Eleanor Roosevelt, 1958

'Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person... Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.' Eleanor Roosevelt, 1958

The Small Places has moved...

The Small Places has moved to a new home here, including all the old posts. Any posts after 6th March 2014 will appear on the new website, but old posts are preserved here so that URLs linking here continue to work. Please check out the new site.

Tuesday, 6 September 2011

How 'transparent' are personal budgets?

[Note: The research referred to in this post has been expanded upon since it was written and published in the Journal of Social Welfare and Family Law (Series, L. & Clements, L. (2013) 'Putting the Cart before the Horse: Resource Allocation Systems and Community Care', Journal of Social Welfare and Family Law, 35(2) 207-226).  A pre-print version of this paper can be downloaded from here]
The personalisation agenda in adult social care is a bit of a hobby of mine.  It is massively important for understanding the landscape of adult social care today.  Sometimes, when I'm bored of the Mental Capacity Act, I indulge myself by doing little research forays into personal budgets, resource allocation systems, brokerage, providers and rules and regulations (see, e.g., this post on whether personalisation is inadvertently criminalising carers).  I know, I'm a very sad person.

The thing that interests me about personalisation is that it's simultaneously such a brilliant and yet dastardly idea.  The central idea is that instead of the local authority deciding what your needs are and matching them with community care services they have chosen, under 'self directed support' or personalisation you participate in assessing your own needs, then the local authority convert this into a cash value using a Resource Allocation System (a RAS), and then you spend that money on the services you think will meet your needs.  For people who would prefer to minimise contact with social services, who would prefer to research and choose their own services, who would like to be able to threaten service providers with taking their custom elsewhere instead of being stuck with a slot in a 'block contracted' service, for people who want to go to the gym or a football match or the pub instead of a day centre, for people who would like to employ a personal assistant directly instead of dealing with the vagaries of domiciliary care agencies - it is fantastic.  Well, almost.  When people have the knowledge, support and adequate resources to meet their needs and achieve their goals, personalisation is fantastic.

Personalisation is not without its critics.  And no, David Brindle of the Guardian, it's not just paranoid social workers who think it's a challenge to their role, and it's not just the Daily Mail fantasising about spending social care money on prostitutes and lap dancing  - there are concerns about personalisation from a range of perspectives.  The organisation In Control were the pioneers of personalisation, and in 2009 they held a conference entitled 'Don't be Fooled by the Law' which explored tensions between personalisation (which is a policy, not a law) and community care law.  Concerns were voiced from a range of legal professionals around whether pure self-assessment would miss important issues, whether personal budgets attracted safeguarding issues, who was liable if a person was placed at risk, and also whether eligible needs would still be met under personalised models of care.  The issue I want to focus on today, however, is whether personalisation is as 'transparent' as it's advocates suggest, and whether it does offer opportunities for 'cuts by the back door' as its detractors say.

Transparency is central to the ideals of personalisation and may be legally important

[Edit: See Postscript 2 below for more information and a response to the issues raised in this post from In Control]

In their conference reported (Don't be Fooled by the Law) In Control stated:
In Control’s view is that FACS is not in fact “fair” and should be abolished, and that a RAS should become the single, clear and transparent way of determining the indicative resource allocation for individuals. 
They later addressed the concern that RASs are not transparent:
Q5. In reality the RAS is rarely transparent. Sometimes there are multiple versions of the Self-Assessment completed (“user,” “carer,” “care manager”), and then all the power is in the hands of the Local Authority to interpret this data and allocate resources as it wishes. 
Of course, any system is open to abuse and in a situation of budgetary pressure it would be remarkable if there were not examples of Local Authorities which found ways to make use of the reformed system to achieve short-term savings in ways which conflict with the Disability Legislation. Sometimes, individual managers who are under pressure to deliver savings targets do this, on other occasions there is little doubt that SDS is seen from on-high as a way to contain costs, and little more than this. This is extremely sad. In Control is absolutely adamant that it is unacceptable, and we are equally clear that it is not the Government’s intention in its Putting People First policy. Where we encounter such bad practice our approach is firstly to remind the Authority concerned of the Statement of Ethical Values which they agree to on joining In Control -this is the bedrock of all our work - and secondly to offer advice and guidance as part of our leadership development programme, and thirdly to advise them that they are liable to challenge under the Disability Discrimination Act 2005. If a Local Authority is challenged under this legislation, it may well be faced with Judicial Review Proceedings which will cost large sums of public money.
RAS's are touted as being more 'objective' than resource allocation done through traditional means; on a positive note this may mean that service users who are widely offered less attractive packages of support (particularly older people) may benefit.  However, it is in the nature of the RAS that some people will not benefit, because the resources are not being increased overall - they are being redistributed.  This is really clear from In Control's own chart from their guidance on creating a RAS:


The smoothed purple area reflects the new entitlements for service users calculated using the RAS, and the blue lines represent existing amounts spent on a traditional care plan.  You can see that some people have more money to purchase services, but you can see that other people's budgets have been drastically cut.  The interesting questions for lawyers is whether their eligible needs can still be met from this amount.  In the case JL v Islington (2009) the parents of a disabled child challenged a drastic reduction in his care budget following application of a sort of banded award system similar to RAS's.  The judge stated that the amount awarded at must be flexible, and if the amount arrived at by resource allocation procedures was insufficient to meet eligible needs, then it must be increased.  Imagine the cost to the system if all the people in who had their care packages cut successfully challenged it, meanwhile the people at the lower end were being awarded more...

In another important case, Savva v Kensington and Chelsea (2010), the judge stated:
The personal budget must be sufficient to purchase the services and is needs-led, and it seems to me that the only way in which a service user can be satisfied that the personal budget has been correctly assessed by the Panel is by a reasoned decision letter. [44]
and
That principle is directly applicable in the present context, and the problem of course, in this case, is that a reading of the letter from the authority, which states that the Panel has kept the allocation at the same personal budget, provides no indication whatsoever as to why the Panel arrived at this decision. [46]
The question is, if a local authority is relying on a RAS that is basically a mathematical algorithm based on multiple choice assessment responses, how 'reasoned' can this letter be?  A case that is headed to the Supreme Court will soon test this issue.  In KM v Cambridgeshire County Council the Court of Appeal described the process for arriving at an award using a RAS as 'tortuous' [2], [7], but did conclude that the council had sent an 'intelligible eventual explanation' and the decision to award that amount was rational.  The Lords of Appeal commented:
There has of course to be a rational link between the needs and the assessed direct payments, but, in our judgment, there does not need to be a finite absolute mathematical link. [22]
The Supreme Court will consider this issue further.  It will be interesting to see how far local authorities must make clear the reasoning involved in the RAS to service users to explain their awards, and whether this in itself is deemed a sufficient explanation.  It seems to me that unless the underpinnings of RAS's are made transparent, there is a real danger that the reasoning behind an award would become "computer says so".  In any case, however, it strikes me as a significant public interest issue to understand the general basis upon which community care resources are being distributed.



Why should we worry about what's in a RAS?

I would not for one minute deny that traditional systems for allocating resources in community care are highly subjective, and rife with opportunities for discrimination and unfairness.  However, I would contest the idea that RAS's themselves are either fair or objective.  They encode in their calculations certain assumptions about how much it would cost to meet a person's eligible needs.  This might include, for instance, assumptions about the cost of care services in the area, which may not take into account the cost of specialised services for meeting a person's needs, or it may inhibit purchasing from smaller or higher quality care providers that are more costly.  In a paper by one of the architects of personalisation Simon Duffy (2005) gives an example of a very primitive RAS in two tables on pages 7 and 8.  Note that people who live outside the family home get twice as much money as those who do not.  Now, clearly this is only a sketch and not a real functioning RAS, but it has clearly built in assumptions about the level of support a person will get from their family, with no consideration of how much support their family is able and willing to provide.  Some RAS's include a 'cost abatement multiplier' - which Luke Clements, in his excellent and entertaining paper on personalisation, describes thus: 
It is at this stage that any science in the process is jettisoned in favour of witchcraft. The resultant sum is then reduced. The reason for this has variously been explained as providing ‘headroom to avoid overspending’ or to avoid inducing ‘dependency’ (see L Clements, ‘Individual Budgets and irrational exuberance’ (2008) 11 CCLR 413–430). (p4)
It would be interesting to see what 'rational' explanations for cost abatement multipliers could be offered in court...

There are other reasons why it would be useful to look at RAS's.  Some people may need more help managing their personal budget, for instance through buying in brokerage services - it would be useful to know if this is factored into the award they are given.  If it is not, then we should seriously consider whether RAS's embed discriminatory practices against people who lack the mental capacity to manage their own individual budget.  It would be interesting to know whether a local authority operates the same, or different, RAS's for people who, e.g., are older, have mental health problems, have learning disabilities or physical disabilities.  It would be useful to know what kinds of questions in the assessment are linked to the RAS - are there salient issues that might affect somebody's community care needs that elude this form of 'multiple choice' assessment-by-numbers?  For all these reasons and more, I contend that it is very important we are able to explore the underpinnings of the RAS's operated by the local authorities.  But here's the problem.

