Personal budgets for social care

About personal budgets

What is a Personal Budget?

A Personal Budget is a sum of money allocated to you as a result of an assessment of your needs. The amount of money you are awarded is based on the 'eligible needs’ you have at that time. Eligible needs are those which the local council's policy says it has a duty to support you with.

To start with you are given an ‘indicative budget’ (an estimated budget) so that you can develop a support plan, with help from others as necessary, based around what matters to you and what works for you. This gives you the chance to have more control over how your support is provided.

A Personal Budget is not in addition to mental health services and support, but a different way of making the ‘social care’ element of the funding for them available.

By April 2013, all councils should be offering offer Personal Budgets to all those who are eligible to receive support, including people with mental health needs.

Why have Personal Budgets been introduced?

Personal budgets were introduced in 2008 as part of a new process to give people greater control over the way they receive their support. This is usually called Self-Directed Support and is one aspect of the changing approach to meeting citizens needs called ‘personalisation’.

Personalisation intends to ensure that:

• people are able to be a part of their community
• good advice and guidance is available to everyone
• services are in place to help prevent crisis and sort out difficulties at an early stage
• where people require longer-term support, it is designed and delivered with them to meet their individual needs and preferences, which is where Personal Budgets come in.

What can I use a Personal Budget for?

You can use a Personal Budget in a variety of ways, but what you use it for must be directly related to meeting your ‘eligible needs’ for social care.

Some of the ways in which people using mental health services have chosen to use their Personal Budgets are:

• getting help with cooking, shopping and cleaning
• having short breaks or a holiday
• leisure activities, e.g. an art class or a walking group
• having driving lessons
• buying specialist or computer equipment to make life easier
• buying membership of a gym or sports club
• finding a job or learning new skills
• having an aromatherapy massage or other alternative therapy

Examples of how other people are using their Personal Budgets

The increased choice and control provided by a Personal Budget has enabled people who use mental health services to meet their needs in a far greater variety of ways than was possible before the introduction of self-directed support. In every case listed below, the local council was satisfied that the activity or item paid for was directly related to meeting needs for which the Personal Budget was provided.

• fees for singing lessons
• fees for horse riding lessons and the necessary clothing
• travelling abroad for a short break
• travelling abroad to see relatives
• hairdressing equipment
• a music-composing computer programme
• a graphic art computer programme
• exercise equipment
• driving lessons
• a car
• a shed, gardening tools and plants
• fees for a gardening tutor
• fees for security guard training
• tennis club membership
• decorating and re-carpeting a flat
• transport to pick children up from school
• gym membership
• cinema tickets
• african drumming lessons
• jazz music lessons
• MBA course fees
• A tattoo apprenticeship.

I like the flexibility that Self Directed Support gives you as I feel it is important to be able to use different approaches and ideas with different people, which is unlike traditional services. I think you need to get the holistic picture of a person and think outside the box to find out what people would like and what would be best to suit their needs.

What can't I use a Personal Budget for?

 A Personal Budget cannot be used:

• for anything that is not directly related to meeting your eligible social care needs
• for things which the local council has prohibited. These vary, but generally include gambling, debt repayment, alcohol and tobacco, anything which is illegal, and anything which will cause harm to yourself or other people
• to meet needs in ways which are solely the responsibility of the NHS, such as the provision of medication.

Getting a personal budget

How do I get a Personal Budget?

In general, the process works as follows:

• You have a needs assessment to establish which needs you have that can be supported ('eligible needs')
• You are allocated an 'indicative budget' (estimated budget)
• You develop a 'support' or 'care' plan for using the indicative budget to meet your eligible needs.
• You submit your plan for approval to your local authority
• You revise your plan if necessary.
• Once your plan is approved, you will be told the final amount of your Personal Budget and can make the necessary arrangements to get the support you have chosen.
• You will be asked to attend a review of your plan and the amount of your Personal Budget on a regular basis (this generally varies between 3 and 12 month intervals, depending on circumstances)

How do I get my needs assessed?

