A leading disabled academic has urged MPs to dismiss the conclusions of the public spending watchdog and accept instead that the government’s strategy on social care personal budgets is “fundamentally flawed”.
Peter Beresford, professor of citizen participation at the University of Essex and emeritus professor of social policy at Brunel University, has told the Commons public accounts committee that the National Audit Office (NAO) misunderstood the impact of personal budgets on social care.
He told the committee: “The implications are too important for the service and appropriate use of public resources for me not to act.”
NAO concluded in its report on personal budgets in social care last month that personal budgets and direct payments were “an important way of giving care users more choice and control over their services”.
But Beresford (pictured) said NAO had failed to realise that while the use of direct payments – which enable service-users to take a cash payment to manage their own support – had been a success, the same did not apply to personal budgets.
Direct payments were introduced in 1996, while personal budgets – originally defined as an up-front allocation of cash that would empower service-users to choose how they received their support – were introduced nationally in 2008.
But the way that personal budgets were introduced and developed means that this up-front allocation simply provides an “indication” of how much funding a service-user will receive to pay for their support, while frontline social care staff usually ignore this figure when setting someone’s actual personal budget.
In written evidence submitted to the committee, Beresford says: “Councils have created the bureaucracy to deliver up-front allocations in order to claim they have reached their targets, but they have not changed the way needs are assessed and resources allocated.”
He said this meant that personal budgets for social care had become a “phantom policy”.
Beresford submitted his written evidence as the committee prepared this week to take oral evidence from civil servants and care organisations for its own inquiry into personal budgets in social care.
The Care Act made personal budgets for social care mandatory for all eligible users from April 2015, while the Department of Health wants between 50,000 and 100,000 people to have a personal health budget by 2020.
Beresford said that the five per cent of service-users who use direct payments to employ their own personal assistants, and are given large enough payments to meet their leisure, social and personal care needs “consistently enjoy much better outcomes”.
But he said this had nothing to do with personal budgets and their use of an “up-front allocation”.
He said the three-fold increase in the number of users of direct payments since 2010 had been mostly due to service-users who use them to pay invoices for traditional services they would have received anyway, and there was evidence that this group achieved no better outcomes “than any other recipient of regulated services”.
Beresford, who is co-chair of the national service-user network Shaping our Lives, warned the committee that the consequences of not abandoning the government’s current policy on personal budgets would be “a continued very large waste of public effort and resource”.
He argues in his written evidence for a new “personalised” system of assessing the needs of service-users that would allow for the “full individuality” of their “lived experience of need” that would set “a level of well-being that is right for them”.
He said: “This cannot happen under [the current system] where ‘need’ has to be fashioned to match resources.”
He said that a new system must acknowledge that there is a “cash limit” on the provision of social care.
This would mean there would have to be “an ability to acknowledge if there is not sufficient public funding to meet all assessed needs” through the resources provided.
He said: “The acknowledgement of unmet need will ensure the democratic process is fully informed about the real cost of enabling all to have a level of well-being that is right for them.”
Beresford told Disability News Service that the personal budget system makes it easier for local and national government to disguise the unmet need in social care.
He said: “The social care system is in total melt down and the talk of personal budgets is still as if there is a wonderful system out there (which some local authorities are failing to do properly) that makes life great for disabled people.”
But he said that personal budgets were instead a “smokescreen” or “fig leaf”, which disguises the fact that unmet need “rises and rises”.
He said this had implications not just for social care, but also for the NHS, where personal health budgets were “a terrifying Trojan horse and inherently destroy any idea of universality and the meeting of need”.
He said: “Nothing will happen to sort out the disastrous funding situation and Poor Law principles of social care so long as personal budgets in their present hopeless form continue to act as a diversion.
“One day, because of fundamental demographic change, a government will have to put social care on the same footing as the NHS and challenge the ludicrous present divisions in terms of principles and funding.”