Personal Budgets in the UK - Essay Example

Annually, at least one and a half million people in the UK look to their local authorities for personal care and support due to disabilities brought about by age or otherwise. The assistance they get could vary from a couple of hours sitting to give a member of their family a break from caring, through to living permanently within a registered home. To date, there are close to 17000 organizations that provide adult social care and employ close to 1.6 million workers across the public, voluntary and private sectors. It is believed that at least 6 million adults or more spend time caring for the disabled or older family members (Peach consultancy 2010:4). In response to the increasing demand and the rising public expectations based on choice and quality, the government decided to act. It set out to transform the way in which care and support were offered for the older and disabled adults. At the heart of this transformation was a very powerful idea that would potentially revolutionize how the disabled and older persons received their care. The idea was basically based on personalization. That is, instead of commissioning care and support services for people living in its area, the local authority would provide eligible persons with their own personal budgets so they could acquire help and assistance that would be more attuned to their individual needs and circumstances (Hatton, C. & Waters, J. et al. 2008:81). Personalization is aimed at giving the people more choice and control over the kind of support they acquire. It is defined as the ability of an individual to determine what type of support to get despite the mode of payment used by the one seeking healthcare services. These may include direct payment or personal budgets. Direct ayments are defined as the direct cash payments given to service users in lieu of community services that are in demand based on assessments done they are aimed at giving a wider choice to the clients (Davey, Fernandez, Knapp, Vick, Jolly and Swift 2007:42). Personal budgets on the other hand describe the allocations given to users after assessment which meets their assessed needs fully. This is all in part of the government’s wider agenda to improve efficacy and responsiveness of public services. These personal budgets can provide flexibility, choice and control to the service users (Leadbeater, Bartlett and Gallagher 2008:26). Further, they can improve health and well-being and ultimately, user satisfaction. They provide opportunities to make cost savings to the users and hence more control of their financial savings. Making these budgets can be quite a hassle for beginners. However, there is much literature on ways of creating them and will be addressed to help Mr. and Mrs. Lee create theirs without much difficulty. The report will also look at the theoretical perspectives of the personal budgets, value underpinnings as well as the legislative requirements for successful budgets. Background The case looks at Mr. and Mrs. Lee who are British by ethnicity. Mr. Lee is disabled and sleeps downstairs as a result of his limited mobility. He has an electric chair that he is able to control on his own for his mobility. He had a severe stroke and a previously fractured femur. The stroke left Mr. Lee with a weak left side which meant that he had to re-learn some of the skills that he already was familiar with before the whole incident. Skills such as eating, swallowing, telling time and being able to write had to be re-done afresh. The only person who was available to support him was his wife who did all she could. However, an operation that she underwent left Mr. Lee on his own which meant that he had to seek the services of council carers for his daily routine. After the operation, Mrs. Lee had to take time to recuperate and this meant she could not be of much assistance to her husband as she was prior to the surgery. The four visits given daily by the carers were not enough and the personal care routine was more than Mrs. Lee could handle in her condition. As a result, there was a need to ensure that the needs and risks of her husband were met and managed effectively within his own home. Planned intervention: At this juncture, the necessity of a personal budget came to the fore to help continue with Mr. Lee’s treatment with the help of the social services. The need for a broker arose to help detail the requirements, the options and the methods that the family could choose to ensure they got the very best despite their position and health status. To help him recuperate, the use of the personal budget was best applied as a way of ensuring that Mr. Lee got the best possible services around. Intervention here is taken to mean the orchestrated attempt to help Mr. Lee cope with his ailment with professional assistance aiding him recovery. The social model will help bring him closer to the society rather than make him feel excluded from it. Theoretical Perspectives There is a need to move from the medical based model of disability to something that is more humane and something that caters for the interests of these disabled persons. By using the medical based model, the individual feels as if they are a machine that can be fixed and directed towards meeting the normative values of the society. For Mr. Lee, suffering from stroke and getting nearly paralyzed on the left side of the body is a great challenge. It has made him change the way he interacts with the world he was so familiar with before the condition arose. As such, it calls for new thinking in the line of socially-approved methods that allow for greater involvement of social works. This makes caring for these individuals easier, without making them feel physically impaired. This calls for