There are two ways you can request and receive a needs assessment. This will depend on whether you are already using secondary mental health services or not. Secondary mental health services are those provided by specialist mental health teams in hospital or community settings.

If you are already receiving secondary mental health services
Your care co-ordinator, or if you do not have one your nurse, social worker, occupational therapist, or other 'key worker', should know how Personal Budgets are being introduced in your area and be able to support you to access the assessment.

If you are not receiving secondary mental health services
You can approach your local council social services team direct. The law says that the local council must carry out a needs assessment if:

• a person appears to the local council to be in need of a community care service, or
• a person is disabled, or
• a person is looking after someone else – such as a relative, friend or neighbour.

If you feel that one (or more) of these applies to you, you should request an assessment. You can find the contact details for your local council in your local phone directory, or from Disability Rights UK (see Useful contacts).

The needs assessment
Each council has their own way of doing assessments, but any assessment should be 'person-centred', placing you at the centre and focusing on what you think your needs are. You can ask a friend, family member or an advocate to be with you at the assessment meeting if you wish (see Advocacy in mental health).

First you will have an initial assessment, which might be done over the phone, or by a self-assessment form.

If this shows that you do not have needs that the council is required to support you with, they will let you know about alternative sources of support.

If it shows you do have needs they will support you with, then you will have a full needs assessment. This usually involves a meeting with someone from social services, or someone from your local mental health services, such as your care co-ordinator or key worker. It is likely to include a discussion about your personal history, your social circumstances, the symptoms of your ill health and how this affects your daily life, and what you think your needs are.

Sometimes it can be difficult to think of everything on the day of the assessment. So it might be an idea to think about what you think your needs may be, in advance. You could, for example, keep notes or a diary about all the times that you:

• need support to do something – how often and how long it takes
• are prevented from doing something because you don't have the support to do it
• do something, but with difficulty, and when having some support would make things a lot easier for you.

You should think of all aspects of your life, as the assessment should cover:

• daily routines and tasks, such as preparing and cooking food, washing, and looking after yourself
• involvement in family, social, community, employment and learning activities
• keeping yourself safe
• any needs arising from your culture or religion
• what help you already receive, including the help you receive from relatives or friends and if they are happy to carry on offering this. It is important to be clear that an assessment must look at all of your needs, and not just those which are not being met by a carer. This is because carers must be asked if they are 'willing and able' to continue some or all of their caring role before this can then be taken into account.

How is my indicative budget worked out?

Your assessment will allow the council to decide which of your needs they can support. To do this they rate the risks you face to your independence and wellbeing, using criteria (often referred to as 'FACS') which are based on Department of Health guidance. There are four ‘levels of need’ which councils allocate support to. These are 'low', 'moderate', 'substantial' and 'critical', and most councils only meet needs which they have rated as ‘critical’ or ‘substantial’.

The levels of need recorded in your assessment are usually then converted into an 'indicative' amount of money (a rough estimate) by a process known as a Resource Allocation System (or 'RAS'). A few councils use different ways of deciding how much your Personal Budget will be, and your care co-ordinator/key worker or the council will explain this.

How do I create a plan to use my Personal Budget?

Once you know your indicative Personal Budget, you can start to draw up a plan to explain how you would like to use the money to meet your needs. The words 'care plan' are used in some areas, and the words 'support plan' are used in others. Depending on how far services are integrated locally, your care/support plan for a Personal Budget may be a part of your Care Programme Approach (CPA) care plan (if you have one), or it may be a separate plan.

Getting support
Your care co-ordinator/key worker will need to be involved in your plan, as they will put it forward for approval when it is completed. You may wish to draw up your own plan and then discuss it with them, and you might involve friends or family members, or an advocate or other paid supporter in doing this. Alternatively, you might want to work out the plan directly with your care co-ordinator/key worker.

You should be encouraged and helped to develop your plan in a way that you find easiest, and this can include creating your own folder or scrapbook. Some people have used their computer to make a slideshow, others have included music and photographs to illustrate the things that are important to them. If you do any of these, it may also be necessary to complete a form which translates your plan into a format which the people who need to agree it can understand.

