The IBSEN project - National evaluation of the Individual Budgets pilot projects

SPRU research team

• Caroline Glendinning
• Nicola Moran
• Parvaneh Rabiee

External collaborators

• David Challis, Personal Social Services Research Unit (PSSRU), University of Manchester
• Sally Jacobs, Personal Social Services Research Unit (PSSRU), University of Manchester
• Mark Wilberforce, Personal Social Services Research Unit (PSSRU), University of Manchester
• Martin Knapp, PSSRU, London School of Economics
• Jose-Luis Fernandez, PSSRU, London School of Economics
• Ann Netten, PSSRU, University of Kent
• Karen Jones, PSSRU, University of Kent
• Jill Manthorpe, Social Care Workforce Research Unit, Kings College London
• Martin Stevens, Social Care Workforce Research Unit, Kings College London

Project summary

Background

Individual and personal budgets lie at the heart of government policy for improving choice and control for people needing social care support. Individual budgets offer a transparent way of allocating resources to individuals. Knowing the level of resources at their disposal can help individuals plan and control how their support needs are met.

Individual budgets (IBs) were piloted in 13 local authorities across England between 2005 and 2007. In addition to introducing new arrangements for assessment, resource allocation and support planning, the pilots were also tasked with bringing together several different funding streams and integrating their respective assessment processes. (However, NHS resources were excluded from IBs.) The pilots were subject to a comprehensive evaluation by the IBSEN (individual budgets evaluation network) team.

Aims of the evaluation

IBSEN aimed to identify whether individual budgets offer a better way of supporting disabled adults and older people than conventional methods of resource allocation and service delivery and, if so, which models worked best for which groups of people.        

The evaluation had five strands:

• experiences and outcomes for users and carers
• the cost-effectiveness of individual budgets in comparison with standard approaches
• implications for social care and other agencies (such as health) and the impact on service providers
• how services purchased through individual budgets were commissioned, managed and coordinated
• the implications for social services and the social care workforce, including workload, training, legal and professional issues.

Design and methods

At the core of the IBSEN evaluation was a randomised controlled trial - one of the very few conducted in English adult social care. This large scale study of the costs, outcomes and cost-effectiveness of IBs was complemented by process evaluations of the implementation of IBs, conducted through interviews with key local authority managers and front-line staff; and by in-depth interviews with a subsample of people recently offered IBs.

Findings

IBs were generally welcomed by users because they offered more opportunity for choice and control over support arrangements than conventional social care arrangements. However, there were variations in outcomes between different groups of IB users; satisfaction was highest among mental health service users and physically disabled working age people and lowest among older people. There was little difference in the average cost of an IB compared with conventional social care support, although again there were marked variations between user groups; the costs of an IB were lowest for mental health service users and highest for people with learning disabilities. IBs appeared to be cost-effective in relation to social care outcomes, but not for psychological well-being. Indeed, for older people, there were no differences in social care outcomes between IBs and conventional services; the latter were slightly more cost effective and older people receiving these felt happier.

The implementation of IBs involved numerous practical, organisational and cultural challenges for staff at all levels in local authorities. Challenges included devising new assessment mechanisms and processes for determining the levels of IBs; agreeing support plans with IB users; and managing personal and financial risks. Front-line staff were particularly concerned about establishing what were legitimate and appropriate uses of an IB.

Although IBs were intended to integrate resources from a number of funding streams (and reduce duplicate assessments in the process), numerous legal and accountability barriers were encountered, despite enthusiasm on the part of pilot site staff. On the other hand, the exclusion of NHS resources from IBs created local difficulties because of the integration of health and social care services in some of the pilot sites.

Impact of the study

Presentations summarising the evaluation findings were made to the (then) Minister for Adult Social Care, Ivan Lewis, and to the Improving the Life Chances of Disabled People Inter-Ministerial Group. Summary reports were written for non-academic audiences and front-line social care staff. Two national conferences were organised and IBSEN team members undertook a wide range of speaking engagements in the UK and internationally, to both academic and policy audiences.

Subsequently:

DH published a detailed commentary on the evaluation findings. An extensive range of good practice guidance was commissioned in response to evidence from the evaluation on the challenges of implementing this new approach.

Further research to identify good practice in allocating individual budgets to older people and people with mental health problems, and their respective carers, was commissioned by the Social Care Institute for Excellence on behalf of DH.

The experiences of the evaluation shaped the DH approach to the piloting and evaluation of NHS personal health budgets (PHBs).

Evidence from the evaluation on the integration of funding streams shaped the Department for Work and Pension’s ‘Right to Control’ trailblazer pilot projects that were introduced by the Welfare Reform Act 2009. The experience of IBSEN also informed the design of the evaluation of the ‘trailblazers’.

The IBSEN evaluation was cited by the House of Commons Health Committee in its 2010 report on Social Care.

The Audit Commission drew on the IBSEN evaluation to shape its investigation into the financial management of personal budgets (Audit Commission, 2010).

A personalisation ‘toolkit’ for local authorities was informed by the learning from the evaluation.

Both the main IBSEN evaluation and the linked study of the impact of IBs on carers were cited in the 2010 DH ‘Vision for Adult Social Care’.