Dissertation complete copy template

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“What are Social Workers’ perceptions of the difficulties and
opportunities of implementing Personal Budgets?”
iv: Preamble and Introduction
Personal Budgets (PBs) are the latest concept to try and “personalise” services
for individual service users. Personalisation in the United Kingdom can trace
its origins back to the Independent Living Fund (ILF) that was established in
the 1980s’ following pressure from Disabled Groups who wanted the freedom
to spend money on services that statutory social care agencies could not
provide. This cash for services approach continued in various guises with
Direct Payments becoming a mandatory service approach for all service users
(SUs) under the Health and Social Care Act 2001 (HM Government, 2001).
As a consequence this left care providers with a dilemma because existing
personalisation initiatives were designed for those who found the confines of
social care services restrictive in being able to live the lives they wanted. They
were simply not intended for the most vulnerable in our society or those who
had been subject to a rapid decline in their capacity. Yet, it is hugely
empowering for people, when given the chance to be able to make their own
decisions about choosing the care they receive, in fact with the Mental
Capacity Act 2005 (HM Government, 2005) making independent decisions
has become an indisputable right.
“You spend your whole life making decisions about things- your
work, your relationships, your children; you don’t suddenly give
up that responsibility because you’re older” SU participant, In
Control Study (Bowers et al 2007, p.4).
PBs differ from previous attempts at personalisation, the most significant being
that both private and public Sector services can be purchased. Direct Payments

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proved popular with those who had low-level needs or who had a strong
support network because it effectively placed them outside of the
responsibility of the statutory social care agency. Unfortunately this
contributed towards relationships between social workers and SUs that were
increasingly distant with an emphasis on budget/risk management instead of
face-to-face development. This has only contributed to the societal myth that
social workers are only involved when it comes to taking something, like a
child or money away rather than genuinely seen to be changing lives.
The major significance of PBs is that they are not just empowering through
choice but as Leadbeater, (2004) argues enable participation from both SUs
and Social Workers. Since 2003 when the first pilot schemes were
commissioned by the government, the central template for all PBs has been the
support plan. This template is a needs assessment that identifies where need
exists within the values of the Common Assessment Framework (CAF) and
how the personal budget will be spent to meet that need. Financial
Assessments are aligned to need by using a Resource Allocation System
(RAS) to calculate the value of how much money is allocated to address each
need.
The Social Worker works with the Service User to review the personal budget,
with the latter encouraged contacting their Social Worker if their needs
change. In the support plan the worker will look to capture the views of the SU
to justify why the budget is being spent in a certain way and can look to
withdraw services if there is evidence that they are no conductive to meeting
the agreed aims of the support plan. In addition, if there is a change in
circumstances, the plan can be amended and approved by a senior practitioner
or line-manager without the need for the assessment process to be started

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again. This is particularly beneficial in emergency situations and those whose
circumstances can fluctuate suddenly because there is provision for a “one-off”
payment to be made in circumstances where for example a carer has been
taken sick. In the rigid world of managed services, the SU would be given few
options because they would be confined to the restrictions of a care contract
that they had not signed and had no involvement with yet were bearing the
impact of the consequences.
Older people should have been able to reap just as substantial benefits from
these initiatives as any other service user group, yet as this study highlights
this is not happening. There has been very little research or investigation into
the reasons behind this trend, yet with PBs becoming a permanent part of
Social Work practice it will become increasingly essential to understand not
just if they are working, but how they work to benefit a group of people that
represent such a large part of our society.
This study looks at the impact PBs have had from a professional relationship
perspective and the changes in practice approach that have been necessary in
making personal budgets work for older people.
Why older People?
I found during my experiences undertaking a 100 day practice placement in an
adult community assessment team that very few adults were being offered
Personal Budgets. The Social Workers who I worked alongside disclosed a
range of barriers that impaired their confidence in being able to offer them to
their SUs. One explained that those with forms of dementia were unsuitable in

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accordance with agency policy, while others said that they simply did not have
the support networks in place to reap the benefits.
This experience reflected much of my initial research on Personal Budgets
which features in the literature review. While the barriers have been identified
that are restricting access, there is very little in the way of existing theory to
develop an understanding towards how social workers can break down these
barriers and enable not just access to personal budgets but successful
relationships.
If this is not achieved then Social Work would be guilty of discriminating
against a group of people in failing to provide support that would enable them
to enjoy a greater quality of life. This study aims to help develop new theory to
reduce the restrictions on access for older people.
Why focus on social worker’s experiences?
Older people should not be viewed as a singular group but composed of unique
individuals who have strengths and weaknesses. A qualitative study based
upon SU experience has been completed in the past (Bowers et al, 2007 and
Chester et al, 2010), yet these fail to provide the understanding necessary
beyond the rudimentary like or dislike disclosures. What is known is that
service users are offered personal budgets disproportionately less than other
SU groups and the Social Work practitioners hold the key in understanding
why this is as they wield the power of who gets to use them and who does not.

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Access to personal budgets is the biggest barrier and those who have used
them find themselves marginalised by services that are simply not equipped to
meet their needs. This was the biggest problem encountered when offering
direct payments to older people but as the literature review highlights, it has
been promised that these shortcomings were a thing of the past and PBs would
enable the facilitation of more involved relationships between SUs and the
services they receive.
My study helps to contribute to the development of an understanding why
there is such a large chasm between the promises made by government in
outlining their vision for the PB system and what is being delivered in practice
for older people. In choosing a grounded theory approach that utilises semi-
structured interviews it was possible to obtain open responses from
professionals to ascertain how specific aspects of service delivery impacted on
the professional relationship with service users. It should not be a linear
relationship and social workers also discussed their involvement in working
with support groups/carers or third party brokers who are the source of
services that SUs have purchased with their budgets. This gives the results of
the study a holistic view of the attitudes and experiences regarding
professionals in their approach to personal budgets, while developing new
theory to identify how service delivery.

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V: Literature review
This literature review critically analyses the existing research that has been
developed to identify the characteristics of Personal Budgets (PBs) and the
difficulties and opportunities that their implementation presents to Social
Workers and Service users.
What are the changes and why are they happening now?
The decision was taken to focus the review on research undertaken post 2003
as this is when the first personal budget pilots were commissioned by “IN-
CONTROL”, who have had a key influence in helping to shape their
development. This is due to the Government’s long-standing ambition to
develop a new form of service delivery outlined in “Our Care Our Say” (HM
government, 2006).
IN-CONTROL is split into three phases which were characterised by their
structured nature in being limited to certain user groups, high levels of funding
and a training support programme.
“The change from the prevailing systemof social care to one of
self-directed support can be represented as a move from a
professional gift model to one of citizenship….The disabled person
stands at the centre of the systemand is assumed to have all the
rights and responsibilities attached to citizenship. They are
expected to be part of the wider community, both using the
communities support but also contributing to it” (Poll et al, 2006,
p27-28)
Critics (Beresford 2010 in Greener et al 2010) say that much of the positive
feedback does not reflect the reality of PBs in the practice field because

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outside those pilot areas, practitioners will be expected to function under more
limited resources once the generous pilot funding has been reduced.
“Yet here was a policy with a very limited evidence base and little
clarity about its actual meaning or implications, which was
adopted and where national implementation was expected to be
achieved all within a space of five or six years”
(Beresford, 2010, cited in Greener et al 2010, p.238).
The positive outcomes of the initial pilots has convinced HM Government to
progress nationally with the programme with their most explicit reasoning
being as a cost-saving initiative and as a method for providing more choice.
Unfortunately the two are not compatible aims. Saving money through hard
quantitative cuts has become the main agenda in HM Government policy,
while defining choice remains very much an empirical concept that requires
the consultation of service users.
“What we’re going to be saying is that it’s not about spending
more money. It’s about focusing on what matters. If they spend
£350 on a laptop and that allows them to reconnect with their
friends if they have a disability and have not been able to leave
the house- we recognise it’s the small things which make a huge
difference.
If they are eligible, and part of their need is to get out and that
means getting a taxi to the cinema, fine. It comes down to whether
you think people have personal autonomy” (Stratton, 2010, p.13).
Paul Burstow, Minster for Care, announcing the HM Government strategy for
the national roll-out of personal budgets across the health and social care
system. The initial budget allocation for this strategy to be implemented
appropriately was £16bn at the time of the article, but this was cut following a
comprehensive spending review. This automatically limits the potential for
expanding choice through the avenues presented by IN-CONTROL and other