What to include in your plan
This varies, but usually includes:

• what your eligible needs are, e.g. to reduce your social isolation
• how you would like to meet them, e.g. join a local club
• what your goals are, e.g. to make new friends
• how to manage risks (including how to manage your support at times when you may be unwell)
• any unpaid support that you already receive, e.g. a relative who looks after you.

How you want your needs to be met
Creating your care/support plan provides a good opportunity to think about what your needs are and how you want them to be met. You will want to know what services are available to you, but you can also consider other ways in which you might meet your needs. For example, if you need to 'reduce your social isolation', this could be done by getting help to leave the house and mix with people. There are many ways in which you might achieve this, such as:

• having a person you trust to accompany you and give you the confidence to meet other people
• joining a local club or activity class that interests you
• using an established social centre or day service where you feel safe.

Each of these things will have a cost, and it is important to ensure that your plan meets all of the needs you have within the indicative budget you have been allocated. If this does not seem possible, your care co-ordinator/key worker may have to present a case for it to be increased.

Describing the goals (or 'outcomes') you want to achieve: Goals and outcomes are words used to describe what the support you receive should be enabling you to achieve in your life. So, from the earlier example, if you chose to join a club to get out and mix with people, this may be helping you towards the goal of making new friends or going to a social event on your own.

Identifying and managing potential risks: It is also important to look at any risks to how your support is delivered. For example, when you are unwell you might isolate yourself and not let a support worker visit you. Your plan needs to show how you could manage such risks. This might include who will manage your support when you are not able to direct or manage it yourself.

If the amount of support you need can change quite quickly, it is important to plan for any increase in support you will require. You might like to use a ‘crisis plan’ or ‘advance decision’ (see Mental Capacity Act) to show that you have thought this through. The assessment and Resource Allocation (RAS) processes do not always pick up such changeable support needs adequately, and it can mean that the amount of your 'indicative budget’ will need to be revised.

Informal support: Your plan should identify support that you receive from family and friends, or your local community. The local council will fund the eligible needs that you have that are not being met by other people, and must also check whether the people who support you are eligible for an assessment of their own support needs (a 'carers assessment').

It is very important to be aware that anyone providing you with unpaid support does not have to do so. Before the local council can take their contribution to meeting your support needs into account, any carer must be asked if they are both willing and able to continue. Sometimes people have been providing support because no other support was available and they may need to reduce or even stop providing that support.

Why does the local authority have to approve my care/support plan?

Local councils have to be confident that the way you use your Personal Budget will meet your needs. They cannot approve it if they believe it places you in a dangerous situation, does not meet your needs, or if any risks that have been identified cannot be adequately managed. If they have any such concerns, they should discuss these with you with a view to overcoming them by revising your initial plan.

In many areas there is a 'panel' to which every Personal Budget care/support plan goes. This panel may make suggestions about revising your proposed care/support plan or ask you some questions before they agree to it. Sometimes, panels have refused to fund certain activities because they cannot understand how they relate to meeting eligible needs. For this reason it is important that your care co-ordinator/key worker understands the link between your proposals and your eligible needs very clearly. You may be offered the opportunity to explain this to the panel yourself, although this is not yet common practice.

In a few councils, ‘risk enablement panels' have been set up, which have people who use mental health services as members. If they identify any risks for you, they will actively look for ways to agree a safe plan, by talking things through with you and your care co-ordinator/key worker.

Panels do not always make decisions that people are happy with, and it is important that you are told how you can challenge the decision if you wish to, and where you can get support from to do this.

How much money will I get when my Personal Budget is approved?

Once your plan is approved, the local council will confirm the amount of money that you will receive as your Personal Budget. Because everyone has different personal circumstances and needs, there is no 'standard' amount of money that you will receive – it is personal to you.

Using a personal budget

How do I use my Personal Budget to get the support I have chosen?