[Edit: 02/03/2012 Since writing this piece I have continued to try to find out about RAS's for a research paper which I hope to publish at some point in the future.  My findings suggest that the these concerns about unfairness in the RAS may be well founded, but perhaps of more interest is the finding that many local authorities have found them to be so inaccurate they have simply abandoned using them.  Of those that continue to use them and supplied the relevant information, the gap between 'indicative amount' and 'actual allocation' is so significant, and so often people receive less than the RAS indicates, that the idea the RAS creates a 'fair and transparent entitlement' is laughable.  I wonder what the point of the RAS is at all, if care managers end up using different means to work out the cost of a budget?]

How transparent are local authorities' RASs?

As I said, personalisation is a sad little hobby of mine, so I wrote to various of the 'Total Transformation' local authorities who In Control worked with to test out the personalisation of adult social care.  I asked them various questions about how personalisation was going for them, and also for the mechanisms underpinning their RAS.  I didn't write to them all as this isn't a full blown research project and I didn't have the time, and I also wrote to Cornwall Council, who are not a transformation local authority, but it was where my doctoral research is based.  I made all my requests through the third party website What Do They Know, so they are available for all to view.  And yesterday I sat down and belatedly collated all the links and responses into this google spreadsheet.  The spreadsheet is (if I do say so myself) quite interesting for reasons unrelated to RASs, as it contains links to different authorities' policies around mental capacity and CRB checks, and also information on the number of legal challenges they have received in relation to personalisation.  Interestingly, Lancashire apparently received 30 legal challenges (including letters before action that didn't go to trial) last year, while Hartlepool received none, and [edit 07/09: I just spoke to Kent's FOI officer by telephone, who says they received a request this week asking whether they have had any legal challenges relating to the amount awarded in a direct payment.  She says that their legal team advised her they had had none to date.  Not even letters before action.]  Most areas seemed to be having around 5 or 6 personalisation related legal challenges a year; I'm not really equipped to say if that's a lot in the great scheme of things, but some readers may know.

The thing that is striking is that whilst most local authorities were happy to share policies and documents galore (sometimes nothing to do with what I had requested!), there was a marked reluctance to share information about the RAS in any great detail.  West Sussex and Hampshire Council were the most 'transparent', in that they provided information on the points that would be scored by different responses to the assessment questionnaire.  I have to say, I am still not clear from these responses how you get to a cash entitlement, it would have been nice to see a spreadsheet or something you could 'test drive', but certainly it is interesting to be able to see what questions are asked, and how much weight is attached to different responses.  Kent County Council responded that they did not operate a RAS.  Cambridgeshire, Hartlepool and Lancashire gave sort of vague descriptions of how they had developed their RAS's, but little detail on the content of the RAS or how it worked.  None of these responded to follow up requests for further information (although - if they received the requests - they would be required by the Freedom of Information Act 2000 to either treat these as new requests - that should have been responded to months ago - or as internal reviews meriting a response).  Interestingly, Cornwall County Council and Essex County Council applied exemptions contained within s36(2) Freedom of Information Act 2000 to supplying this information.  Essex have yet to supply the 'public interest test' itself, but I've chivvied them with a phone call.  Cornwall Council said this:
The RAS is a spreadsheet (at present) that uses questions in ACS overview assessment to produce a financial indication of how much it would cost to meet a person’s needs. If this was made available on the website then anyone completing the assessment may be able to answer the questions on the assessment in such a way as to produce a higher personal budget than they need. This could have serious implications on ACS’s management of their budget. This would also mean that a person’s assessment of their needs (our legal assessment tool to comply with Community Care Act) would not be accurate. The Council has considered the request very carefully and has decided that the information requested would, if disclosed, in the opinion of the qualified person, be prejudicial to the effective conduct of public affairs under S.36 of the Freedom of Information Act 2000.
This is quite an interesting response.  Basically, it seems as if Cornwall (and perhaps others) are concerned that by disclosing how their RAS calculates entitlements, service users will 'game' their responses to assessments in order to get their hands on more cash.  This strikes me as going entirely against the ethos of Personalisation, which emphasises trust in service users to determine their own needs and spend resources wisely in order to meet them.  It also strikes me that the public interest test has failed to take into account the public interest arguments I have outlined above: namely, that it is important that we are able to scrutinise the assumptions built into the RAS and understand how adult social care teams are distributing their resources.

