What are Individual Budgets?

These are allocations of public money to a person requiring health or related care, based on their level of need. They can use this money to choose appropriate goods and services rather than passively receive traditional services. The real focus should however be on the stating point of ‘self-directed support’, that is of enabling people to take control over their own lives. Individual Budgets then provide a means by which they may be able to make a reality of plans to meet their hopes and dreams. The approach means moving away from an emphasis on what people are unable to do, which is currently expressed in what people’s ‘needs’ are. It starts from who they are, what their interests, networks, skills are and how they can best be used with additional support, to meet their goals.
The flexibility of individual budgets means that services can be truly person-centred, because each holder is able to develop a package of support tailored to their needs and can co-ordinate across different funding streams.
Individual budgets have been piloted in social care, but the government is encouraging all local authority Adult Services should to take this approach forward as part of greater personalisation of services from April 2008. The policy builds on Direct Payments, which were introduced into social care in 1996 and operate on a similar basis. Direct Payments have been slow to develop for people with mental health issues, but numbers of people using them are now increasing.
The ability to personalise care would be particularly relevant to the growing number of people who need to manage one or more chronic medical conditions. So far, however, the government has said that individual budgets should not be extended into the NHS, although many areas operate joint services.
People with long-term medical conditions develop expertise about what works best for them. Individual budgets would allow them to harness that knowledge to improve their care, choosing which strategies to adopt to meet their health goals. They could work with a peer supporter instead of working with a professional, and could then demonstrate to their care co-ordinator how their purchases contributed to their health goals and they would continue to be monitored by their GP or psychiatrist. Particularly for people who receive health and social care services, an individual budget would allow them to co-ordinate care and decide on the best balance between social supports and clinical care.

There is no evidence that money is misspent or that personalising care costs more. On the contrary, there appears to be significant scope for savings in the reduced use of acute care.
One of the most important lessons from all the Individual Budget pilots both in the USA and the UK is the need to provide support to ensure that individual budgets meet people’s needs. The support needed is; an information and advice service that will help people identify their goals, make informed decisions about how best to meet them and develop a spending plan; and a management service that can take over the paperwork and financial transactions.
People who have used a self directed approach often express a preference for peer support over support from a professional. Together’s ‘Wellbeing Approach to Involvement’ could be a means by which potential peer supporters are identified and trained. Local authorities and primary care trusts could invest in the capacity of a range of organisations to provide support services, so that people who choose to direct their own care are guaranteed access to the type of support that best suits them.