Commissioning adult social care services through personal budgets and direct payments 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 Department of Health, however, requires a deeper understanding of the best ways to implement personalised commissioning, according to 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. Much of the positive evidence for personalising commissioning, however, is old or relates to subgroups of users. The NAO believes there is a strong case for better use of existing surveys and evidence gathering, so the Department and its national partners understand the relationship between the different ways to commission personalised services for users, and improvements in user outcomes. The Department is extending personal budgets in healthcare and has an ambition that between 50,000 and 100,000 people will have a personal health budget by 2020.
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, while 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. For example, around 120,000 personal assistants are employed by users with direct payments 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 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. The Department’s monitoring regime does not enable it to fully understand how personal budgets and direct payments improve outcomes. In addition, the Department has not investigated how services can be personalised when money is tight. It is not clear whether local authorities will achieve the spending reductions they have forecast without putting user outcomes at risk.