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studies. More recently the Government has sought to commission qualitative
financial audits that justify cost-saving approaches without including an
empirical evaluation.
An audit by KMPG (2010) commissioned by HM Government explicitly
views the benefits as providing an opportunity to save costs, with increased
quality of service being brought about organically through SUs being part of a
competitive market place. They argue that practitioners and service providers
become complacent through having over familiar relationships that serve the
interests of each other rather than the individual SU. In putting choice in the
hands of the customer, they can decide if they wish to spend money on council
sourced services or from a private source. Direct payments never enabled this
and placed SUs into the private sector. While this was an empowering concept,
it inadvertently encouraged practitioners to focus on SUs who remained
recipients of statutory block contracts. SCIE (2011, p.3) have found that the
same scenario is unfolding with PBs because the complexities of the system
leave social workers more confident in being able to manage services, rather
than place older people in a uncertain situation that depends upon their self
determination. PBs should give the flexibility to work with both sources of
service ensuring that both practitioners and SUs not only have more choice,
but that it is used to achieve the best outcome.
Is resource management and choice a compatible agenda?
Choice requires options and this means investment is necessary not only in the
form of monetary means but in further longitudinal research projects that
measure the impact of the choices made by service users to help them make

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more informed decisions independently to promote the requirements of The
Mental Capacity Act 2005. This in effect places SUs in the empowered
position to make decisions in the professional relationship.
Land and Himmelweit (2009) reported that the appeal of saving money was
the wrong paradigm to develop PBs and that is was misleading to represent
them as providing quality outcomes without the guarantee of quality services
to supplement them. They argue that personalisation simply “takes the logic of
privatisation one step further” and that the market logic argument argued in the
KPMG (2010) study “does not automatically hold in the market for care and
even special efforts to create them may not be successful” (Land and
Himmelweit, 2009, P.17). In other words, developing PBs without providing
strong foundations through good funding is akin to building a house upon
sand, it may initially look pleasing but the lack of support from external
elements will simply lead to it being washed away.
“The success or failure or failure of any social care policy must
ultimately rest on the acknowledgement that unlike in many other
parts of the modern economy there is an irreducible time
component to good care. This is true whether that care is
provided ‘free’ by informal carers or by waged workers paid by
the state, by private sector care providers or directly by those
needing care or their families. In an economy in which nearly
everything is produced faster than everbefore, this means that
the opportunity costs of providing the time that good care
requires rises. A society that wants its older and disabled people
well looked after needs to devote the necessary resources to it, and
the opportunity costs of those resources inevitably rise. This too
needs to be acknowledged” (Land and Himmelweit, 2009, p.6).
How do Personal budgets change service delivery?
Leadbeater et al (2008, p.11) believes “people’s relationships with
professionals change. In the traditional approach, professionals in the case of

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social care it is social workers-assess need and entitlement, plan and often
provide services and judge the quality of outcomes on the person’s behalf. In
self-directed services professionals retain a critical overview of service quality
and outcomes but they become more like advisers, counsellors and brokers
guiding people to make more choices for themselves.” However that is based
on the assumption that PBs save time to enable social workers to allocate time
towards SUs in these roles. Much of the following existing research on PBs
explains that for older people there are barriers that need to be negated if PBs
can be the solution in allowing these relationships to flourish.
Older adults have been largely overlooked in the analysis of the impact that
PBs will have on their working relationship with practitioners. The outcome of
this lack of professional understanding is that there is a respective level of
knowledge being communicated to the SU with a study from DEMOS (2008,
p.22) highlighting that 80% of social care and health users “did not understand
PBs and why they are being used”.
What is known is that supplementary studies show (Tyson et al, 2010, Hatton
et al 2008, IBSEN, 2008) that the most receptive groups have been the long-
term physically impaired, who have a long history of working with
personalised service concepts such as the Independent Living Fund and Direct
Payments, while older adults lack the benefits of informed experience derived
from these earlier forms of personalised approaches. It is important to note that
these were largely theoretical based studies using existing data as a point of
reference. The DEMOS study shows a particular theme for focusing a
narrative upon cross-comparison with direct payments. This is not particularly

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relevant when evaluating the impact of personal budgets on older people as
they had very limit access to the original direct payments scheme.
Leadbeater, (2004) argues that PBs work “based on long-term relationships”
and because many older adults access services at a point of crisis, it is not
possible to develop any long-term aims from these situations. Hatton et al,
(2008) also suggested that older people accessing services at a crisis point
were doing so for the first time in their lives and were not used to engaging
with social services. However it should be down to the role of brokers who
work with services to help inform service users of the right options available to
them.
What support is there to deliver the “right” outcomes for Service Users?
Scourfield (2010) has identified that PBs require SUs to develop much broader
relationships with brokers who hold a greater micro understanding on a
particular service area. Support Brokerage (SCIE, 2009, P.12) “is best
understood as a set of tasks to enable people to plan and arrange social care”.
Since the Seebohm report (1968), these tasks were completed by Social
Workers and other professionals in relationships between SUs characterised by
largely linear arrangements that placed an expectation on the professional to
have a macro understanding of the range of services available to the service
user. The development of PBs makes such an approach ineffective because it
requires the service user to identify the services that will work for them, with
the range of services as broad as the consumerist market will allow. Scourfield
asks how brokerage relationships can be successful for the needs of the service
user if they are not developed within the social work field.

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This opens up another debate if being a “social-worker” is entirely necessary
for successful service relationships for service users. The current landscape for
service roles has been fragmented into distinct separate specialism’s that
require a unique expertise. Social Work as a profession is a very recent
concept and one that has a history of being anything but distinct. It
encompasses a broad range of skills and disciplines that to the public at large
can be very difficult to comprehend.
Clarke et al (2007, p.76) believe that the concept of the ‘professional’ has been
overvalued, while the “capability and capacity” of SUs underestimated. As a
result “this was rarely resolved in favour of a consumerist version of choice.
Instead, professional knowledge was conditionally desired and seen as
necessary”.
In the personal budget model, the theoretical change of relationships should
show less dependency on the individual professional towards what Scourfield
(2010), has identified as a “gatekeeping” role in monitoring decisions made by
SUs. Meanwhile the increased use of multiple specialist brokers to access
private sector services would logically result in a more diverse range of
knowledge available to both professionals and SUs.
“Brokerage is now considered a critical element in ensuring the
success of the personalisation agenda. Therefore, where it is
situated organizationally and ideologically is not inconsequential
both in terms of the accountability, profile and quality of the
‘brokers’ and the extent to which SUs can feel properly IN
CONTROL of their own care or support” (Scourfield, 2010,
p.859).

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Greener et al (2010) supplement this with the identification of what has been
defined as “local knowledge” that in a linear professional-client relationship
does not get utilised as effectively as it can in a PB context. Local Knowledge
is part of the framework for developing HM Government’s “Big Society”
agenda (Big Society Network, 2011), that looks to abolish dependency upon
costly professional dependence, while bringing in those from the margins of
society to play a bigger role. The impact on relationships with SUs results in
more specific and personal understandings from professionals into the issues
that affect their lives. Such local knowledge has become a scarce resource
amongst all professionals as commuting distances increase and people relocate
to achieve career ambitions with increased frequency in a globalised
marketplace. Yet, many older people acquire this knowledge organically
through years of living and working in their community, perhaps holding a
greater informed local knowledge base than other user groups. This argument
is seen from a broad macro perspective of society, but it does not account for
the micro-level diverse differences that can affect the quality of these
relationships at a local level.
Williams (2008, and 2006 in Pearson, 2006) explains in a narrative overview
that the reason PBs have such a small empirical knowledge base within the
context of older people to reference is because there is little previous
understanding of their experiences with direct payments. The biggest
difference between direct payments and PBs is that the former simply allowed
access to privately sourced services only, while the latter provides an
opportunity to purchase services from the public and private sector. As a
result, professionals have more direct involvement working with the PBs
concept and are more accountable for the outcomes.

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Williams (2006 in Pearson, 2006) believes that because older people were
effectively excluded from the option of direct payments, as the 1996 Act
placed an upper age limit of 65 on their use, this placed them at a disadvantage
when it came to accessing personal budgets. This age limit was only removed
in 2000 with mandatory provision available since the start of the Personal
Budget pilots in June 2003. The argument for these restrictions was that older
people could not generally manage such a complex service independently. In
the contemporary era of modern personalised social work such an argument
looks incredibly oppressive especially in line with the GSCC code of “treating
each person as an individual” (GSCC, 2003, 1.1).
Henwood and Hudson (2007) were commissioned by HM Government to
identify if the Independent Living Fund (ILF) should continue or be replaced
by personal budgets. They identified that the ILF “did not perform well against
such criteria” (Henwood and Hudson, 2007, p.39) for evaluating their
promotion of self-determination by SUs. It argued that while it had offered the
first opportunity for SUs to experience purchasing their own services (it started
in 1988), the criteria for enabling this was so complicated that it had actually
increased dependence upon professionals. The government responded to these
difficulties by scrapping the ILF, direct payments and other service payment
schemes in favour of the singular PB system. Although much of evidence from
this study suggests that Direct Payments still exist as a more convenient short-
term payment for services known in Hertfordshire as “one-off” or “block
payments”. Their method evaluated the ILF using personal budgets as a
distorted barometer. At the time, IN-CONTROL was the only pilot scheme and
was well funded. The ILF initially struggled for funding and lost HM

