Magazine article Public Finance

Getting Up Close and Personal

Magazine article Public Finance

Getting Up Close and Personal

Article excerpt

Reform of public services is now getting personal. After fixating on structures and ownership, policy makers and managers are recognising the requirement to involve people directly, putting their needs and nature first when considering service design. Now, personal budgets have caught the government's attention as a mechanism to do this.

These involve funding allocated specifically to meet an individual's needs and either held on a persons behalf or given as a direct payment. In the social care system, local authorities have just been given a major grant to bring in personal support, including personal budgets, to adults, over the next three years. In the health service, under Lord Darzi's reforms, people with long-term conditions have been promised personal care plans. Pilots of individual budgets, which involve funding from various sources, get under way next year.

And in education, personal skills accounts, which inform people of the funds available for them to spend on accredited colleges and training providers, are to be trialled imminently.

So if personal budgets are a solution, what's the problem? Progress in public sector reform has been significant, from providing the most effective services for the money being spent on them, to getting the most out of services to achieve a fairer society. But there is a sense that the use of single drivers to improve public services - from central targets to quasi-markets - has been exhausted.

While these reforms have improved performance, in some areas they have left the workforce alienated and the public uninspired. Practitioners might feel they operate in a different world to that of five years ago, yet the outcomes and the users' experience have not changed as radically. Too often, services that are impersonal are also ineffective and inefficient. The standard way the state provides services - en masse to an identified population through poorly integrated structures - is not always the best way to aid people through current challenges.

Sometimes support is not tailored enough to the persons circumstances. Often the front line is unable to make the decisions or use the resources that would enable them to help citizens. And often citizens are not able to participate in solving problems that affect them.

Public services involve complex and chronic issues, and social needs often overlap or are deep-rooted. At the same time, public services must be accountable, fair, responsive and affordable.

But complex problems don't always require complex policy. Social care - support for people with a range of needs arising from physical or learning disability, old age, or mental health problems - is now leading public service reform in terms of adopting a simple, effective, approach.

Personal budgets - which inform people, following a needs and means assessment, of their funding allocation and allow them to choose the support they need will be introduced across local authorities. For example, a disabled person might use her personal budget to go away for a short break to an accessible holiday home. This might be a cheaper way for her to be included in society than a respite break offered by the council. She would get a budget allocation based on her needs, and be responsible for getting adequate care, but the support would be of her choosing.

Early trials of personal budgets are promising. The social enterprise company In Control ran 17 local authority pilots, funded by the Care Improvement Services Partnership, the Improvement and Development Agency, the Department of Health and the Cabinet Office. The evaluation of the pilots, by Demos and Chris Hatton of Lancashire University, found positive results across all kinds of care needs in adults and the range of established social care measures. More than 80% of the budget recipients changed the services they used, and only 1% reported a worse quality of life compared with standard forms of care support. …

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