Manchester Adult Social Care Services has transformed the way they work with the aim of giving people ‘a life not a service’. George Devlin, Head of Workforce Planning and Development, explains how all users are now offered personal budgets, and given advice on how to make the most of them.
In the last three years, Adult Social Care in Manchester has introduced a system of personal budgets as part of a transformation programme aimed at putting customers at the heart of everything they do.
“I know people use the word transformation a lot but we really have. The whole organisation has changed,” says George Devlin, Head of Workforce Planning and Development.
“We have been going through a complete transformation of service delivery as a result of the commitment to personalisation – to transform services to give people a life, not a service – that’s our vision.”
“It’s very much around the principles of putting people first, promoting independence, enabling people to make choices, delivering services early that are preventative and that people can access easily. We are working all the time on the principle that our role is to enable people to build on the things they can do and use their strengths to increase their confidence”, says George.
Personal budgets
As part of the transformation of services, Manchester Adult Social Care introduced a system of personal budgets.
They set a target that by 2008/09 everyone who was eligible would be able to have a personal budget – over 5,700 people now have one.
Customers’ needs are assessed, a support plan is drawn up and people are allocated a personal budget. This is expressed as a cash amount, but does not mean everyone receives a cash payment. There are three main ways people can receive their personal budget.
“The decision would be, is it a virtual budget, is it a cash budget, or is it a combination of the two?” says George.
Manchester Adult Social Care works with customers to help them decide which option is best for them.
A cash budget is where someone receives regular cash payments or a single payment and they can choose how they spend it and which services they use.
“Some people take that money and set up their own care,” says George.
“They do it in a whole range of ways. Instead of having meals on wheels, some people have bought a PC with internet access so they can order the meals and have them delivered to them – other use the money to employ a personal assistant.
“Or they can have a virtual budget which tells people the amount of money they are entitled to but we have contracts with a range of providers including homecare and day services – so instead of giving people the money, we ensure the service is provided up to that amount of money.”
The key to the success of a virtual budget is that the customer then has a direct relationship with the service provider who must then involve and engage them in how the service is provided.
The kind of personal budget people chose is up to them – our role is to support them to make the choice and ensure they get what is right for them.
“Currently a higher percentage of older people continue to take a service against a cash budget – people with physical disabilities are very keen to take personal budgets,” says George.
Brokerage service
If people choose to take the cash payments, it does not mean they are left on their own to find their own care without any help.
The team in Manchester have developed a brokerage service which helps people use their money to access the services they need, which reliably looks around the local community and enables people to access what is there, using their money.
“If people want to employ a personal assistant, then we will support them to employ one, supporting with Criminal record checks, payroll and audit support” says George.
Greater choice and independence
George says deciding how to spend your budget can be daunting for some people, but it can offer people more independence and greater choice. The service aims to highlight to customers that there are a range of options available.
“We are saying to people they don’t have to just take what they’ve got, there are a whole range of services and ways to arrange support out there.”
As an example, George tells the story of one young person from Manchester with multiple health needs who has used her personal budget to employ a team of personal assistants. She used to rely on homecare but she did not regularly see the same carers and they did not get to know her or her needs.
Employing personal assistants directly using her personal budget has given her a more consistent and personal service. As their employer, she has even chosen to manage their National Insurance Contributions (NIC’s) and tax.
“We pay her the budget and she manages the support she needs and all aspects of managing her staff team including tax, the insurance, and holidays. She says if is liberating and she has grown in self-esteem and confidence as well as receiving the kind of support that enables her to live her live as she chooses. It is such a powerful example of what personalisation can do and she has become much more articulate herself about what she needs. She is a good advocate for the introduction of personalisation, and has assisted us in training staff, providers and other customers” George says.
“Not everybody takes on all of the responsibility in terms of recruitment, payment, tax, NIC’s and health and safety. We enable them to access other companies who will do all that for them and then all they do is directly manage what the person (the carer or Personal Assistant) does when they come.”
A seamless service
George says they have learnt a huge amount from restructuring the Adult Social Care Directorate in Manchester and they constantly reflect on what they are doing.
They have aimed to make personalisation part of everything they do and ensure that users experience a seamless service whether they need short-term advice or longer term support.
“If advice and guidance is needed, then that is given. If it’s some kind of direct support, then that would be through reablement. If at the end of reablement people still have long term support needs, then they would have an assessment against Fair Access to Care Services (FACS) criteria and as a result of the assessment and the support plan, they would be allocated a personal budget,” says George.
At each stage, George says, the aim is to give people the information they need to make informed decisions that are right for them.
“The important thing for us is that we enable people to make choices.”