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Wide Variation In Implementation of Self-Directed Support


Community Care magazine has reported that the latest government figures show a huge national variation in the implementation of personal budgets. Originally the plan had been for all adults entitled to publicly funded adult care to have personal budgets by 2011, but the date was put back to 2013 when the deadline began to appear unrealistic. In the end the national figure for 2010-11 was 29.2% , compared to 13% in 2009-10. The biggest surprise, though, has been the variation in the scores for different local authority areas.

Implementation rates ranged from 4% in Somerset to 71% in Manchester. Figures were generally higher on the north of Engalnd and lower in the south-west. Oxfordshire was very close to the national average, with 29.5% of clients receiving care through individual budgets. Locally this compares to 53.9% in Buckinghamshire and 10.6% in West Berkshire. But do these figures give a good indication of how well SDS is working? Other statistics would suggest not. For example in Oxfordshire the percentage of older people discharged from hospital who were still living at home 3 months later was 82.2%, compared to 98.1% in West Berkshire 98.1% and 79.1% in Bucks - the exact opposite pattern to that for implementation of individual budgets.


The Association of Directors of Adult Social Services (ADASS) has also urged caution, suggesting that aiming for 100% adoption would mean pushing personal budgets on some people who didn't want or need them, such as older adults with dementia. This reflects the experience of many people working on the ground. In May of last year, a joint survey by Community Care and Unison found that 83% of social workers thought that cuts would impede the implementation of self-directed support, with only 41% still believing that personal budgets would help clients to live independently in the medium to long term. Through Community Glue, we have often come into contact with service users who preferred the arrangements under the old system (where the amounts included Direct Payments were explicitly linked to the assessed need for services) as well as older adults who have struggled with the idea of managing their own budgets at a stage in their lives when many would rather be putting their feet up.


So why are the government still pressing for 100% adoption by April 2013? On factor must be budget pressure. Many have commented that cuts have underminsed the original purpose of personalisation, which they fear has simply become a back door for cuts. Another issue is the passing of the Health and Social Care Act 2012, parts of which are clearly aimed at creating 'personal health and social care budgets' that span NHS and local authority responsibilities. It seems that for better or for worse, the pressure to implement personal budgets for scoial care is now unstoppable.


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