the introduction of a social model of disability (Kearney and Pryor, 2004:163). The social model of disability identifies with the individual’s systematic barriers, negative attitudes, and the exclusion from the society, whether purposely or inadvertently, allowing the individual to engage in activities that would be viewed as impractical for them in normal life. It is true to state that the worst form of disability is the one that the society practically allows to take root instead of doing away with stigmatization (Goodley, 2001:207). Whether physical, psychological, sensory or intellectual, the society has the ability to make these variations a norm. The implication herein is that people can live with and feel part of a family or exclude them from the society and make them feel inadequate. As such, the social model postulates that the society is the greatest influence in ensuring that the physically impaired persons feel safe within their environment or feel neglected within the same (Priestly, Jolly, Pearson, Ridell, Barnes and Mercer, 2007:1193). When it comes to making personal budgets, the society is supposed to be collaborative and allow these individuals to get the very best from the services they receive from the local authorities. This means that each individual has a chance to experience better services, better care and more personalized attention despite their social impairment or physical attributes (Power, 2010:90). By being a broker, I was awarded an opportunity to serve the Lees in making better choices which would have been quite difficult since they had very little knowledge of the system. With such knowledge in my possession as a broker, I was able to help these individuals make decisions that allowed them to enjoy the rest of their lives under specialized care and at affordable rates (Fernandez, 2007:98). With the use of retrospective approaches, the brokers are able to use an open-ended and subjective process to determine the individualized funding allocations which allow individuals to be fully involved. These approaches are person-centred and entail creating an individualized service plan that is agreed upon by both the individual (and family) and their account manager (Brick, Nolan, O'Reilly and Smith, 2010:187). Here, the individual can agree on a support program or package that is then calculated based on an hourly fee-for-service reimbursement rate. The work of the account manager is to provide on-going support in the area of budget management and update their clients on the monthly progress. In this case, handling Mr. Lee’s case with his wife present was a very important step since she was to directly help the carers in helping Mr. Lee through his daily therapy. Brokers should also apply prospective models to allow the individuals to come up with support packages based on the funds available for them to utilize in the long run (Power, 2010:92). Individual budgets include one that is brokered by a fund held by an organization that is not providing a service. Another form of the individual budget is as an indirect fund or third party trust where individuals are chosen to administer and manage the fund (often family members or friends). Thirdly, it can be as vouchers to be used on approved services or as an individual service fund where money is given to the care agency that renders the services or as cash payment directly into a user’s account (Brick, Nolan, O'Reilly and Smith, 2010:191-2). Whichever option that is chosen, the society should be ready to provide the necessary amenities that allow the disabled to feel part of the general society. From what I observed as a broker, brokers should work towards offering services on a need-based platform (Fernandez, 2007:100). Legislative Requirements After wide consultations with key stakeholders, the department of health came up with some principles that ought to be adhered to when dealing with issues related to personal budgets. The main aim is to ensure that the right balance between giving people control, keeping them safe and protecting the resources of the National Health Service (NHS) are maintained and observed by all involved stakeholders. The first thing that a broker should be aware of during this whole process is the need to uphold all the NHS policies and values which dictate that services are free at the point of use (Peach consultancy, 2010:8). There should be clear accountability for the choices made which means that the broker cannot at any time impose their will on the family or the victims. The policy also requires that those with personal budgets should not be denied essential treatment nor are they to be entitled to more expensive services under the NHS. Neither are they allowed preferential access to NHS services (Davey, Fernandez, Knapp, Vick, Jolly and Swift 2007:72). It is also expected that as a broker, adherence to the rules should be paramount. As such, every individual is entitled to healthy well-being with a plan being reached between the broker and the individual. This plan should be safe, admissible and meet the required health and well-being outcomes. As detailed in the NHS and Community Care Act 1990, local authorities are expected to assess the care needs of any person who appears to need them and decide in the light of the circumstances on how to provide them (Glasby and Duffy, 2007:45). The Fair Access to Care services (FACS) guidance issued under section 7 (1) of the Local Authority Social Services Act 1970 ensures that the eligibility criteria for adult social care be revised to establish fairer and more consistent way of doing things in the country (Priestly, Jolly, Pearson, Ridell, Barnes and Mercer, 2007:1193). Transparent arrangements dealing with continued clinical oversight must be based on