Karen Jones, Ann Netten, José-Luis Fernández,
Martin Knapp, David Challis, Caroline Glendinning,
Sally Jacobs, Jill Manthorpe, Nicola Moran, Martin
Stevens and Mark Wilberforce

 At heart of ‘personalisation’ agenda
 Promoting choice
 2005 Cabinet Office Strategy Unit report
 2005 Social Care Green Paper
 Built on experiences of:
 Direct payments
 In Control

 Greater role for users in assessing needs
 Users should know resources available before planning how needs met. Resource Allocation
System (RAS) recommended
 Encourage users to identify desired outcomes and how to achieve these
 Support individuals in using IBs
 Test opportunities to integrate funding streams and simplify/integrate/align multiple assessment processes and eligibility criteria
 Experiment with different ways of deploying IBs

 Adult social care (gateway to IB)
 Supporting People (DCLG)
 Independent Living Fund (DWP)
 Disabled Facilities Grant (DCLG)
 Access to Work (DWP)
 Integrated Community Equipment Services (DH)

Considerable local and individual flexibility:
 Cash direct payment
 Care managerheld ‘virtual budget’
 Providerheld ‘individual service account’
 Indirect payment to third party
 … or combinations of these

 13 local authorities
 representative mix but higher than average take-up of direct payments
 Mix of user groups (OP, LD, MH, P/SI)
 Mix of funding streams

 Do IBs offer better way of supporting disabled adults and older people than conventional methods of resource allocation and service delivery?
 Which models work best and for whom?
 Evaluation covered:
 User experiences, implementation experiences, funding stream integration, impact on care managers, impact on providers, risk and protection, outcomes, costs, cost-effectiveness

Do individual budgets offer a better way to support disabled adults and older people than conventional methods of resource allocation and service delivery?
If so, which models work best and for whom?
Evaluation dimensions
User experience
Carer impact
Workforce
Care management
Provider impact
Risk & protection
Commissioning
Outcomes
Costs
Cost-effectiveness

 Randomised trial – 500 each IB and comparison groups across sites and user groups
 Baseline data on circumstances and current support arrangements
 Outcome interviews after 6 months
 IB group – content and costs of support plans
 In-depth user interviews 2 – 6 months – support planning process
 Interviews with IB leads (x 2), providers, commissioning managers, other managers
 Interviews and diaries, front-line staff and first-tier managers

 Randomised controlled trial – within each site, users allocated to IB or comparison group
 Baseline data from LA records
 Follow-up outcome interviews after 6 months
 Analysis IB support plans
 In-depth user interviews – support planning process
 Interviews with IB leads, funding stream leads, providers, commissioning and other managers, support planning organisations
 Interviews and diary study, front line staff and first tier managers

1594 of the 2521 individuals randomised (63%) consented
Final sample of 959 people:
 34% physically disabled
 28% older people
 25% with learning disabilities
 14% using mental health services
Wide variations in age, functional need and FACS level
IB and comparison groups not different at baseline
Note : IB not in place at 6 months for everyone

Average weekly value of an IB:
£359 learning disabilities £228 older people
£310 mental health users £149 disabled people
Average weekly cost across all user groups =
£279 for IB group … £296 for comparison group
Care manager support for IB group (£19) was higher than for those with conventional support (£11)
Cost variations : higher costs for those who declined an IB ; and for those without a support plan at 6 months

 Funding stream integration
 99% support plans contained social service funding
 11% of support plans contained SP funding
 8% of support plans contained ILF monies
 1 support plan contained Access to Work funding
 No support plans contained funding from DFG

 67% IB managed as a DP
 MH (89%) more likely
 OP (56%) less likely
 20% managed by local authority
 13% managed by an agent
 1 IB administered through a Trust
 4 had services organised through a provider

Personal assistant
Home care
Leisure activities
Planned short breaks**
Other
Direct payments
% Mean annual expenditure
64 £8,940
20
43
£7,140
£2,020
24
23
£1,750
£930
Managed budgets
% Mean annual expenditure
47 £7,420
40
24
£7,480
£1,750
15
21
£5,460
£270

Accommodation
(N=24)
Cleaning service
Decorating service
Gardening service
Employment and occupation
(N=16)
Going out: trips/cinema etc
Health-related (N=3)
Private health care
Classes/arts and crafts
Gym membership/swimming
Computer maintenance
Admission fees for service user and PA
Massage for carer
Alternative therapy


 10% for less than one month
 51% for more than 3 months
 11% not all in place


 Interviews at 6 months; only 45% had IB support in place
 Measures:
 Quality of life (7-point scale)
 Psychological well-being (GHQ12)
 Social care outcomes (ASCOT)
 Satisfaction (7-point scale)
 Differences between IB and comparison groups
 Multi-variate analyses

 Quality of life
 Overall sample – no significant difference
 MH – IB group better QoL
 Psychological well-being (GHQ12)
 Overall sample – no significant difference
 OP – IB group lower well-being
 Both measures – bigger IBs = better outcomes
 Social care outcomes (ASCOT)
 Overall sample – no significant difference
 IB group higher scores in ‘control over daily living’ domain
 LD – higher levels of control
 Satisfaction
 IB group more satisfied overall
 P/SD IB group more satisfied

 Positive effects of IBs
 QoL, social care outcomes and satisfaction
 Older people
 Concerns about managing budgets?
 Anxiety about change?
 Lower budgets, more personal care, less flexibility?
 Level of IB affects outcome

 Are improvements in outcomes justifiable in terms of costs?
 Combined data on costs and outcomes
 Some evidence of cost-effectiveness in overall sample in respect of social care outcomes
 Weaker evidence of cost-effectiveness with respect to psychological well-being
 But significant variations by user group:
 IBs more cost-effective for PD and MH groups
 No evidence of cost-effectiveness for OP