[Edit 08/09: Update - Lancashire County Council responded to my request for more information on the mathematical formula used by the RAS to determine the indciative amount today by saying:
After having done an extensive search, I can confirm that Lancashire County Council do not hold any further information relating to your enquiry.
They state in their documentation that they do use a RAS, but they appear to be saying that they don't actually have any information on how it works. This seems absolutely incredible, so I've written a request asking them to clarify whether this is their position, or whether they're just applying an FOIA exemption and not sharing it with me.  I wonder if this is linked to their 30 legal  challenges last year!]

[Edit: 02/03/12: Cornwall Council contacted me to say that they had received a new request and decided to disclose their RAS after all.  You can find it on their FOI disclosure log.

Since writing this piece I have contacted 20 more local authorities, all of whom supplied details of their RAS, except Croydon.  Croydon did not say which part of the FOIA they were relying on to refuse to supply this information, but I will quote from their explanation of why:
Upon request we provide customers with quite precise details of how our RAS tool has calculated their indicative allocation. This of course is always specific to their circumstances and subject to a full explanation of the purpose and role of an indicative allocation. However, there are a number of reasons why it would be inappropriate for us to share or publish our precise formulas in their totality. The main ones are:
1.) The function of the RAS tool is to generate an indicative allocation to start support planning. Our RAS policy (which you have been sent) provides a far clearer and fuller explanation of our resource allocation system.
2.) If people completing the form (or advocating) were aware of how the answers impacted on the indicative allocation, then they may be incentivised to provide inappropriate answers to try and get a higher indicative budget. This could have serious implications for our assessment and support planning processes; and potentially even threaten the sustainability of our adult social care budget.
3.) The work of adult social care is in achieving personalised outcomes for individuals which are sustainable. The best way to promote this overriding objectiveis to focus on the community care assessment in the first instance. Over-emphasis on the RAS tool is very unhelpful from an operational and financial perspective (both generally and in individual cases).
4.) The RAS tool is developed and maintained iteratively based on learning from practice. Changes to the RAS tool can be made at any time it is felt appropriate. It is the RAS Policy that represents Council Policy, not the tool itself. The aim of these changes is to improve the reliability of the indicative allocations so that they can better inform support planning, etc. It is important to remember here that the RAS tool does not “allocate” anything. The production of an appropriate, outcome focussed support plan is the mechanism / system by which resources are allocated.”
Oh Croydon... I even wrote in my FOI request that it was for the purposes of research into transparency!  It's interesting that Croydon's refusal to disclose details on the RAS attaches to the ideological incoherence at the heart of these systems.  On the one, they are meant to create 'entitlements', and Croydon are worried that if people understood the RAS they'd rig their responses so they would be 'entitled' to more and the entire resource distribution system would collapse.  On the other hand, Croydon are quick to point out that the RAS doesn't, in fact, create a fixed entitlement.   "It is important to remember here that the RAS tool does not “allocate” anything", and so - the implication is - I don't really need to know about it anyway.  Thank you Croydon for such a fascinating response for my research on RAS's and transparency.]  One has to wonder, if the RAS "doesn't allocate anything" what the point of the costly and time consuming development and use of such systems is?

I have made many, many Freedom of Information requests in my time, and I have never felt as if I have hit such a brick wall in obtaining information as trying to find out more about RAS's.  This seems, to me, to be entirely out of keeping with the spirit of personalisation, and in a wider sense the transparency agenda promoted by this government.  Because I wasn't quick enough in chasing up local authorities for their responses, I didn't clock until last week that many of them had ignored my requests for clarification.  Unfortunately, this leaves me with a very short timescale as the clock for referring the matter to the Information Commissioner's Office will expire on 18th September.  Hopefully something more will come back by then, but so far the answer to my question seems to be: No, RAS's are categorically not a clear and transparent way of distributing resources.  Not yet, anyhow.

[Edit: 30/9: Essex County Council have now completed their 'public interest test' and have decided that it weighs in favour of disclosure after all.  Their RAS points scoring system has duly been disclosed here (pdf).    I'm still not sure how this relates to cash amounts, but I've sent a follow up request asking them.  After further correspondence, Lancashire have disclosed the full RAS system.  You can see their points scoring system here, and how points translate to indicative amounts here.]

