health
has stated that everyone receiving Social Care will be told what
their Personal Budget is by April 2009, an initiative which is likely to
facilitate a step change in the whole area of self directed
support.
If Health and Social Care funding (and other streams)can be
pooled, this can lead to significant benefits and increased
flexibility for people – and remove barriers between types of
provisions which users have long considered to be ‘absurd’, eg.
not being able to access podiatry services through social care
funding.
Development of a diverse and accessible local ‘market’ of
support options is crucial.
The prospect of ‘having to’ employ a PA does still seem to be a
common deterrent for individuals, emphasising the importance
of the need for ongoing support for people who want to go
down this route. However the ability to have funds to pay
informal carers / people in the community who already provide
support is a much appreciated benefit.
Small changes can make a huge difference to someone’s life
and a step by step approach of small changes can lead to
significant improvements over time.
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Flexibility is key. Older people appreciate being able to mix and
match different options (eg. more traditional services with newer
approaches). People (including some from BME groups) have
appreciated the flexibility to meet their needs in a more
appropriate way – although it was recognised that there is more
likelihood of a language barrier existing for some older BME
people in trying to set up and manage their own support.
Service users don’t just need their budget allocation – they need
in some cases to be supported to develop the confidence and
skills to direct their own support ‘You don’t just become a
manager overnight’. It is also important to remember that
money is not the only tool – often discussion within this area
revolves around Personal Budgets, yet money is only one asset
which is available to people in directing their own support.
A range of examples of how others have used DP’s and /or IBs is
very helpful – for both the potential recipients and people who
are working to support them.
It is vital to start ‘where older people are’ – individually - and
work from there.
For many older people, their first contact with ‘services’ is often
at a time of crisis, therefore finding the right time to introduce
SDS options can be a tricky balancing act between avoiding a
time of urgent need and introducing these options early enough
before more traditional options become ‘embedded’ and
perceived to be too difficult to change.
Professionals can be wary of SDS at first, however helping to
improve quality of life for people through supporting their SDS
often leads to much increased job satisfaction and takes people
back to ‘why they got into this profession in the first place’.
It is vital that organisations and professionals recognise that this is
not another box to tick or another part of the job – ‘this is the
job’.
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