your money and your life: the impact of self-directed support and personal budgets john woolham

Your money and your life: the impact of self-directed support and

personal budgetsJohn Woolham

The impact of SDS & personal budgetsStructure

– Context of SDS & PBs– Description of local research site– Objectives (& what this presentation will cover)– Methods– Findings– Conclusions

The impact of SDS & personal budgetsContext

– Personal budgets & SDS – another means of achieving:

• personalisation • empowerment • choice

o Evidence base remains weak at the present timeo Contested areas – service users as customers or

citizens?

The impact of SDS & personal budgetsContext

– Personalisation: an elusive policy aspiration over last quarter of a century

• Disability rights in USA• Case /Care Management• Social model of disability• Valuing people• Personhood & Kitwood’s work• Core social work values

The impact of SDS & personal budgetsDescription of local research site

• Shire county, 600,000+ pop• Conservative controlled • Population growing (and ageing) rapidly• Spends more than it should on younger & less on older

people• 26% of entire SSD budget tied up in residential care• Struggling to manage budgets – expecting the worst• Aspirations for radical change• Decided to use ‘In Control’ to transform local social services • A ‘transformation’ team within Adult Social Services

responsible for driving change.

The impact of SDS & personal budgetsObjectives of research

• Extent to which principles established in the ‘In Control’ approach were being realised in ‘roll-out’

• Satisfaction of recipients with SDS/PBs• Impact of SDS/PB on lives of recipients.

– This presentation – focus is only on impact.

The impact of SDS & personal budgetsDesign & methods

Research design Choice of methods Questionnaire design

Choice of questions Layout and design Piloting

Sampling REC review Survey administration

The impact of SDS & personal budgetsResponse rates & comparability of samples

The impact of SDS & personal budgets: health, personal safety, empowerment, isolation & dignity

SDS users were more likely to say their health had improved, and that they felt safer in their homes than people who used ‘traditional’ services.


SDS users were more likely to say they felt safe when they went out and that they felt they had more control over the support they used


SDS users were also more likely to feel their social life had got better, and that people treated them with more dignity.

The impact of SDS & personal budgets: care & support

The kinds of care and support purchased were also different amongst SDS users.

The impact of SDS & personal budgets: impact on ‘areas of life’

On a range of different ‘areas of life’ SDS users felt that their funding package or budget had been helpful.

However…..

The impact of SDS & personal budgets: impact on ‘areas of life’

….Substantial proportions of people also felt that SDS had not made a difference to them over the past year.

The impact of SDS & personal budgets: impact on ADL (higher scores = higher levels of functioning)

IBSEN service users had higher scores. Comparison of ‘traditional’ and SDS groups showed little difference: on some measures traditional users had higher levels of functioning

The impact of SDS & personal budgets: impact on well-being/ill-being

SDS users had lower ‘mental distress’ scores. Lower aggregate scores were evident amongst SDS users across all main care groups

The impact of SDS & personal budgets: impact on quality of life

Locally, slightly more SDS users reported that the quality of their life was ‘good’ on the whole.

The impact of SDS & personal budgets: differential impact by care group

Older people Other care groups <65 yrs

Margin of difference

(%) Trad SDS Trad SDS 65+ <65

Health has got better 7 (7%) 3 (6%) 25 (9%) 24 (19%) -1% 10% More safe at home 30 (29%) 19 (35%) 70 (26%) 57 (45%) 6% 19%

More safe when out 8 (8%) 8 (16%) 46 (18%) 52 (41%) 8% 23% More control over support 20 (21%) 16 (31%) 68 (26%) 88 (70%) 10% 44% Social life has got better 9 (9%) 5 (10%) 80 (30%) 79 (63%) 1% 33%

Treated with more dignity 39 (39%) 22 (42%) 102 (40%) 60 48%) 3% 8% The difference between ‘traditional’ and SDS groups was slight amongst older people, and large amongst people aged under 65 years

The impact of SDS & personal budgets: costs and cost effectiveness

•It was extremely difficult to get reliable information about package costs.

•SDS users received more money than traditional service package users (44% more overall).

•Differences were much greater in some care groups: (111% for older people).


There was a clear ‘skew’ in traditional packages toward less expensive packages.


Data above the horizontal line = worse than average. Data to the right of the vertical line = more expensive than average. Little evidence of benefit on ADL, but greater cost.


For GHQ, benefit is evident, but so is cost.


IBSEN found no benefit for older people.

This study suggests limited benefit but greater cost.


For younger adultsSDS users (on left) had better outcomes than older people on both ADL and GHQ scales.

Costs were also greater

The impact of SDS & personal budgets Conclusions

• SDS users were more likely to report improvements in health, feelings of personal safety, control over their support, being treated with dignity that their social life had improved, and less likely to be experiencing mental distress.

However….


• There was little evidence that SDS users were any more likely to be able to perform ADLs

• Substantial numbers of SDS users said their budget hadn’t made a difference to them in respect of ‘areas of life’

• Impact was differential – younger adults had the best outcomes on the measures used. For older people differences between traditional and SDS users were much less marked.

• Transformational impact greatest amongst ‘self completers’ - implications.


• Costs more for SDS userso SDS as the ‘means’ not the end. If SDS costs were

equivalent to ‘traditional’ packages, would this lead to poorer outcomes for SDS users?

o If costs of ‘traditional’ packages were increased commensurately with SDS costs, would this lead to better outcomes for ‘traditional’ package users?

• Are there better ways of achieving personalised services for some people than personal budgets and SDS?

The impact of SDS & personal budgets Conclusions : SDS/Personal budgets: a false prospectus?

• Are people who use budgets customers or citizens? Is being a ‘customer’ empowering – now and in the longer term?

• What impact will SDS have on people who have impaired mental capacity?

• Are the improvements in outcome sustainable within a local care economy based on market principles & values and a shrinking resource base?

• If SDS isn’t the most effective way of achieving personalisation for some people – will there be any turning back from market forces?

References

Carr, S. & Dittrich, R., Personalisation: A Rough Guide (2009) SCIE., London. Carr, S. Choice, Control & Individual Budgets: Emerging themes (2007) SCIE., LondonClarke, J., Smith, N., & Vidler,E., The Indeterminacy of Choice: Political, Policy and Organisational Implications (2006) Social Policy & Society 5.3. p 327-336 CUP. Clarke, J., Newman, J. & Westmarland, L., The Antagonisms of Choice: New Labour and the Reform of Public Services (2008) Social Policy & Society (7) p 245-253 CUPGlendinning C., Challis, D., et. al IBSEN Evaluation of the Individual Budgets Pilot Programme (2008) SPRU, University of York. Hatton, C., Waters, J. et al. A Report on In Control’s Second Phase Evaluation and Learning 2005-07 (2008) In Control Publications, London. Poll, C., Duffy, S., et al A report on In Control’s First Phase 2003-05 (2006) In Control Publications, London.

your money and your life: the impact of self-directed support and personal budgets john woolham

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