Your Personal Budget can be held and spent in a number of ways, or in a combination of these ways. Your care co-ordinator/key-worker will be able to give you full details of the options available in your area, but they generally include:

• Receiving it into a separate bank account (specifically for direct payments), as a direct payment. You would then use the money in the bank account to arrange to buy services or support to meet your needs yourself. The money is paid directly to you or to someone who has agreed to hold the money for you. There are a number of ways in which you can be supported to use direct payments effectively, and the council or the local direct payments support service will provide information on them. The uses to which you put your direct payments must be in line with meeting the needs in your care/support plan. In most cases, the local council has a duty to make direct payments available, but there are a few cases where they can choose whether or not to.

• Asking the local council to hold some or all of your Personal Budget which it will then use to pay for services that they provide themselves, or services that they buy from other organisations for you.
• Some local councils will offer you the option of transferring your Personal Budget to another organisation that provides services that you want to use, or that can access them from other organisations for you. This is sometimes called an Individual Service Fund, where the organisation which is holding your budget makes an agreement with you, guaranteeing that you remain in control of the resources and the support you receive.

Although direct payments are increasingly being described as the council's 'preferred option', you do not have to take a Personal Budget as a direct payment. You should be given information on the ways that the money can be held and managed, and have support if you need it in deciding which option, or combination of options, will suit you best.

There are restrictions that you will need to be aware of, such as:

• If the council hold all of your Personal Budget there will be certain things that its financial procedures will not allow but which might be possible if another organisation holds the money or if it is made as a direct payment.
• Direct payments cannot be used to buy services from a local council, so you may not want to receive all or some of your Personal Budget that way.

So, try and think as broadly as possible about how your support needs might best be met. Not restricting yourself to services that have already been commissioned by your local council, could give you more options when spending your Personal Budget.

How will the local council know how I spend my Personal Budget?

Your care/support plan will be reviewed regularly by the local council to make sure that you are achieving the goals or 'outcomes' you identified in your care/support plan. If your circumstances change significantly, you should contact your care co-ordinator/key worker who can arrange to review how this might affect your Personal Budget.

If money has been paid by the council to other organisations to provide support to you, they will be asked to show the council how it has been used. This should involve asking you if you are happy with the support that you are receiving.

If you receive a direct payment, you will be asked to show how you have spent it. Some councils ask for copies of bank statements, receipts and invoices to be sent to them at regular intervals; others ask for them to be available for ‘auditing’ if necessary and for a ‘self-declaration form’ to be completed. Your local council will let you know how they want to see this information.

Rules around money

Will a Personal Budget affect my benefits?

No, a Personal Budget is money for social care or support. It is different from the money you may get in your benefits, and is not counted as income for benefit or tax purposes.

However, it is very important to be aware that income from certain benefits may be taken into account when assessing your financial contribution towards the costs of your social care support (also referred to as 'charging' for social care). So, while your benefits are not affected, the fact that you receive certain benefits may mean you have to pay more towards your social care.

Do I have to pay anything towards my social care?

Yes, you might have to. Although people using mental health services were not usually assessed for ‘charging’ in the past, many are finding that they now are when they receive a Personal Budget.

A financial assessment will determine how much, if anything, you should pay towards the costs of your social care support. Generally, if you are on a very low income, you will not be expected to make a financial contribution for your support. Also, if you have any 'disability-related expenditure' (expenses you have to pay as a result of your mental health problems), you may be able to exclude them from your ‘total income’ when being assessed.

If you are charged for services and it does not seem reasonable or you are unable to pay, you have the right to ask the local council to review your contribution. As with other complaints, even if you are in dispute with the council over its charges, the council must still ensure that your eligible needs are met.

If you have been discharged from hospital under section 117 of the Mental Health Act you cannot be charged for the 'aftercare' support to which the section relates while the section remains in place. (See  Community care and aftercare for further information.)

Can I receive a Personal Budget if I'm on section 117 aftercare?

Yes, section 117 is designed to ensure that some people who have left hospital receive co-ordinated 'aftercare'. Being on section 117 does not prevent you having a Personal Budget to meet the social care needs identified in your section 117 Aftercare plan. However, some councils and their NHS partners are reluctant to give Personal Budgets because of local funding agreements for section 117. At present, it is not a legal requirement that you are offered a Personal Budget.

