Around 500,000 people in England currently commission adult social care services through personal budgets and direct payments.
The National Audit Office, which monitors how effectively taxpayers’ money is spent, says the initiative is an important way of giving care users more choice and control over their services. When implemented well they improve users’ quality of life, the organisation adds.
However, the Department of Health requires a deeper understanding of the best ways to implement personalised commissioning, in order to ensure the best possible outcomes.
“Giving users more choice and control over their care through personal budgets and direct payments can improve their quality of life, but much of the positive evidence for personalised commissioning of adult care services is old. The Department [of Health] now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes,” says Amyas Morse, head of the National Audit Office.
Local authorities spent £6.3 billion on long-term community care in 2014-15. Around 500,000 adults in England received personal budgets in 2014-15, varying between 10% and 100% of users across authorities.
The Care Act made personal budgets mandatory for all eligible users from April 2015.
The NAO found that some authorities have transformed their care and support processes to ration their resources fairly, share information about a broad range of local services, and monitor and manage spending on personal budgets efficiently
Others are finding personalising commissioning a challenge as they seek to save money, and are constrained in how they can personalise care by the need to reduce overall spending.
There are circumstances under which personalised commissioning can reduce the costs of care, the NAO found. For example, around 120,000 users with direct payments employ personal assistants to provide personal care, which is generally a cheaper option than homecare.
The Care Act guidance, however, acknowledges that responding to users’ needs and their desired outcomes can increase the cost of care. The NAO also found that some authorities are struggling to manage and support their local care markets as well as we would expect of a well-functioning public service market.
The Department of Health expects the value-for-money of personalised commissioning to come from improved outcomes for users, not necessarily from savings, which differs from local authorities’ expectations that savings can be made by personalising care.