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Editor’s blog Friday 24 September 2010: Learning from individual budgets - IBSEN's choice

It's easy to be critical of the Department of Health; often with good reason.

Nonetheless, they have at times done some good work, and commissioned others to do so. I was having a crawl about their website, and found this study of the introduction of personal budgets in social care, published in 2008.

Greater use of personal budgets is one of the more enlightened bits of the NHS White Paper. Yet it is not going to be a a panacea (though it may possibly have some placebo effects).

The IBSEN (individual budgets evaluation network) review of use of individual budgets in social care found that:
- Individual budgets (IBs) were typically used to purchase personal care, assistance with domestic chores, and social, leisure and educational activities;
- People receiving an IB were more likely to feel in control of their daily lives,
compared with those receiving conventional social care support;
satisfaction was highest among mental health service users and physically disabled people and lowest among older people;
- Little difference was found between the average cost of an IB and the costs of conventional social care support, although there were variations between user groups;
- IBs appear cost-effective in relation to social care outcomes, but with respect to psychological well-being, there were differences in outcomes between user groups.
- Staff involved in piloting IBs encountered many challenges, including devising processes for determining levels of individual IBs and establishing legitimate boundaries for how IBs are used; there were particular concerns about safeguarding vulnerable adults;
- Despite the intention that IBs should include resources from different funding streams, staff experienced numerous legal and accountability barriers to integrating funding streams; at the same time there was frustration that NHS resources were not included in IBs;
- IBs raise important issues for debate, including the appropriate principles underpinning the allocation of resources to individuals and the legitimate use of social care resources.

It recommended more research into:
• Relative benefits and drawbacks of different approaches for different groups of users.
• Longer-term evaluation of costeffectiveness in comparison to conventional support.
• Impact of different Resource Allocation System approaches including outcome-focused
• Impact on provider stability and service unit costs as block contracts are replaced by
individual purchasing.
• Quality and supply of personal assistants and other supporters.
• Quality and supply of care-workers more generally.
• The role of carers in support planning, managing individual budgets and providing
support paid for by individual budgets.

Be warned - the executive summary version alone runs to 60 pages. But this is proper, serious work.

Light weekend reading. Enjoy!