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Government support in the early 90s as a recession took hold. There is little to
prevent a repeat performance for personal budgets if funding cuts continue.
Our Health, Our Care, Our Say (HM government, 2006) and Putting People
First (HM Government, 2007) redefined the social care landscape by
promising that every service user would be given the support to choose what
services they wanted. PBs were to be the main tool to achieve this aim, but it
became the obligation of the individual to fulfil this with an expectation that
society would be willing to provide a more extensive network of support. On
reflection these HM Government documents were the product of an entirely
different political landscape that was purposely designed to theoretically
outline the future direction of social care services. They are highly relevant to
this study because political thinking is ultimately the basis upon which the
direction of future policy on personal budgets will take.
“At the same time as giving people greater control and choice over
the services they use, we also need to ensure that everyone in
society has a voice that is heard. When people get involved and use
their voice they can shape improvement in provision and
contribute to greater fairness in service use” (HM Government,
2006, p.157).
Is the existing Personal Budget infrastructure sufficient?
It is a noble ambition, but it is arguable if anything tangible has been done
towards enabling these community-wide relationships to develop. Instead, IN-
CONTROL pilot areas Tyson et al, (2010, p.48) have had to spend resources
on creating new brokerage services such as “Shop4Support” which is an online
catalogue that enables SUs to purchase what they want. The obvious barriers
for older people in accessing the internet and physical accessibility issues were

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not discussed in their findings. There is currently no statutory legislation to
encourage already time-stretched Social Workers to help their SUs access
“community services”. Aside from the IN-CONTROL targets to provide
personal budgets, there is no structure in place towards developing the
relationships that will enable the PB concept to work successfully.
“As the policy was not originally available to this group it is
possible that an information lag exists, resulting in a take-up being
behind that of groups who have been eligible since the enabling
act. It is also possible that older people, like those with learning
difficulties and mental health problems have been considered less
likely to be able to cope with the responsibility of managing the
payment and personal assistants. Therefore it is not considered an
option unless there is an obvious source of support, such as a
family member. However support from formal support
organisations was also found to be important, although they too
felt that younger people required more support than younger
disabled people” (Clark cited in Pearson 2006, p.48).
Support organisations have been identified (Tyson et al, 2010, Scourfield,
2007, and SCIE, 2009 (a)) as the key factor in ensuring that PBs maximise
their potential. IN CONTROL have identified in their third development
phase, that access to these is uneven across the country with a clear divide
between rural and urban areas with the former having significantly reduced
input from support organisations. The fragmented nature of varied support
brokers often means a broader ranger of locations that SUs need to visit or
contact for support. This situation undermines the aim of Putting People First
(HM Government, 2007, p.1) that promised “access to high quality support
should be universal and available in every community”. It has not been
considered how this support shortfall will impact on accessibility for older
people who are more likely to need such support to help access services due to
mobility related impairments. One aspect is clear, if older people are unable to

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access services then they will simply not be able to develop working
relationships with them to access the services they need.
“Those who work for the direct payments (personal budget)
support organizations have much greater opportunities to spend
more time face to face with clients; they can offer practical
assistance and, if needs be emotional support. Workers in such
support organisations engage in practices that are designed to
empower direct payments (Personal budget) recipients. Arguably
this area of work could be an important revival of social work
with adult SUs” (Scourfield, 2007, p.118).
Glasby and Littlechild (2009) have said that the slow development of support
organisations is undermining efforts to build professional relationships
between SUs, their communities and professionals. They praise the work of
disabled focus organisations such as the Essex Coalition of Disabled People
(ECDP) in promoting the needs of their members to professionals at staff
meetings and at community forums, yet they admit that for older people there
is no recognised voice. Again, they cite the short history of PBs and low
uptake of their use amongst older adults as the cause for a lack of
organisational support.
The appraisal of support agencies from Glasby and Littlechild (2009) and
Scourfield (2007) lack empirical experiences from support organisations to
help their audiences grasp a deeper understanding of why support
organisations are able to develop relationships while statutory agencies are not.
Scourfield does mention the high levels of bureaucracy at statutory level but
the sector is often blessed with a higher skilled full-time workforce, unlike
many support organisations that rely on the goodwill of volunteers.

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One argument from SCIE (2009 (a), p.20) suggests that because there is a
separate funding stream for health and social care eligibility criteria in gaining
funding for services it is placing multi-agency work between the two sectors in
an adversarial position with agencies “seeking to pass the costs of support into
other agencies; in all cases it is individuals who are at the risk of losing out.”
They recommend that HM Government needs to take the lead in ensuring
“policy coherence” and “equity” to all SUs because those older people with
complex needs encompassing both their physical and social health find
themselves frozen out by those agencies looking to cut costs. An adversarial
relationship between agencies creates barriers for SUs aiming to purchase
services that meet their needs.
In Scotland, this situation has been recognised through their own independent
pilot areas recommending in the most recent report (Changing lives, 2009,
p.21) that “co-production” is a key method in being able to deliver
personalised outcomes. These outcomes can only be delivered successfully if
partnership agencies are committed to contractual obligations and standards
that must be met if they want to continue to benefit from the custom of the
Service User. The obligations are defined as “Shared Learning Partnerships”
(Changing lives, 2009, p.34), these are assessed against indicators that
identify the contributions needed to develop rewarding relationships.
Scotland has a 10-year history of working with personal budgets and was the
first area of Britain to pilot them. This ensures that Changing Lives is a more
longitudinal study that was able to include the experiences of the whole
support network of service users from across various different backgrounds
and need requirements. The problem with IN-CONTROLis that the studies

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have been carried out as the concept develops which holds benefits in
identifying function barriers to the concept but is limited because like many of
the other studies it can only use direct payments or other forerunners to the
concept as a comparison. This has led to Personal Budgets largely avoiding
criticism because they would easily appear as an improvement on existing
personalisation approaches because they build upon the lessons learned from
previous experiences. As Personal Budgets are a relatively new concept in
England and Wales, those experiences are less informed meaning that it is far
easier for research to rely on comparisons to a previous method of
personalisation that has a deep knowledge pool to work with.
The impact upon service users
With this lack of an existing structure of partnership accountability in England
and Wales, older people have no alternative but to seek support from family,
friends and informal support relationships. An IBSEN (2008, p.54)
comparative study between PBs and existing approaches pinpointed that “the
opportunities to pay informal carers was perceived to be particularly beneficial
for those who needed familiarity and routines”. Older people found them more
flexible than direct payments in this respect. However this has led to these
relationships becoming the main source of helping older people to manage
their implementation.
Older people recorded the lowest scores for personal budget aspiration and
“were significantly less likely than other user groups to report that the process
had changed their view on what could be achieved” (IBSEN, 2008, p.83). The
reasons debated for this are that older people can feel overwhelmed by the

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complexities of the new system and have the highest proportion of “proxy”
relationships with Social Workers. As PBs have enabled more informal carers
to be paid out of the personal budget fund, the more involvement that
professionals have in working with informal carers as they take the role as a
service provider. As a consequence this results in an expectation from social
workers, perhaps unwittingly upon the caring relationship to develop an
understanding of PBs to help support their service user to justify the financial
outlay being bequeathed to them.
“A very important message for rolling out independent (personal)
budgets for older people is that they may have a negative impact
on psychological well-being, at least in the ways these new
arrangements were introduced and implemented during the pilot.
The results suggest that while lower-levels of well-being or higher
anxiety levels might be slightly more prevalent among those older
people able to respond in the interview, higher levels of anxiety
appear to have been systematically attributed to more vulnerable
older people who had (personal budgets) by their proxy
respondents. We cannot distinguish whether this is due to the
concerns of more vulnerable older people, less able to respond on
their own behalf, or of their relatives (the most frequent proxy)”
(IBSEN, 2008, p.87).
These concerns could be attributed to the lack of specialist brokerage services
that provide supportive relationships in not just aiding SUs in choosing the
right services but giving social workers an informed base on which to develop
them. SCIE (2011, p.4) found that older people viewed the “psychological
benefits” of PBs to hold as great a significance for them as the practical
support element. They gained increased self-worth through being able to
achieve outcomes through their own contributions but felt that this needed to
be supplemented equally with practical support from social workers and
support agencies.