Postscript

After posting this piece, I was interested to see these comments from social work students and practitioners on twitter (@thesmallplaces) about RAS's:



These comments suggest quite a concerning picture: that local authorities may be chopping and changing between using RAS's depending on what produces the lowest cost care plan; that practitioners themselves do not understand how the awards are arrived at; and that some RAS's may indeed reduce the awards available to people living with carers (although, these may be sensitive to what support carers are willing and able to offer).  In any case, there have been lots of reports on people's experiences of using personalisation - I'd like to see more on how RAS's are being developed and used in practice as well.

Postscript 2: In Control and transparency

Since writing this post In Control got in touch through twitter and drew my attention to their evaluation report for the transition project they ran. The relevant pages on RAS's are on p36-46.  Passages of interest include:
'Self-directed support will not function without a robust system that can put money in the hands of ordinary citizens in ways that are fair, transparent and efficient.' p26
'The RAS, whatever the finer detail, must contain at its centre a simple set of transparent rules to demonstrate how the individual gets a fair budget, according to their needs and social circumstances.'  p38
This extract from a chart on page 44 may also be of interest:

The report is really interesting in terms of exploring how RAS's are developed, and if you're a fellow RAS-geek it's well worth a read.

And for the avoidance of doubt, I asked In Control on twitter whether they thought local authorities should disclose the rules and formulae underpinning the RAS, and this was their response:



I should say at this point, if it wasn't clear at the start, I think personal budgets have tremendous potential.  My concern is that the chief aims of the personalisation agenda - empowerment and transparency - are undermined by practices like refusing to be transparent about how awards are arrived at, or only using the RAS if you think it will cut the cost of a care package.  I would also comment in passing that in discussions over the fair distribution of resources, we should not lose sight of the most significant problem facing social care today: the overall shortfall of resources to distribute. 

39 comments:

  1. For your information http://benefits.tcell.org.uk/forums/personnel-budgets-direct-payment-london-borough-foi-request and http://benefits.tcell.org.uk/forums/direct-payments

    ReplyDelete
  2. What a brilliant FOI request - thanks very much for that!! For those who need inducement to follow Kevin's links, it's to an FOI which asked “How many people in numbers are being supported by either Personnel budgets or direct payments for past or current year and could these be listed by main disabling condition”

    Brilliant.

    I also forgot to mention SCIE's Rough Guide to Personalisation:

    http://www.scie.org.uk/publications/reports/report20.asp

    And their other personalisation resources:

    http://www.scie.org.uk/topic/keyissues/personalisation

    ReplyDelete
  3. Hi again Kevin,

    Hope you don't mind but I took the liberty of asking London Councils to re-supply the data as a spreadsheet so I can do stuff with it:

    http://www.whatdotheyknow.com/request/information_on_personal_budgets/new

    Also I've asked them to add in where direct payments are paid to a third party, and the total number of service users to see if there's a relationship between the size of the average DP and the number of service users each council supports. (it'd be useful to know their FACS threshold too, but I forgot to add that in so have put it as a follow-up)

    ReplyDelete
  4. Great blog. Very interesting and informative and helpful in our challenge to the LA. Currently going through RAS with my learning disabled and autistic son. Complex situation due to `ordinary residence' regulations.
    His package has been funded at a certain level by one LA for 13 years. After deregistration of his home the LA in which his home is situated have reaasessed via the SAQ and RAS. The result came out as £10k less - approx 75% of the amount the original LA was paying!? Now the LA are trying to get Continuing Healthcare money not only to make up the deficit but cover a major part of the full funding i.e. all his 1:1 support!! Will now be asking the LA for clear details of how the RAS came up with the result.

    ReplyDelete
  5. Hi Mike,

    Goodness RAS and ordinary residence combined sound like a nightmare! You might be interested in the social care portability bill that has been introduced by a peer:

    http://www.disabledgo.com/blog/2011/06/peers-portability-bill-would-set-right-a-fundamental-wrong/

    It'd be very interesting to know if they are able to tell you how they arrived at that amount...

    ReplyDelete
  6. Fascinating, illuminating (dont take that the wrong way - I mean making it so clear that there is little rationale or equity in RAS systems) and profoundly depressing - all in one. Thank goodness for people like you who go on relentlessly interrogating and worrying the system.

    ReplyDelete
  7. Thanks for your kind words Lucianne, hopefully it'll be part of a wider conversation about how personal budgets can work if RAS's are a) so lacking in transparency; and b) so hard to connect with people's needs.