the actual needs of the individual irrespective of their race, gender, sexual orientation or beliefs. This should be in accordance with the race relations (amendment) Act 2000 which places this duty on local authorities. They are expected to consult with representatives of any minority communities and monitor the implementation of their policies throughout, checking for any remedial action if policies are found to be wanting (Leadbeater, Bartlett and Gallagher, 2008:83). According to the law, these personal budgets are entirely voluntary and no one will be forced to follow a certain manner of managing their budget. Therefore, all decisions are expected to be as personal as possible with appropriate support offered to those who may benefit more from a more personal approach. This is as detailed in the Community Care Directions 2004 which requires services to consult fully with the person being assessed on the best possible way of meeting and addressing all their needs (Glasby and Duffy, 2007:45). This can be noted in the Mr. And Mrs. Lee were able to recognize the benefits of having carers visit the home four times a day and the need to have Mrs. Recuperate after her surgery. I was assigned to broker a deal with them because it was a voluntary gesture that they wanted to see to fruition for the sake of their health. As a broker, adhering to all these rules is necessary to ensure that people get the best benefits in relation to the needs they have. Each individual is entitled to better health care despite their background and despite the disability levels. As such, Mr. Lee expects the local authorities to present a formidable plan that will help him cater for his medical expenses and receive the best under the NHS policies. Mrs. Lee would also like to get a good plan that would enable her husband to get better treatment from experienced carers. This will only be possible if the local authorities adhere to the rules. As such a representative of the local authorities, the broker is expected to present the very best plan and offer advice in relation to the facts and the assessed needs. Mr. Lee also has the right to be accorded the best carers as he would choose given that creating a good rapport allows patients to heal faster due to the relaxed nature of the psychological capabilities (Hatton, Waters, et al., 2008:86). Values Underpinning Social Responsibility as a Broker As stated earlier under theoretical perspectives, the issue of social models on disability take centre stage. As a broker, the main aim is to demystify the whole care giving process and allow each individual to feel as part of the larger society. As such, every person that has a disability or has any requirements that require them to choose a personal budget should not feel left out or discriminated by the society. Instead, the society should play a huge role in encouraging them to apply for such financial incentives (Goodley, 2001:208). As a broker, the weight lay squarely on my shoulders to ensure that the Lees got a care plan that suits their needs and supports their ambitions. The barriers that had placed in their way due to their health problems would be sorted out by having care plan that would look into their needs and address them to their satisfaction. I further learnt that as a broker, one should not be subjective. Instead, one should objectively take the family and the individual through the whole plan and ensure that they understand what is expected of them during the whole period. This requires transparency, accountability as well as honesty so as to ensure the best is achieved and everyone goes their way happy of their achievements. The elderly are not by incapacitated nor do they cease being human beings after a certain age. They deserve the same respect they had previously and a safer transition period as they age (Hatton, Waters, et al., 2008:89). They should ensure that they use language or a mode of communication that all are conversant with as a way of ensuring that everyone is on board. The disabled have to be treated as human beings since they are such. Each suggestion, idea or characteristic shared should not go contrary to this either. They should work towards reducing barriers that would prohibit them from making the very best decisions from the information given or based on their impairment (Goodley, 2001:209). Reflection on the Practice While under placement, several things became clearer. The interaction with those in the same line of health provided major insights. First and foremost, I learnt that it was entirely important to plan well. As such, good planning should assess the potential risks and establish the means via which they will be managed. As such, the brokers are expected to detail the available care options but also act as assessors working to fix any risks that may be hidden from the patient’s eyes. Additionally, they should not escape their expertise (Sullivan, 2006:78). Secondly, the whole attribute of personalized budgets should allow for more innovation in meeting the health and well-being outcomes of the potential patients. This means that the brokers should ensure that the patient chooses the best care plan that is more likely to meet the agreed healthcare outcomes. These should further meet the approval of the FACS guidelines (Sullivan, 2006:79). In relation to Mr. Lee, the need for his wife’s presence was necessitated by the fact that some of the issues needed someone able to understand the requirements and satisfactorily approve of their assistance to the patient. Given that the wife has been offering the greatest support to him, the wife was also allowed to make some of the decisions. Consequently, she would approve of the care plan as a way of ensuring the patient experienced the best care and