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“Consultation with recipients-including, especially, older people-
has also found that a major concern is the quality of advice and
support available to people using direct payments or personal
budgets” (SCIE ResearchBriefing 20, 2009, p.10).
Existing concerns and remedies for where change needs to be
made
The advocacy role of Social Workers is a vital skill in ensuring that these
separate sources of support function collectively to understand the needs of
their SUs. An empirical, non-structured interview study by the Joseph
Rowntree Foundation (Horton, 2009, pp, 1-2) concluded that “continuous
dialogue is key to the success of these partnerships” and that “older people
place a higher value on information than other groups”. Unfortunately the
following evidence suggests that there are barriers in existing social work
practices that are preventing this skill from having an influential impact.
Hernandez et al, (2009) argue the existing “tick-box” approach to care
management has led to insular practice amongst practitioners who simply do
not need to develop relationships to fulfil the demands of their role.
“Where staff valued participation as an essential organizational
activity, evena ‘right’ of SUs, they tended to be more creative in
their practices and facilitate a safe space for everyday
participation. This required insulation from ‘tick-box’ approaches
to user involvement and unsupportive organizational
environments. This tension was increased when a service relied on
a number of funding strands, each of which required different
reports to describe the outcomes of the sections of work they were
paying for. One staff member described how seldom heard
participants were constantly having to fill in forms and were
losing ‘the magic’ of participation” (Hernandez et al, 2009, p.731).
Leadbeater, (2004) warned that a “tick-box” culture would undermine the
benefits of PBs providing a valuable opportunity for participation with SUs.

22
Personalisation of services is the macro outcome of a personal budget but the
quality of their delivery is being undermined by what Dustin, (2007) describes
as care management. The consequences of this have been to create services
that are “overlapping” and “poorly co-ordinated”. Dustin’s argument presents
Care Management as fundamentally in the spirit of providing a standardised
social care system of delivery defined as “McDonaldisation”, which like the
fast-food chain seeks to provide a uniform experience for everyone. This is
clearly at odds with the aims of personalisation which seeks to provide
services unique to the needs of the individual.
“Further, the opportunity to practise casework skills has been
limited by the fragmented purchaser role. Social workers acting
as care managers have skills that are not required within the
care-management role. They are expected to assess needand
purchase provision of services, but they are not intended to be
involved in the provision of direct services. Therefore one of the
hallmarks of casework, an ongoing professional casework
relationship with SUs is not possible for care managers. Without
an ongoing professional relationship with SUs, the care manager
role is perceived as a superficial role by some social workers”
(Dustin, 2007, p.36).
Manthorpe et al, (2009, p.1293) think “this process of personalisation will
inevitably alter the world of social work and care management with adults,
progressing to add that “a combination of such roles must be predictable”.
Their study interviewed a range of practitioners on the quality of their training
experiences and it was evident that the training was supplementary to existing
care management approaches that were being used. Despite one participant as
quoted “the concept expresses all we have ever aspired to in our professional
practice”, it was not being converted to the practice field because the
constraints of bureaucracy, a hallmark of care management approaches were a
major constraint towards being able to employ personalised methods.

23
Many of the pilot areas from which the study was conducted did not start with
a clean slate, which perhaps would be logistically impossible, but still in the
hope that such conflicting methods could integrate seamlessly into the existing
approaches. Chester et al (2010), anticipate that local authorities will move
away from Care Management approaches with older people when they find a
care arrangement that works to deliver proven results. They argue that Care
Management’s predictability provides professionals with outcomes that they
feel confident in delivering, as opposed to the more unpredictable nature of
unproven, yet more flexible options offered by PBs.
“It may be, for example, that care management itself will become
a discrete area of activity with a more intensive focus, as
illustrated in pilot projects that preceded the community care
reforms. Care Managers’ activities could increasingly focus on
those with more complex needs, with some of those with low and
moderate level needs directing their own care” (Chester et al,
2010, p.2535).
The Perils of Care Management Approaches to service delivery
This hypothetical benefit does not account for the impact that having two
conflicting approaches to service delivery will have on the relationships with
SUs. Care Management arguably can never be discrete in relation to PBs
because they are so contrasting in their ethos, with care management largely
promoting increased control over services, while PBs aiming to devolve that to
the SU. Splitting the two methods between complex and low level need cases
might appear rational, but in practice would face financial barriers in finding a
range of appropriate staff that can multi-task to appropriately to deliver a range
of approaches.

24
Dustin (2007) identified that care management follows a linear system that
enabled less skilled staff to work efficiently, which appealed to Social Work
authorities who only have the resources to supply temporary staff. The
Chester et al (2010) study also does not address the findings of IBSEN (2008)
and Scourfield (2007) that PBs are not a method for saving time by enabling
SUs to direct their own care but an opportunity to enable to do this if the
appropriate support services are in place. Care Management is so structured
and time consuming in delivery that the ambitions for SUs to deliver their own
care could be being undermined by its continued use as a method of service
delivery.
It could also lead to confusion and frustration amongst practitioners who are
given the skills to make a difference in their relationships with SUs but the
opportunity to utilise them is limited by a lack of clear role definition, a benefit
that Care Management would appear to offer.
“Professionals should act as advocates for users, helping them to
navigate their way through the system. That means clients having
a continuing relationship with professionals who take an interest
in their case rather than users engaging in a series of disconnected
transactions with disconnected services” (Leadbeater, 2004, p.61).
Bev Maybury, The project lead for the Oldham Council authority’s
individualised budget pilots (Community Care, 2006) admitted that PBs “no
longer have the degree of control we had previously.” Oldham’s solution “has
been creating a risk enablement panel that responds to high risk situations,
with a less intrusive approach. There is a tendency to make people go through
procedures designed for the most complex situation than modify our
approach”. This is an example of using the freedom of PBs to develop more
flexible service approaches towards SUs. A care management approach had

25
proved too rigid and required social workers to exert control over the situation
through a set of defined stages.
Hunter and Ritchie (2007) argue that the skills necessary for person centred
planning or defined as “co-production” cannot simply be acquired through
“technical skills” and “procedures” which are the hallmark of the professional
but as Clarke et al (2007) argued previously, consequently tip the balance of
power too heavily to the side of them. Instead approaches should “evoke the
spirit of enquiry, humility and partnership”. The barrier to successful co-
production has been that some professionals have been overtly protective of
their professional hallmarks and have been overtly reliant on technical skills
and procedures that fail to engage the participation of SUs because of the lack
of accessibility in helping them understand professional discourses. As a
consequence “co-production” is reduced to becoming the product of the
professional with SUs lacking the informed knowledge to make an influential
contribution.
The need for clarity and guidance in Personal Budget Implementation
While evidence that this has been recognised is present in Bev Maybury’s
approach, there is little explicit policy or guidance that has been issued that
defines how these approaches can be delivered in an accessible way for all.
That is ultimately the purpose of the IN-CONTROL pilot areas but the
problem for relationships is that the promises made to SUs publically in the
past within Our Care, Our Say and Putting People First may not be kept
without compromises that could leave SUs feeling misled, ultimately

26
damaging the Social Worker/Practitioner relationship, an unfortunate outcome
of a concept that has been sold upon improvements to the lives of SUs.
Literature outcomes
This literature review has identified 3 macro themes:
(a) The arguments for the practice benefits of Personal Budgets
(b) The existing known impact of how these benefits have changed the
Social Work and agency working relationship with older people.
(c) Discusses if these benefits are being delivered and the implications of
any difficulties upon these relationships if any identified barriers are
not tackled.
The most common central theme that much of the research is collectively
agreeable to ensuring the success of PBs regardless of user group is the
appropriate support from brokers and other support services. While research
from Scourfield (2007), Glasby and Littlechild (2009), Tyson et al, (2010)
and SCIE, (2009) have all referred to warnings that their implementation in
regards to older people has not had the necessary growth expected to meet
their support needs, there are no empirical contributions from Social Workers
themselves to express why this has not occurred and the limitations that it has
had on their relationships in working with older people. It is perhaps the most
striking theme that can be derived from this literature section that despite an
identified inadequacy that caused IN-CONTROL (Tyson et al, 2010) to spend
resources in developing new support services, it has not been questioned as to
why this is necessary when one of the initial benefits of the PB concept
(Leadbeater 2004, KPMG, 2010) was that it would provide an opportunity
for existing community services to provide support options, thereby reducing
the financial and workload burden on the statutory publically funded sector.

27
This lack of consideration for practice implications largely due to the lack of
empirical reference in accessing the consequences of the PB approach is most
apparent in studies that were carried out by those outside the field of social
work practice. In the cases of KPMG, (2010) and Leadbeater, (2004) a
possible methodological weakness was the apparent lack of empirical
consultation with SUs and Social Workers. As an outcome, much of these
studies focus on the financial or other theoretical benefits that overlook the
practice orientated arguments identified in Scourfield (2007), Manthorpe et
al (2009), IBSEN, (2008) and Tyson et al (2010). The latter research was
generally qualitative and used empirical practice experience, even if it was
derived from older studies with Direct Payments as a comparative basis for
explaining their outcomes. While the former used quantitative statistics to
create argument that aimed to propose definitive outcomes. Leadbeater, (2004)
appears to have taken a systematic review approach to deliver his findings at
the time, this would have been entirely appropriate given that his brief was to
inform HM Government on the state of service funding at the time.
The problem with quantitative studies in a field as variable as Social Work
practice is that it attempts to develop a uniform, logical approach to practice
through establishing patterns from the data, often aiming for validity using
statistics to justify outcomes. As a result, the outcomes argue an ideal
framework for practice that does not recognise those variables to practice that
deviate from the identified norm. This only serves to place an unrealistic
expectation upon social workers when the unpredictable reality of the practice
field cannot fit within the confines of an ideal, but must be expandable to meet
the requirements of the situation.