    ReplyDelete
  8. Lucy hi,

    Not at all, this should help out also http://www.londoncouncils.gov.uk/services/datasharelondon/stats/LSDS/default.htm

    http://www.personalhealthbudgets.dh.gov.uk/ and http://carerwatch.wordpress.com/2011/09/13/personal-health-budgets-the-views-of-service-users-and-carers-2/

    If you can email me again, I should be able to send you some other links

    ReplyDelete
  9. Community Care has again recently covered DP's http://www.communitycare.co.uk/Articles/2011/08/19/109083/personalisation.htm and http://www.communitycare.co.uk/Articles/2011/08/19/102669/direct-payments-personal-budgets-and-individual-budgets.htm

    ReplyDelete
  10. My analysis (PBDP) looks and reports on a different approach of, obtained through a Freedom of Information request and can be verified by London Councils own data http://www.londoncouncils.gov.uk/services/datasharelondon/stats/LSDS/default.htm , the DoH transformation cost of £520million for the UK, £42million in London has seen a poor return given the population in London is about 7.5million people. Is this reflective across the rest of the UK?

    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128368.pdf
    and
    http://www.pssru.ac.uk/publications.php , http://www.scie.org.uk/ and http://www.in-control.org.uk/ are some of the national programmes funded by HM Government.

    ReplyDelete
  11. http://www.24dash.com/news/housing/2011-09-14-Lord-Freud-reveals-direct-payments-pilots-at-NHF-conference#.TnDmM8iI--g.twitter posted today

    ReplyDelete
  12. http://www.edf.org.uk/blog/ is also good for E & D issues

    ReplyDelete
  13. Hi Kevin and Anonymous,

    Thanks very much for those links. Kevin, I'd love to hear more about your research - but I don't have your email address and I couldn't find it by googling you. Would you mind emailing or tweeting me - you should be able to find details through this blog and my twitter name is @thesmallplaces?

    I'm getting really interesting feedback on this piece though, and will try to find time for updates as everyone's clearly interesting in personalisation.

    Cheers, L

    ReplyDelete
  14. NAO report:

    Oversight of user choice and provider competition in care markets

    Shortcomings must be addressed if value for money is to be secured in the future for users of social care “personal budgets” once they are extended to all eligible users by April 2013.

    http://www.nao.org.uk/publications/1012/oversight_of_care_market.aspx

    ReplyDelete
  15. Really interested by Cornwall's comment, I did hear that assessors there were asking for information on how the RAS was worked out so that they could explain it to people they were supporting, they kept being told they didnt need to understand it. I think managers have now been given the spread sheet but its still points makes prizes!

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  16. Lucy hi,

    Forgot to mention, if you are interested in RAP and it data/information https://nascis.ic.nhs.uk/ if the site you need. It does require you to register.

    ReplyDelete
  17. Personalisation
    What’s housing got to do with it?

    A report by ADASS http://www.adass.org.uk/images/stories/Policy%20Networks/Housing%20Brochure.pdf

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  18. Cheers for those Kevin, that report looks really good!

    L

    ReplyDelete
  19. Lucy hi,

    Cam accross this site today http://www.scoop.it/t/personalisation

    ReplyDelete
  20. Thought these might be of interest also.

    http://benefits.tcell.org.uk/forums/financial-management-personal-budgets

    http://benefits.tcell.org.uk/forums/experiences-and-expectations-disabled-people

    ReplyDelete
  21. Caring for our future

    DoH http://caringforourfuture.dh.gov.uk/2011/09/15/personalisation/

    ReplyDelete
  22. Social care and health integration – the service user perspective

    refer http://www.scie.org.uk/news/blogs/lisabostock.asp

    ReplyDelete
  23. This report presents the findings from a qualitative research study commissioned by the National Audit Office to examine the users’ experiences with personal budgets in adult social care.

    Personal budgets only offer users genuine choice and control over their care when they receive the money for their care package directly to spend how they see fit, the research found.

    Managed budgets, where the local authority or a third party manages the finances on users’ behalf, do not lead to real choice for users. The research showed users tend not to realise they could exercise choice and control over their care, often continuing as under the previous system without being aware they receive a personal budget.

    Users of adult social care services are primarily interested in getting good quality care, rather than focusing on choice per se, but they do not necessarily know what they miss out on by not having choice and control over their care.

