Evaluation of the Individual Budget Pilot Projects

Karen Jones, Ann Netten, José-Luis Fernández,Martin Knapp, David Challis, Caroline Glendinning, Sally Jacobs, Jill Manthorpe, Nicola Moran, Martin Stevens and Mark Wilberforce

Individual Budgets (IBs)

At heart of ‘personalisation’ agenda

Promoting choice

2005 Cabinet Office Strategy Unit report

2005 Social Care Green Paper

Built on experiences of:

Direct payments

In Control

Principles underlying IBs

Greater role for users in assessing needs

Users should know resources available before planning how needs met. Resource Allocation System (RAS) recommended

Encourage users to identify desired outcomes and how to achieve these

Support individuals in using IBs

Test opportunities to integrate funding streams and simplify/integrate/align multiple assessment processes and eligibility criteria

Experiment with different ways of deploying IBs

Funding streams in IBs

Adult social care (gateway to IB)

Supporting People (DCLG)

Independent Living Fund (DWP)

Disabled Facilities Grant (DCLG)

Access to Work (DWP)

Integrated Community Equipment Services (DH)

Potential deployment options

Considerable local and individual flexibility:

Cash direct payment

Care manager-held ‘virtual budget’

Provider-held ‘individual service account’

Indirect payment to third party

… or combinations of these

The IB pilots 2006-7

13 local authorities

representative mix but higher than average take-up of direct payments

Mix of user groups (OP, LD, MH, P/SI)

Mix of funding streams

Evaluation

Do IBs offer better way of supporting disabled adults and older people than conventional methods of resource allocation and service delivery?

Which models work best and for whom?

Evaluation covered:

User experiences, implementation experiences, funding stream integration, impact on care managers, impact on providers, risk and protection, outcomes, costs, cost-effectiveness

IBSEN evaluation

Do individual budgets offer a better way to support disabled adults and older people than conventional methods of resource allocation and service delivery?

If so, which models work best and for whom?

User experience

Carer impact

Workforce

Care management

Provider impact

Risk & protection

Commissioning

Outcomes

Costs

Cost-effectiveness

Evaluation dimensions

Evaluation design

Randomised trial – 500 each IB and comparison groups across sites and user groups

Baseline data on circumstances and current support arrangements

Outcome interviews after 6 months

IB group – content and costs of support plans

In-depth user interviews 2 – 6 months – support planning process

Interviews with IB leads (x 2), providers, commissioning managers, other managers

Interviews and diaries, front-line staff and first-tier managers

Data collection

Randomised controlled trial – within each site, users allocated to IB or comparison group

Baseline data from LA records

Follow-up outcome interviews after 6 months

Analysis IB support plans

In-depth user interviews – support planning process

Interviews with IB leads, funding stream leads, providers, commissioning and other managers, support planning organisations

Interviews and diary study, front line staff and first tier managers

People included in the evaluation1594 of the 2521 individuals randomised (63%)

consented

Final sample of 959 people: 34% physically disabled 28% older people 25% with learning disabilities 14% using mental health services

Wide variations in age, functional need and FACS level

IB and comparison groups not different at baseline

Note: IB not in place at 6 months for everyone

Costs Average weekly value of an IB:

£359 learning disabilities £228 older people

£310 mental health users£149 disabled people

Average weekly cost across all user groups =

£279 for IB group … £296 for comparison group

Care manager support for IB group (£19) was higher than for those with conventional support (£11)

Cost variations: higher costs for those who declined an IB; and for those without a support plan at 6 months

Funding streams

Funding stream integration

99% support plans contained social service funding

11% of support plans contained SP funding

8% of support plans contained ILF monies

1 support plan contained Access to Work funding

No support plans contained funding from DFG

Deployment options

67% IB managed as a DP

MH (89%) more likely

OP (56%) less likely

20% managed by local authority

13% managed by an agent

1 IB administered through a Trust

4 had services organised through a provider

Patterns of Expenditure

Direct payments Managed budgets

% Mean annual expenditure

% Mean annual expenditure

Personal assistant 64 £8,940 47 £7,420

Home care 20 £7,140 40 £7,480

Leisure activities 43 £2,020 24 £1,750

Planned short breaks** 24 £1,750 15 £5,460

Other 23 £930 21 £270

Examples of Innovation

Accommodation (N=24)

Employment and occupation (N=16)

Health-related (N=3)

Cleaning service Going out: trips/cinema etc Private health care

Decorating service Classes/arts and crafts Massage for carer

Gardening service Gym membership/swimming Alternative therapy

Computer maintenance

Admission fees for service user and PA

IB Process

45% IB services in place at interview

10% for less than one month

51% for more than 3 months

11% not all in place

Do IBs impact on outcomes?

Do IBs improve outcomes?

Interviews at 6 months; only 45% had IB support in place

Measures: Quality of life (7-point scale) Psychological well-being (GHQ12) Social care outcomes (ASCOT) Satisfaction (7-point scale)

Differences between IB and comparison groups

Multi-variate analyses

Outcomes Quality of life

Overall sample – no significant difference MH – IB group better QoL

Psychological well-being (GHQ12) Overall sample – no significant difference OP – IB group lower well-being

Both measures – bigger IBs = better outcomes

Social care outcomes (ASCOT) Overall sample – no significant difference IB group - higher scores in ‘control over daily living’ domain LD – higher levels of control

Satisfaction IB group more satisfied overall P/SD IB group more satisfied

Overall outcomes

Positive effects of IBs

QoL, social care outcomes and satisfaction

Older people Concerns about managing budgets?

Anxiety about change?

Lower budgets, more personal care, less flexibility?

Level of IB affects outcome

Are IBs cost-effective?

Are improvements in outcomes justifiable in terms of costs?

Combined data on costs and outcomes

Some evidence of cost-effectiveness in overall sample in respect of social care outcomes

Weaker evidence of cost-effectiveness with respect to psychological well-being

But significant variations by user group: IBs more cost-effective for PD and MH groups No evidence of cost-effectiveness for OP