28
What this study identifies is how, through the perceptions of social workers,
how relationships between SUs and Practitioners have changed as a result of
all the upheaval that has been identified in the pursuit of personalisation. This
is an important perspective to acknowledge because without an understanding
of how relationships have changed through the PB method, it ensures that
approaches to practice using PBs are not effective as they could be in meeting
the needs of SUs. The following interviews with Social Workers were
completed to provide a practice insight behind the debates argued for and
against personal budget implementation defined in this literature review to
understand how they function within these relationships to deliver outcomes
for SUs.

29
vii: Methodology
The aim of the methodology was to develop a framework that would enable
the development of new theory for increased understanding upon the themes
identified from the literature review. This called for a qualitative approach
because a major characteristic of this (Geertz, 1973 in Shaw and Gould,
2001, p.7) is that it encourages a “holistic” perspective to be developed into
the “particular” through interpretation of experiences. As a summary, this
method helps to deliver a broader understanding of the individual rather than
the collective, an outcome that fits comfortably within the shared values of
professional social work (GSCC, 2002).
Within the methodology of qualitative research, the specific method was
informed by a grounded theory approach. The strength of applying this method
is that it constantly enables the research process to move on towards gathering
new data because any new developing theory is defined by Alston and Bowles
(1998) as “grounded in the data”.
“Indeed, Strauss and Corbin (1998) emphasise that data analysis
can begin with the first interview or piece of evidence that is
gathered, a process which encourages the researcher to think
analytically rather than descriptively, and so move on to
theorising without becoming lost in a mass of complex data”
(Strauss and Corbin, 1998 in Alston and Bowles, 2003, p,204).
The benefit of this approach being informed by grounded theory is that it helps
to ensure that repetition in the research responses from the participants is kept
to a minimum. It would not have been appropriate to have used a postal
questionnaire strategy in this study because while it may have encouraged a
higher response rate, it would not necessarily have led to the development of
new theoretical ideas. The decision was taken at the initial planning stage to

30
use semi-structured interviews that would enable the growth of new theory
through capturing the unique disclosures of each individual participant. This
avoids a major shortcoming of the questionnaire approach identified by
Aveyard (2007) that the question responses become contaminated by pre-
determined choices if the participant has the time to think about them. As this
study aims to be a reflection of current practice experiences it was important to
capture the individual actual knowledge of each individual participant. An
additional benefit is that semi-structured interviews were found in the initial
pilot study to maintain relevance towards the indentified themes more
appropriately than in-depth interviews. However, because the initial pilot was
taken from a sample outside the boundaries of the agreed ethics approval
arrangements, the results have not been included in the results of this study.
Data Collection
An initial interview was informed upon the existing theory and key themes
extracted from the literature review. The interview is structured using set open
questions upon micro themes that enabled participants to expand upon them to
develop a macro understanding of these themes. The outcomes from their
contributions provided an informed basis for the next interview, a process that
ensures that each interview is responsive to the outcome of new theory. Once
the themes had reached what Strauss and Corbin (2008, p.145) define as
“saturation”, which was identified by constant comparison to existing data
from the participants during the coding process to indentify repetition of
responses that leads to the development of no new theory, consequently
undermining the purpose of the data collection process. It is at this point of
“saturation” that data collection was considered completed.

31
Shaw and Gold (2001, p.64) argue “it is not a specific technique,
but rather a methodological orientation that seeks to base
theorizing in the data, rather than imposing a pre-determined
hypothesis.”
Interviews were recorded verbatim by using teeline shorthand that was
transcribed within 24 hours post-interview. The decision was taken to utilise
this skill because some participants did not wish to be recorded and in the
interests of maintaining trustworthiness in the outcomes it was important to
maintain consistency by ensuring that interviews were held under the same
applied method for gathering data.
Coding Methodology and data analysis
Coding was developed by analysing the interview transcripts to identify Invivo
codes (Alston and Bowles, 2003, p.212) which “come directly from the
language of the people being studied and are usually vivid in imagery as well
as being analytically useful.” The benefit of this method in my coding process
was that (a) It provides raw data that helps “to distance oneself from
assumptions before the fieldwork and from the emerging analysis, in order to
return repeatedly to the data” (Lacey and Duff, 2007, p.11). Using constructed
or sociological codes formulated by this researcher could have caused
contamination of the raw data that provides the basis for the outcome of new
theory through their interpretation. In the interests of trustworthiness it was
considered essential to develop a clear distinction between the raw data
provided by the participants and the interpretation of that information by the
researcher using theoretical memos.
Theoretical memos (Strauss and Corbin, 2008, p.119) were found to be
beneficial because they helped the researcher in developing an understanding

32
of their own personal world-view towards the research question and how it
develop as they became more informed through the research process. It also
helped to reduce bias towards certain themes, in demonstrating a clear
distinction between the arguments of the researcher and the participants.
The themes were identified by using colour-coding to indentify key terms that
were important in developing new theories to the main research question. In
the early interviews the frequency of new codes was numerous but eventually
once each code had been saturated, the frequency of new codes became less
frequent. This provided a clear indication that no new theory could be
generated and by establishing a pattern of frequency it highlighted the
significance of a certain theme across a broad range of participants. Each
theme that emerged from the coding could then be explored in a theoretical
memo. This process is informed by the “open-coding” methodology defined by
Strauss and Corbin (2008, p.195).
It was recognised that an electronic software package such as NVivo had the
potential to provide a more efficient way of identifying themes within the
transcripts. However the limited reflexivity afforded by the time constraints
placed upon the research would have not been sufficiently beneficial in
enhancing the quality of the data to justify learning a new software package for
the purpose of managing the data of 10 participants. Another limitation on its
application in this study is that it does not recognise tee-line symbols, thereby
requiring the transcription process to be completed twice and undermining the
potential for a more efficient coding process in this study.

33
Research Sampling
The participant sample was identified according to 3 mandatory requirements
defined as follows:
1.) The participants must have current practice experience of working
with Personal Budgets
2.) The participants must have current practice experience of working
with older people
3.) The participants must be aware and protected by the ethical
approval agreement between the researcher and the local authority
who agreed to enable research to be carried out within their
organisation.
Hertfordshire Social Services Authority in the South-East of England was
approached by the researcher for help in selecting participants that met
these criteria. Ethical approval was sought and granted (Appendix 1) by
Hertfordshire Adult Care Services’ Ethics Approval Committee following
a meeting with their Assistant Director who helped set the acceptable
ethical boundaries for the study.
A barrier to participation was identified during the selection process that
further ethical approval would have been necessary to include participants
from other social services authorities. This was not possible because of the
time constraints on the study and the comparatively long process of gaining
ethical approval from each authority. It is a regret that other social services
authorities were unable to contribute to this study as their experiences had
the potential to provide an interesting cross-comparison to the perspective
from the Hertfordshire sample. It is the researcher’s recommendation for

34
any future supplementary research that may be carried out upon the basis
of the findings here that such a comparison would be useful.
Participant Characteristics
In total 10 participants contributed to the study. They were selected via an
appeal sanctioned by their Assistant Director who distributed an internal e-
mail asking interested participants to contact the researcher directly. The
interviews were not initially capped at 10 but during the interview process the
saturation of the data had been reached at this point and it is of the informed
opinion of the researcher that it would not have been beneficial to the study in
extending the study beyond this participant number. All names within
disclosures made during interviews have been deliberately omitted to preserve
anonymity to ensure that any issues that could be considered personally and
professionally sensitive could be shared openly with minimal anxiety.
This approach ensured that consent to comply was solely on a voluntary basis
and there was an additional tick-box provided to enable participants to
withdraw their consent to participate at any time during the interview. Contact
details were also provided to ensure that there was the option for participants
to withdraw their contribution at any time leading to the proposed submission
date of May 16th 2011.
All of the participants were based within the same social services community
assessment team for the Hertfordshire Social Services Authority. Each
participant held the professional status of “social worker” as their title role.
Some had experience working in a broad variety of different settings prior to
taking up their current role within the Community Assessment Team. During

35
the interviews it became apparent that each professional worked with a variety
of service users in differing circumstances, a typical reflection of the diverse
role a social worker undertakes working in a statutory local authority setting. It
is important to note that all of the participants interviewed were female and
eight of the ten participants had some experience of working in hospitals.
These consistent elements of the demographic data were interesting but could
not be explained through the data generated by this study.
The first four interviews were conducted face-to-face on location at a local
Social Services Office. Due to the professional obligations of the participants it
was decided that telephone interviews would be used for the final 6
participants. It was the decision of the researcher to consider that the benefits
of carrying out telephone interviews that could be arranged and postponed
more responsively to the demands of services outweighed the negatives of
losing the phenomenological experiences that would be obtained on location.
These were considered unnecessary in presenting the data from a grounded
theory perspective.