    Personal budgets, and direct payments in particular, can enable those within the social care system to use their budget in innovative ways, but effective support planning and a well developed market of providers are instrumental in helping them get the most out of their personal budgets.

    The research was conducted using a qualitative methodology, including 48 face-to-face depth interviews with people receiving personal budgets and/or their carer, and a further 6 telephone depth interviews with the professional lead on personal budgets in each of the local authorities involved.

    http://www.ipsos-mori.com/researchpublications/publications/1443/Users-of-Social-Care-Personal-Budgets.aspx

    ReplyDelete
  24. Lucy well done for http://www.whatdotheyknow.com/request/information_on_personal_budgets#incoming-212935

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  25. This is very interesting and as work in a charity supporting disabled people I have been involved in Direct Payment issues from the very beginning and not just since Personal Budgets. You say service users can use their budgets flexibly and this indeed was what Individual Budgets are about but Gateshead insist that the legislation is not in place so only provide Direct Payments and in essence provide only funding for Direct Payments to employ PA's and little else. If service users do not agree with their assessed care plan they are told they will have to receive Commissioned Care which of course is going to be more expensive. We therefore spend our time making complaints which is the only way to appeal the situation. Direct Payments have been absolutely fantastic for some disabled people over the many years I have been around but In Control raised expectations and now Councils argue 'no legislation'. Until the legislation is in place for true flexibility there is no choice and control. Commissioning is shrinking the market around personal care, forcing down charges (except Council's charges) and does not acknowledge the work of traditional voluntary groups and charities who are not interested in tendering. We find Challenging the system works but it is time consuming and expensive so transparency must be essential.

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  26. Lucy hi,

    You might be interested in

    Thank you for your request of 7 October 2011 under the Freedom of Information Act (2000). Your exact request was:

    “Using the FOI Act 2000, could you please advise the budget allowance/transformation costs to personilization for the years, also if you have this information by area (region)

    2009/2010
    2010/2011
    2011/2012”

    I am afraid that we are unable to comply with your request without further clarification. There are several possible interpretations of the word personalisation. This could refer to personal health budgets, personalised care planning for long term conditions, social care and direct payments and some areas of the choice agenda.

    In order for the Department to answer your request as fully as possible, please specify the area of personalisation to which you refer.

    It may help you to know that the national pilot programme for personal health budgets, which began in 2009 and will run until October 2012, has an annual budget of £4million. The cost of implementing personal health budgets is being reviewed as part of the independent evaluation of the pilot programme and the final report is due in October 2012. The third interim report considered pilot set up costs and is available at:

    https://www.phbe.org.uk/documents/interim-report-jul-2011.pdf

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  27. Lucy hi,

    a follow up question to the DoH and thier reponse.

    Details of the Transforming Adult Social Care grant to Local Authorities, over the period 2008/9 – 2010/11 are contained within the following Local Authority Circulars (LAC):

    LAC (DH)(2008)1:
    http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAuthorityCirculars/DH_081934
    LAC (DH)(2009)1:
    http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAuthorityCirculars/DH_095719
    LAC(DH)(2010)1: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAuthorityCirculars/DH_114788

    The final year of the grant for 2010/11 was included within the baseline allocations to local authorities. In 2010-11 the Government allocated the largest part of this revenue grant – £237 million but also allocated an additional £33.5million capital allocation to help councils with some of the associated infrastructure costs.

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  28. Cheers for those links Kevin, I'll have a read! Back on personalisation a bit next week.

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  29. For those living in London.

    This area of the website has been developed to promote access to statistical information about social care and health in London and encourage benchmarking.

    There are three main sections in this area of the website. Please click on the relevant link to view more.:

    Links to official statistics
    London self directed support statistics
    London Information Exchange Group
    Implementing the Care Funding Calculator in London

    http://www.londoncouncils.gov.uk/services/datasharelondon/stats/default.htm

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  30. What fascinating reading. Am in the middle of a bloody process of trying to get an appropriate sum of money to allow my disabled 20 year old daughter to live as independently as possible. What I suspected was happening is confirmed, at least in theory by this article. The initial assessment form was submitted by the social worker without even consulting my daughter......enough said.....

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  31. Fascinating, illuminating (dont take that the wrong way - I mean making it so clear that there is little rationale or equity in RAS systems) and profoundly depressing - all in one. Thank goodness for people like you who go on relentlessly interrogating and worrying the system.
    Settlement Cash Structured For Flow

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  32. I dont really understand how this works. However, would the writer of this blog be interested in my copying a reply from my local authority after I had refused to accept an indicative budget on behalf of my son who has a learning difficulty? It is pure science fiction and, if it weren't so sinister, would be funny. I'm happy to share it in full if there is interest.