the best health care facilities. This brought out the importance of having a proper assessment of the situation before making any recommendations. Despite the prejudice that they may have faced in the neighbourhood, the healthcare system had sought a way out through which they could cater for their medical bills and receive the best care that they could afford. The placement also brought about the need for attitude changes on issues perceived to discriminatory. As a social worker, prejudices and stereotyping have no place when dealing with patients. The social barriers created by the society should not find way into one’s line of work given the importance of health services within the human society (Glasby and Littlechild, 2009:21). To deal with this, I took time to chat with the family and get acclimatized to their way of life. The fear that being the one to deal with the elderly couple had to be shelved if I was to get it right dealing with the couple. But I got support from others who had prior experience and they gave me a chance to understand what to do and how to do it when in such a situation. I also borrowed from some of the theoretical frameworks that deal with counselling as a way of dealing with their fears and providing them with the comfort they so much required in their distressed moments. Theoretical models proposed by various researchers offered more insight into the importance of personal budgets and how they can be used to protect the health of the disabled persons. As a broker, these informative guides offer greater guidance on the best way of dealing with clients. It guides on how to work without discriminating any of them or working towards social exclusion of these individuals. Being conversant with the rules and regulations that govern social interactions offers a chance for each individual to exercise their rights without making them feel inferior. There are some aspects that one cannot do away with as a broker. The aspect of decision-making, assessment and resource allocation, risk management and enablement, challenging the size of the personal budget and support planning and brokerage are very essential (Glasby and Littlechild 2009:22). These are skills that one ought to possess for a successful deliver of the personal budgets. Without these skills, I could not have assisted the Lees in any way since they form the bulk of brokerage. This is what I got to learn and forms a basis of what I ought to practice in the future in detail. The current placement session offered much exposure and opened me up to new challenges that I will come across in the future. It also gave me a chance to experience the first-hand interaction during a brokerage session which is much different than watching others do it. Conclusion Skills are very important in dealing with patients who want to have their personal budgets. The help accorded to them by the brokers go a long way in informing their decisions and allowing for better incorporation of the type of services they desire for their nature of the problem. As such, each broker needs to understand the legislative requirements that they are expected to follow. The values that should guide them in their operations are all pegged on the way they relate with their clients which needs to be in a positive sphere, given their physical capabilities. This placement allowed me to get firsthand experience and engage in brokerage as a practice for future practice. This has given me much impetus when I get into the field since I partly understand what is expected of me and also how I can fully become good at the act through much more practice and interaction. References Brick, A., Nolan, A., O'Reilly, J. & Smith, S. (2010) Resource Allocation, Financing and Sustainability in Health Care: Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector, Department of Health and Children and Economic and Social Research Institute, Dublin. Davey, V., Fernandez, J.L., Knapp, M., Vick, N., Jolly, D. & Swift, P. (2007) Direct payments: a national survey of direct payments policy and practice. PSSRU London School of Economics, London. Fernandez, J.L (2007) ‘Direct payments in England: factors linked to variations in local provision’ Journal of Social Policy, vol. 36, no. 1, pp. 97-121. Glasby, J. & Duffy, S. (2007) Our Health, Our Care, Our Say – what could the NHS learn from individual budgets and direct payments? University of Birmingham, Birmingham, UK. Glasby, J. & Littlechild, R. (2009) Direct Payments and Personal Budgets: Putting Personalisation into Practice, The Policy Press, Queens road, Bristol. Goodley, D. (2001) ‘'Learning Difficulties', the Social Model of Disability and Impairment: Challenging epistemologies’ Disability & Society, vol. 16, no. 2, pp. 207–226. Hatton, C. & Waters, J. et al. (2008) Evaluation Report: Phase II of In Control's work 2005-2007. In Control, London. Kearney, P.M. & Pryor, J. (April 2004) ‘The International Classification of Functioning, Disability and Health (ICF) and nursing’ J Adv Nurs, vol. 46, no.2, pp. 162–70. Leadbeater, C., Bartlett, J. & Gallagher, N. (2008) Making it personal, London: Demos. Peach consultancy (2010) how to cost appropriately with personal budgets, ACEVO, new Oxford Street, London. Power, A. (2010) Individualised Resource Allocation Systems: Models and lessons for Ireland. Centre for Disability Law and Policy, National University of Ireland, Galway. Priestly, M., Jolly, D., Pearson, C., Ridell, S., Barnes, C. & Mercer, G. (2007) ‘Direct payments and disabled people in the UK: supply, demand and devolution’ British Journal of Social Work, vol. 37, no.7, pp. 1189-1204. Sullivan, A. (2006) empowerment initiatives brokerage: services quality and outcome evaluation, Oregon technical assistance corporation, Oregon. Read More