36
vii: Results and findings
The barriers of funding
The concerns of funding were the biggest and most consistent theme to emerge
across the contributions of the 10 participants. Participants considered the
ongoing cuts to services as having a major impact on the services that service
users could receive. The data highlighted some contrasting theories disclosed
by the participants across the range of interviews towards how far Personal
Budgets could function effectively in consideration of this concern. Particular
scrutiny was expressed towards the lack of suitable alternatives when
conventional services had become too expensive to purchase with the funds
available.
“The other problem is that for people over 65 the RAS score falls
in comparison to those who just had a physical disability. Even
though their need has not changed, just their age” (Interview
Participant 6, Social worker, appendix 2).
“They are offered them (support services) but it is ultimately a
question of money. There is for example (re) ablement packages
that people are offered when they first receive services. That has
been expanded to be offered to everyone, eventerminally ill
people, who were not intended to be on the service. It was
originally intended for overcoming a short-term illness to become
well again. It is subsidised by us.” (Interview Participant 1, social
worker, appendix 2)
Ablement or reablement packages were designed as a short term measure to
save money and time for social work authorities. It is a care package for those
with a short term illness or injury for those who had been discharged from
hospital. The aim of such a package is to provide intense care for 12 weeks to
try and get the recipient to live independently within that time frame. After the
12 week period if their condition has not improved to enable independent
living then the participant should become a SU on a care package to meet the
need that prevents them from living independently. As reablement is a short
term package, it should not be considered for those with a personal budget who

37
typically work towards longer-term outcomes. The relationship with the SU
under a reablement programme is different in that the package is delivered by a
set provider and contains a set routine that is adhered to by the SU to ensure
consistent outcomes are reached (Panorama, 26th July 2010).
There was a counter argument, that provided evidence to illustrate that existing
service methods of sourcing within the confines of statutory provision through
block providers was too rigid and that personal budgets had afforded their
customers with more options while also removing strain from popular block
providers who were oversubscribed as a consequence.
“The ones that we use can often be oversubscribed and stretched,
but they can go to an alternative agency where there is more to
offer their need” (Interview Participant 5, Social Worker,
Appendix 2).
“For example, direct payments allowed a Greek lady to purchase
a Greek personal carer. She is so happy now, she will be at home
with her PA (personal assistant) and they will watch Greek TV. It
allows them (Service Users) to be individuals more, you wouldn’t
get that choice within the confines of a block contract” (Interview
participant 10, Social Worker, appendix 2).
The allocation of funding, is it fair?
The RAS system of allocating points to assessment outcomes that gives them a
monetary value to generate the amount of money a SU has to spend on their
budget was considered “too rigid” (Interview Participant 1, social worker,
appendix 2) and harder to assess need appropriately as it had become driven
by financial outcomes rather than through the assessment of the social worker.
In defence of this, participant 3 elaborated that the RAS system is the product
of consultation with social workers and it has always been necessary for
funding to be allocated from the financial assessment team. The difference
with Personal Budgets is that each financial assessment needs to be conducted

38
individually, rather than taken from a central funding pool as would be the
norm with block contract provision.
“Since the cuts we did not evenbecome aware (of the changes in
budget calculation of the RAS) until we saw that the RAS scores
were buying comparably less than before. For example my client
with a brain injury would have to be assessedat a higher need to
be able to afford the same service” (Interview Participant 2,
Social Worker, appendix 2).
“It is not needs led, it is often resource led, so you have to put
people into boxes, people cannot select the services they want”
(Interview Participant 10, appendix 2).
There was a concern amongst the social workers interviewed that Personal
Budgets “give control to the finance department” due to the fact that it is they
who allocate the precise funding from the RAS scores. This is a major
difference for this service area in relation to how personal budgets were
distributed. It was disclosed that direct payments would often see the service
user make a request for a particular service and the social worker could then
assess if the agency would be willing to pay for it. Part of the PB method has
removed this control of the SU and placed in the hands of external financial
brokers who are accountable for allocating funding but have no direct
relationship with service users or indeed Social Workers. In this setting, they
are employed by the local authority but are separate from social services.
“I do not think they (financial assessment partnership agencies)
are aware of the differences, we have never had to tell them
directly what the money is for. This could have lead to the
increased incidents of financial abuse recorded, for example there
was one lady who had racked up over £1,000,000 in costs, but by
the time the financial team became aware of it, it became
impossible to trace how the money had been spent” (Interview
Participant 1, Social Worker, appendix 2).

39
The practice benefits of set budgets
As the interviews and questions developed through the saturation of the data
sets, the questioning revealed that there were benefits in having set budgets.
One participant explained that it “helps to develop more appropriate funding
streams” and ensures that service users are only spending money where
needed. They argued that Personal Budgets are not a replacement for direct
payments but in providing a set funding allocation to each user it gives them
control of their own funding source. The Social Workers, in contrary to the
understanding provided by the literature review, still used direct payments to
make “one off” payments where the value of a service could not be accurately
determined by a RAS score.
“I have used direct payments since 1997 and I think they have
been responsible for providing a more responsive service, but
personal budgets have made it more organised and transparent
with service users getting a set amount of money.
I think as we get more experience and learn from the RAS scores,
they give us a greater understanding from a management
perspective towards how money can be allocated more fairly.
Everyone doesn’t have the same need, so why should everyone
have the same amount of money towards what you think they
should have…” (Interview Participant 3, Social Worker,
appendix 2).
Is this method accessible to service users?
Participants disclosed that the organisational structure of personal budgets had
created communication difficulties in explaining the outcomes of assessments
to service users. This highlighted indications that their own professional
confidence in offering personal budgets had been damaged and it was easier to
purchase services using the old “direct payments method” that in some service

40
areas has been rebranded within the personal budget framework as being “a
one-off spot payment” or “drop-payment”.
“There are all so many forms; all they (the SU) want is to receive
a traditional service where things are done for them” (Interview
Participant 1, Social Worker. Appendix 2).
“RAS scores are not explained (to the SU) for example, because
they simply want to be getting a service. Where the money comes
from is not important to them” (Interview Participant 2, Social
Worker, Appendix 2).
The level of involvement provided by external support agencies outside the
care sector was universally considered to be close to non-existent in regards to
supporting the development of personal budgets throughout all the disclosures
made by participants. Family members were highlighted as being willing to
co-operate with the concept but they simply did not have the time that would
be expected to ensure the budget could be delivered as required.
“I do not think people realise the responsibility. They get other
people to help to help them out. It is quite a big responsibility, but
they could not do it themselves despite that being the empowering
principle of personal budgets” (Interview Participant 10, Social
“You get a few older people that get a service that they plan, but
generally they need more support than other groups. There are a
number of people who get no support and they are hit hardest. It
comes down to their support, family, people they know or
sheltered housing” (Interview Participant 5, Social Worker,
Appendix 2).
The role of support in Personal Budgets
Leonard Cheshire Disability was singled out as an exception by two
participants in regards to providing supplementary advice and training.
Brokerage Services acted to collect data from social services assessments but
there was no evidence found in the disclosures that their role went beyond the

41
point of service sourcing. This was viewed as a reflection of a time before
Personal Budgets when the reliance on block-contracts made the process of
sourcing services more straightforward because there were fewer choices.
Unfortunately the evidence demonstrated that this approach has not changed
despite the infinite choice offered by personal budgets.
“In delivering a personal budget, the brokerage services do not
actually do anything. The development of the Personal Budget is
directly between the professional and the service user” (Interview
Participant 1, Social Worker, Appendix 2).
“You have Leonard Cheshire to provide invaluable support. They
do gather information towards assessments and look at how
direct payments can be used. They are often more engaging from
a relationship or collective point of view. They will make
recommendations and give advice based upon those” (Interview
Participant, 8, Social Worker, Appendix 2).
In supplement to these disclosures was a universal concern from the social
workers that older people were not getting involved in Personal Budgets
because of the complexities in maintaining them often coupled with the notion
that there was not a sufficient support infrastructure.
“They are simply not taking up personal budgets. It is just too
much hassle. This is because they turn them into employers and
have to do the tax returns…..families have their own lives”
(Interview Participant, 1, Social Worker, Appendix 2).
“It can be more difficult. People do think for themselves more but
only in some cases that have direct payments enabled do people
take advantage of the possibilities. People need someone to help
out with the paperwork” (Interview Participant, 6, Social
It has been argued in the past by KPMG (2010) and Leadbeater (2004) that
personal budgets offer improved control over spending for social workers
because there are more assurance indicators that can help gauge if the money is

