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Personal care budgets: more choice for service users?

'Personal budgets' for disabled and older people became a reality last year. Supposedly they give service users more choice over their own care. But what is their real effect? Adrian Picton investigates.

So what is a personal budget?

Well, previously local councils would directly provide or commission services such as home care, day care and residential care. They would assess each individual to determine which services they need. Now, the assessment instead entitles you to money to cover your needs.

A personal budget can be made up of direct payments, credit for council-run or commissioned services, or a combination. In theory, this gives a person more say over what they receive, even if they choose to let the council manage it for them.

Having this sort of choice and control about how care needs are met is something the disabled people's movement has fought for over years. The principle is therefore welcome.

The problem is, however, that these changes have come in at a time when local authority finances are being squeezed. Behind the rhetoric of 'choice' and 'control' and 'needs-led services', the reality is that services are being turned into cash cows - or destroyed.

There have been several changes in the eligibility criteria for assessment over the last few years. Charges for care services have been increased, or introduced where they were previously free.

Councils have used the whole 'personalisation' agenda to sell off, reduce or cease altogether their own home care, day care and residential services. This has led to hundreds of redundancies, and reductions in hours, pay and conditions.

It is important that disabled and older people can choose who provides the services they need. But it does not follow that everyone will want to stop receiving them from their local council.

For example, disabled people should ultimately be included in mainstream activities wherever possible. But you can't close a day centre and expect someone who has attended for many years, who has friends there, to simply adjust.

In many cases, day centre closures have led to increased burdens on family carers. Most are women who do this work unpaid. They no longer get a day to themselves to get other jobs done - or just to have some 'me time'.

And in general, older people prefer traditional home care services. They don't want to be bothered with employing their own carers.

The move away from council-run home care means it is provided by private agencies. They pay less, train less and have far worse terms and conditions for staff. This means high turnover. In turn, this means service users have to deal with constant changes of carers coming into their home. Continuity of care is extremely important to older people.

Personal budgets should give people more choice, not tell them they can no longer use a traditional service. By removing such services, councils are actually restricting choice.

Councils which have completely removed in-house services could face further problems. If an agency can't fulfil its commitments, or the relationship between a service user and their personal assistant breaks down, the council ultimately has the duty of care.

The Socialist Party says that greater control over your own care is important, but not enough. We also need full funding for care services. Instead, the demands of disabled people have been stole, and personal budgets have become a clever excuse for cuts and privatisation.

Local authorities should reopen closed services, and bring private services back in house. They should set a 'needs budget' at council level to cover the full cost of all services. This could buy time to mobilise a campaign of trade unionists and service users to win the necessary funding back from central government.

Then personal budgets could give disabled and older people real choice and control.

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Where did personal budgets come from?

The concept was introduced in the New Labour government's White Paper "Our Health, Our Care, Our Say" published in January 2006. A handful of local authorities then set up pilots.

Personal budgets were later rolled out across England, and made effectively mandatory through performance targets set by Westminster. Finally, the last Tory-Liberal Coalition government's 2014 Care Act came into force this April, placing a legal duty on councils to provide them for all service users.

Personal budgets are frequently confused with direct payments. Direct payments have been around since the late 1990s. They are a weekly payment for needs such as employing your own carers, or going out for social activities. Part or all of a personal budget can be paid as a direct payment.

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