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    Replies
    1. This the story for most of us. The LDP play a game of poker.So Lucy where do we go to appeal against an indicative amount. According to Cambridge County Council there is no formal appeal process.

      Delete
    2. Hi there, an indicative amount cannot be the last word in a care package - the LA should be able to show that eligible needs can be met within this window. I would start off by asking them to provide you with information on how the LA has assured itself that the person's assessed eligible needs can be met within this amount (for example, by showing the assessed needs against costings for possible services which could meet those needs). Most LA's have a 'panel' who can review RAS entitlements if an increase is needed, you could ask about that.

      If you have ongoing problems which can't be resolved through negotiation and discussion, you have two further options: to make a complaint to the LA (and then, if that fails, to to go the Ombudsman), or you could try to bring a judicial review. If you want to bring a judicial review you will need to act (very) fast as there is a short timeframe for doing this.

      Delete
    3. Hi Lucy
      Thank you for your reply. I have taken on board your reasoned and informed
      approach which I think will help me be more productive in dealing with future problems.
      I have already made a complaint to the Ombudsman for one issue which was upheld and recommended an apology and compensation, which I think is unusual. However, the LDP agenda still grinds on unchanged and further issues
      have arisen and will have to be addressed.
      In addition I felt the need to write to "In Control" as follows:-
      I notice on your web site a lot of the information hasn't been updated since 2011.
      There is a lot of hype about people with disabilities now being "In Control" and
      all the choices they have.
      Now here in the real world in the year 2013 there appears to be a non transparent systemic LDP agenda to reverse this process and they are doing an excellent clandestine job at it.
      There now seems to be a battle between the rights of the LDP and the rights of those with Disabilities.
      Please conduct a survey for me to find out for me how many people with Disabilities are Losing Control to the LDP.
      Could you please put this on your web site
      Thank you

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    4. Sorry Dickie that I only just found this comment in my spam filter! I hope that the Ombudsman can resolve your complaint. Apologies that lots of things on my website are out of date - this is really a blog (sort of like a magazine or journal, only with one author), and it is not intended to be an information service, so I don't come back and update posts to keep them up to date.

      Delete
  33. Thank u for all you have done to look into the RAS, I asked my council (East sussex county council) to send me a copy of their RAS assessment and scoring but I have not had a reply, however when the social worker came yesterday to redo my assessment she did at least bring her laptop and go through the assessment with me.

    Anonymous, yes that would be good if you were able to

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    Replies
    1. Hi
      I am just starting out on what is a horrible journey which having cared for my wife since 2006 she is a young person with dementia like other blog comments - I am being told that the current budget will be reduced by 60% - interestingly the care support plan was been calculated vis RAS to date - but the theme now is "Cost effective" so the new RAS reflects the pressure social services are faced with in delivering the £60M cuts in East Sussex County Council - the RAS is what the users want it to be.
      David Storrs

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  34. Hi Lucy
    If you can look at this :-

    cambridge county council LDP Budget Plans 110927-4
    www.cambridgeshire.gov.uk/CMSWebsite/...aspx/.../110927-4.doc‎

    The bottom line is you cant have any money
    The LDP has a non transparent systemic policy and agenda.
    The Learning Disability Partnership is not supplying a service in
    accordance with its original directive, to support its users wishes,
    but has become an unaccountable autonomy and only serves its own
    interests (Who has authorised this autonomy?).
    It is now not fit for purpose,
    It offers nothing to clients ,
    It has a huge management tree soaking up valuable funds.
    The care manager ab reports to cb manger
    cb manager reports to de the team manager
    de team manager reports to fg the line manager
    fg line manager reports to hi head of operations
    hi head of operations reports to jk director of services
    All these spend their time in meetings to organise meetings
    What is the total of their wasted earnings
    Its name is a misrepresentation, it is not a partnership,
    It cannot offer any services.
    Its personnel have no relevant knowledge or abilities, and cannot
    communicate in direct English, only in convoluted,
    obfuscations, which only serves its own self interests.
    This all causes an incredible amount of unnecessary stress on top
    of that already experienced with family members with learning
    disabilities.
    I would like to know how many people are having these sort of experiences with
    the LDP.
    There should be a dedicated web site for this problem. Collectively we could be a voting pressure group to get honest communication and action.






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