42
being spent appropriately. Using a support plan was designed to make
spending more goal orientated than the boundary-less method of direct
payments.
What can be done to further improve service delivery with Personal
Budgets?
The experiences shared in this study were inconclusive in establishing if this
aim was being met in the service area sampled. Some felt that they were too
rigid and resulted in service-led initiatives that removed the freedom offered
by direct payments. Others clearly felt the distinct opposite and felt that the
lack of control or guidance available was resulting in overspends that led to
resources being wasted.
“Not enough attention is being paid to ensure that the budget is
not being exceeded. It is sent up to the area manager when the
budget is exceededbut this is often too late. At the start I felt
pressure to meet the budget but over time that has been lifted”
“It is very useful as a tool but some people can use it to lead their
practice too much. This results in the outcome of the personal
budget dictating rather than the person dictating the outcome”
Despite the example of Leonard Cheshire there were few examples of the
existing PB infrastructure functioning as an integrated system. All of the roles
were distinctive but fragmented with little co-ordination evident in their
communication to Social Workers who should be working as the central hub to
inform the SU on how their support plan could be amended.
“Call centres are not employed by us, therefore it is naïve to think
that anyone can pick up a phone and know what the care group is
about. SERCO have taken it over and they know nothing about
care groups and the services we offer. It is detrimental to the

43
relationship” (Interview Participant, 9, Social Worker, Appendix
2).
“I think most gyms, for example do not know. They do not know
we are sending service users there. It is a no-contract relationship.
There is no agreement in place with them that is between the
service user and the provider” (Interview Participant, 5, Social
If partnership agencies are not being informed of their obligations and Social
Workers are not aware of them, then the chances of service users being able to
confidently choose a service that will meet their needs must surely be
impaired. The majority of social workers expressed the view that the service
user taking responsibility for their own service was an acceptable outcome of
the personal budget method being applied.
“We capture the care in the support plan. We go out to other
organisations. We help them to deliver the right support and care.
There is no right for businesses to know if they are in receipt of a
direct payment. They are a private business” (Interview
Participant, 9, Social Worker, Appendix 2).
“In our experience we do not get involved with partnership
agencies after a service has been purchased because that
undermines the right of the service user to be able to
communicate their own needs. It could also be a breach of their
confidence if we disclose their concerns to an outside provider
without their prior knowledge” (Interview Participant, 3, Social
However the study with the exception of one interview, strongly argued that
older people could not meet their needs independently. Most felt that direct
payments were useful with a personal budget because they could be used to
access new ideas and services with a block provider being used as the main
care provider. So for example, the home care may be provided by a block
contract but the cinema tickets to go out with their personal assistant would be
paid through a direct payment and justified through a support plan. At the time
of interview not a single participant could provide an example of an older
person who had complete autonomy over the services that they provide, unless

44
they were only in receipt of supplementary services like Cinema Tickets. Most
participants had their personal care sourced by the local authority through a
block contract.
“Now, I understand everyone is allowed a personal budget. But
they do not have to accept it in the format of a direct payment;
they can continue to have a commissioned service. They do not
have to change things” (Interview Participant 4, Social Worker,
Appendix 2).
“The reality is older people want certain things and they are more
rigid in their requirements. They are concerned about having the
responsibility for a budget. But it is is very rigid. It comes down to
either taking a direct payment or a commissioned service”
(Interview Participant 7, Social Worker, Appendix 2).
The interviews showed that people were generally doing both, demonstrating
the major difference between having a Personal Budget method over having
separate funding pools for direct payments. Unfortunately despite the PB
approach promising to integrate everything under the same umbrella in the
expectation that services would become easier to manage for individuals, the
actual relationships between professionals, agencies and SUs are still distinctly
separate.
“I think a lack of confidence and experience of other staff
members is a problem. I think there needs to be a change in
attitudes to ensure autonomy is developed. If they have gotten
into insolvency then you should say fine. We are enabling, not
taking over their lives and they should take responsibility”
(Interview Participant 9, Social Worker, Appendix 2).
“Older people feel safer with managed services, I do fear for the
future of their flexibility (personal budgets), things look a little
grim really. As you cannot do these things without the money, too
many cases are overspends and it becomes perceived as a rolls-
royce service.
The role has evolved towards a business aim. So many things you
learn while qualifying are never given the opportunity in practice.
Nitty-Gritty Social Work has been replaced and it is about speed
and targets” (Interview participant 6, Social Worker, Appendix
2).

45
viii: Discussion of findings
The initial macro aim of this research was to identify how the working
relationship between Older People and Social Workers has changed as a result
of the Personal Budget method. However the research findings revealed that at
a micro level this working relationship was being heavily directed by a diverse
range of factors beyond the reach of the personal budget method that when
analysed in isolation has not facilitated the changes that much of the previous
literature on the topic argued it could. It was decided to change the research
question to reflect the broad range of factors that were influencing the nature
of personal budget implementation. There is no single variable element such as
the personal relationship between actors in the method that is responsible for
the change, but ultimately all of these identified variables are responsible for
the overall quality of Personal Budget implementation and Service User
experience.
Funding remains the significant factor in service delivery.
The quantitative based studies from KPMG (2004), Leadbeater (2004) and to
an extent DEMOS (2008) all argued that the existing figures did not stack up
and that change was necessary to a social care system over reliant on block
contracts that offered too few services to too few providers who were enjoying
a monopoly on provision. It is clear from the disclosures that these fiscal
arguments have forced the issue in regards to the opportunities that older
people are able to access through their Personal Budget.
As was disclosed by Interview Participant 6 there is a chasm in funding
opportunities for older people, who automatically are assessed a lower budget

46
for the same need RAS scores when they hit 65 when compared to those in
other service user categories. This policy could have an impact upon the
options available to service users when choosing services. It could also have a
long-term impact on the investment for services, particularly from the private
sector, if it is clear that older people have less money to pay for services then
those agencies will have or devote less money to pay for developments of
those services. Not giving older people financial parity when it comes to
funding may have perfectly sound fiscal arguments but impairing their ability
to compete in what is a free commercial market is unfair.
The method can work but requires simplifying
Those studies that had a empirical quality to provide a service evaluation SCIE
(2009), Glasby and Littlechild (2009), Tyson et al (2010) and Poll et al (2006)
used the disclosures from service users to argue that putting service users at the
centre of decision making was the right method to meet their best interests.
Personal Budgets were argued to offer more choice, provide better value,
enhance creativity and most importantly put SUs in control.
The findings from this research question those findings as while there is
evidence to suggest that some of the benefits are being delivered, generally
they are being prohibited from doing so because of barriers that can be sourced
to the current social care service infrastructure.
Instead of direct payments being replaced by Personal Budgets, the empirical
evidence gathered from the interviews demonstrates that the format is still
being heavily used under the guise of a “one-off payment” where people are

47
being given the money for situations that cannot be addressed by their current
care arrangements. This is entirely acceptable in enabling service users to
choose what they want, but it fails to take advantage of the long-term support
benefits that can be obtained through following a set support plan that is
amended and adjusted according to the changing needs of the Service User.
This scenario has become increasingly common as many “one-off payments”
are able to take advantage of the capability afforded to Personal Budgets in
enabling those in receipt of local authority services to source others needs
through the private sector. It can be argued that this is an ideal arrangement
because the complexities of arranging personal care independently are far
more difficult to navigate than finding a friend to go to the cinema or choosing
the company to provide you with a hot meal.
Problems arise when you get situations of overspend that can usually only be
reduced by cutting the services that have been sourced outside of a contracted
agreement. Those service users that mix local authority care contracts for
things like sheltered housing, personal care or carers will find that there is very
little money available for them to spend independently on “lifestyle” options
because they are not valued highly by the RAS score thereby giving them low
resources to allocate to these options. Unless they are able to source their care
contracts privately through the budget, which is often an impossible task as
most older people only require such care at a point of crisis, then the majority
of their funding will still be spent on local authority care contracts. Things like
choosing to go to the cinema, funding a taxi to see relatives or arranging a trip
to the shops used to form part of the service in some local authority sourced
care contracts. These arrangements appear to be dying out as companies realise
that they can be paid for separately by the service user in a Personal Budget.

48
Overspends are occurring because of a lack of understanding between social
workers and financial assessment teams. In relying on “one-off payments” as a
short term measure that keep getting renewed instead of developing a long-
term support plan it can be difficult to argue just how valuable a service is to a
service user. This was a major problem with direct payments that personal
budgets can address if used with a comprehensive support plan. It would not
be impossible to find out how money is spent if the RAS is followed
appropriately. Some participants liked the understanding obtained through
having resources directly correlating to need.
Funding has to be more flexible to meet the range of needs
The problem that practitioners have with RAS scores is that they are simply far
too rigid in providing a set amount of money towards a certain service. As the
participants explained, not everyone has the same need, but also not every
service has the same cost and if the service costs beyond the calculations of the
RAS score, then that has to be justified with their manager. These situations
can lead to frictions in the relationship between the service user and their
social worker because they may have chosen a service that they will not longer
receive funding for and is some cases will have to have their case reviewed.
Practitioners found it difficult to explain the RAS scores to service users and
admitted in some cases that they could not understand why certain funding
figures had been reached.
In other cases it was simply impossible to put a value on the service requested
because of difficulties in defining what best value is. Even if the support plan

49
had expressed a desire by a service user to go to a gym, the detail that it was
necessary for one to be close to their home because of mobility issues or lack
of transport can not be considered. As a result, if the calculation was over
because the gym near their home happened to be a premium facility that
charged a fee in reflection of this they could not gain the funding for it because
calculation could not factor in the practical needs of the service user. They can
pay the excess as a “top-up” or they could find a cheaper facility further away,
but such a compromise is indication of a system that is geared towards
maintaining financial restrictions rather than being flexible to accommodate
individual differences. Service Users who have previously been in receipt of
social services have to make fiscal adjustments to their budget to accommodate
the reduction in funding from RAS scores for over 65s as disclosed in the
results.
Then there are the implications of having to pay back the money owed in the
event of an overspend situation. Under a purely managed system the contracts
would be signed by the agency on the behalf of the service user with the local
authority responsible for managing the debt. Under a personal budget system,
even if the money has been bought under a “one-off-payment” if any further
monies are owed then legally the obligation to pay the debt would fall to the
service user if they had signed the contract. In the case example disclosed, as
the provider is not aware of the origin of the funding they may pursue the
recovery of that debt in a way that is not emphatic towards a vulnerable adult.
In most of the cases disclosed the debt will be paid by the local authority but as
in the case of the lady who owed £100,000 it can often be too late before they
hear about it. The financial teams are entirely separate and are not bound by

50
social care codes of ethics. The range of different roles can be confusing for an
older person to deal with, but this is magnified by the lack of engagement
between social workers and financial departments. These overspends are
typically past over to them to deal with and the social worker has to pick up
the emotional fall-out. Even if in these scenarios the money is not claimed, it is
hardly a comfortable ordeal for older people in vulnerable situations.
Support services need to be encouraged to play a more active role.
Leonard Cheshire provided exceptional examples of providing support to
service users in helping them use their personal budget. Practitioners in the
study praised their co-operative involvement and feedback that helped to
reduce the risk of vast overspends being incurred. Greater feedback and co-
operation will lead to a greater turnover of fresh ideas and more control for all
parties concerned. It is obvious that although Personal Budgets offer greater
control to the service user, some of the respondents indicated that this should
mean less control for the practitioner. The latter only occurs if it is allowed
with poor record keeping and co-ordination between agencies the root cause.
If these barriers are removed personal budgets can make the difference in
delivering a better quality of life for older people.
In the cases where the problems were negated, Personal Budgets were used to
provide services that were controlled by the service user that met the unique
circumstances of their needs. Through using the case of the Greek Lady who
purchased a Greek carer as an example that would simply have been
impossible within the rigid confines of a block contract. It would not be

51
economically viable or possible to arrange contracts or to develop relationships
with every single diverse need. The lady in this case identified who could meet
her cultural requirements and paid someone to enable her to do this with her
personal budget.
Practitioners felt positive about personal budgets offering viable alternatives
and solutions to need previously beyond the scope of block contracts. The
panorama offered through the results portrays a perspective that shows both
service users and practitioners struggling to negate the barriers to successful
results. Service Users find it too difficult to overcome the demands of
paperwork and accessing the support to act as employers, while they are not
given sufficient protection if they fall into arrears. Meanwhile practitioners talk
of a difficulty in explaining and selling the PB method to SUs while working
co-operatively with the vast range of support agencies requirement to maintain
it as a coherent system. Instead they can find sanctuary in streamlining the
system by mixing it with contracted services but in doing so are diluting the
benefits.
ix: Recommendations
Based on the findings of this research it is the opinion of the researcher that
further fine-tuning to the personal budget method is necessary if it is going to
achieve its potential in meeting the needs of all older people.
1.) More obligations need to be placed on support services to ensure
collective responsibility.
This research fully supports the recommendations from the Changing Lives
Service Development Group, Personalisation A Shared Understanding

52
(Changing Lives, 2009). Their call for Shared Learning Partnerships would
have been an effective inclusion towards aiding practice in the service area
sampled. It would have helped in the development of clearly defining roles and
expectations to service users through the signing of contracts with all providers
to agree in set obligations to service users.
A contractual agreement of obligation, if not service would tackle the lack of
clarity disclosed by social workers in this study with regards to dealing with a
multitude of different service providers across a range of sectors. The
argument that to provide support in this way to service users undermines the
independence of service users to make independent decisions is not found to
be valid by this research. As the disclosures have indicated, it should be an
integral part of the relationship that a social worker should be able to have
open dialogue with a provider. This would reduce the risk to the service user
but of additional importance would ensure that financial abuse and overspends
could be shrunk, with their current frequency evident in the findings could
severely undermine the efficiency and “best value” arguments of HM
Government if not controlled.
2.)More co-operative relationships need to be forged between agencies to
reach the common goal of working to meet the best interests of service
users.
The lack of co-ordination evidenced in the disclosures between social workers,
brokerage, financial services and support agencies can only be remedied if
there is a clear protocol to encourage communication and the exchange of
information regarding the needs of service users. An example of this lack of

53
statutory legislative obligation can be found in the fact that personal budgets
are simply governed by regional policy heavily amended through
recommendations from the IN-CONTROL pilot studies. Direct Payments
meanwhile were structured accordingly under the Direct Payments Act 1996.
A statutory framework may be developed to support Personal Budgets in the
future as indicated by the third-phase IN-CONTROL recommendations (IN-
CONTROL, 2009, p.60) but as HM Government has decided for it to become
a national requirement of service delivery this needs to become a priority to
give Service Users a fair and balanced relationship across all the sources of
support they utilise to make personal budgets a success for them. The research
sample demonstrated that the development of support plans remains the
product of work between the social worker and service user, except in the
referred case examples to Leonard Cheshire.
Another aspect of HM Government policy that has attempted to change
relationships and devolve decision making to the hands of the service user has
been the principle of ensuring that local authorities place a requirement upon
social workers to offer personal budgets to every service user without any
framework for assessing suitability. This does not work as these disclosures
argue that the circumstances for each older person as so markedly different
that it is simply impossible for some to work with the concept in some sets of
circumstances.
3.)The use of one-off payments must be integrated into the system or
phased out.

54
It is recommended that more preparatory work needs to be made with service
users to determine that they are able to make a decision on working with
personal budgets. There may be an argument for a two-tier form of budgets
that enables the more intensive and resource demanding aspects of housing or
personal care could be maintained within a block contract as necessary, with
other aspects managed through a support plan by the service user as they
capable. The current practice trait of simply placing service users onto
managed services for care and paying out money for “one-off” direct payments
is not a suitable long-term compromise.
The consequence of having a system that requires budgets to be offered but has
an alternative that is inferior does not fulfil the remit of offering more choice.
There are Service Users who are unable to manage personal budgets in their
current format and more options need to be made available other than going on
a purely managed service plan. Instead we have situations where service users
are placed on (re)ablement packages after being discharged from hospital, in
some cases for months on end. These packages are supposed to be intense and
target-led, they are rigid in format and cannot be adjusted for specific service
user requirements. Staying on them for months in the case of an older person
who is showing no significant improvement in their condition would be
demoralising for the service user and isolating in the sense that they can never
build a constructive relationship with their service.
4.) Personal Budgets work best when rigid Care Management structures are
dismantled and decisions are factored with need as the priority.

55
These characteristics were factored in the arguments against care management
approaches and it is fair to say that personal budgets have helped to reduce the
rigid structure of a confined systems based approach. This applies to those
older people who have specific ideas, lifestyle requirements and differences.
Every person has these and it is fantastic that personal budgets have given the
opportunity for these to be met.
However in reference to Maslow’s Hierarchy of Needs theory (Chapman,
2004, in www.businessballs.com/maslow.htm), it is important that the
opportunity to fulfil these higher order needs are not at the expense of others in
crisis situations of not having their lower order, life sustaining needs met.
Personal budgets can be said to have given service users greater control over
their professional relationships with social workers and support services, but it
is a qualified benefit that requires more work in the areas highlighted to ensure
it can go further in achieving this for every service user in every situation. If
this is not possible, then there should be the flexibility in the system to
consider the alternatives.
Thomas Hughes, 2011 “How has the implementation of personal budgets
affected the working relationship between between older people and social
workers?”
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anyone who consults it is bound by copyright.”
"This work may (i) be made available for consultation within Anglia Ruskin
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