Are there any reasons why I would not be able to receive direct payments?

Councils have a duty to make direct payments available with just two exceptions. Councils can choose whether or not to make direct payments available:

• to people who are on conditional discharge from hospital under the Mental Health Act 1983 or the Mental Health (Care and Treatment) (Scotland) Act 2003
• in respect of a service which a person is obliged to accept as a condition of guardianship, leave of absence from hospital or a community treatment order under the Mental Health Act 1983 and certain provisions in criminal justice legislation.

Getting help with personal budgets

How can I get help with Personal Budgets?

You are not on your own. You may want support in any aspect of the Personal Budgets process. Depending on local circumstances and arrangements:

• Your social worker, care co-ordinator or key worker is there to help you.
• You could ask anyone you trust to help you, such as a friend or family member.
• You may already be in touch with a voluntary organisation, like a local Mind. One of the workers from there may be able to support you.
• You may have an advocate, or you could ask your care co-ordinator/key worker or the local council or mental health trust about getting an advocate (also see Advocacy in mental health, and the UK Advocacy Network (UKAN) website for a useful list of member organisations)
• There may be an independent, professional brokerage service where you live. They can usually offer support throughout the process of getting and using a Personal Budget. You may need to pay them a fee out of your Personal Budget. You can find out more from your local council.
• In most areas, there is a 'user-led organisation', such as a Centre for Independent Living (CIL), which will usually be able to help you. You can find details of user-led organisations from Disability Rights UK (see ‘Useful contacts’).
• If you want to take your Personal Budget as a Direct Payment, you will be given details of your local Direct Payment Support Service, or contact Disability Rights UK (see ‘Useful contacts’).

Who can I complain to if I have a problem with a Personal Budget?

Where Personal Budgets are working well, there is clear evidence of the significant benefits that they can bring (see examples below). However, many mental health service users and carers have experienced considerable difficulties in relation to Personal Budgets, reporting particular problems with assessment and approval processes, the accessibility of information and support, and the timeliness of payments being made.

If you have a problem with getting or using a Personal Budget, you should usually speak to your care co-ordinator or key worker first. If you are not happy with their response, they (or whoever else responded to your concerns) should advise you of the local council's complaints procedure.

Alternatively you can make a complaint about your local council through direct.gov.uk (see ‘Useful contacts’).

Most people find the process of making a complaint to be very challenging. You may wish to get advocacy or support from friends, family or other trusted people if you make a complaint.

The Local Government Ombudsman (which oversees councils and hears unresolved complaints) offers 'top tips' to help with making a complaint (see ‘Useful contacts’ for details.)

Useful contacts

Direct.gov.uk
web: direct.gov.uk/en/Employment
Information about employment rights and services and career advice.  Visit the ‘Government, citizens and rights’ section, to make a complaint about your local council

Disability Rights UK (incorporating National Centre for Independent Living - NCIL)
advice line: 0845 026 4748
email: independentliving@disabilityrightsuk.org
web:disabilityrightsuk.org
web: ncil.org.uk
See NCIL website for ‘local services’ to find your local social services department, Centre for Independent Living/user-led organisations, and Direct Payments Support Services

In Control
support line: 0156 482 1650
web: in-control.org.uk
Supports local authorities to deliver self-directed support, and individuals to get more choice and control

Local Government Ombudsman
advice line: 0300 061 0614
web: lgo.org.uk  
See the ‘Making a complaint’ section on their website

Right to Control Trailblazers
web: odi.dwp.gov.uk/odi-projects/right-to-control-trailblazers.php
The Right to Control is a new legal right for disabled people. It gives disabled people more choice and control over the support they need to go about their daily lives

Social Care Institute for Excellence
tel: 020 7024 7650
web: scie.org.uk
Identifies and spreads knowledge about good practice in social care and supports the delivery of personalised social care services

United Kingdom Advocacy Network (UKAN)
tel: 0114 272 8171
web: u-kan.co.uk

Published 2012
To be revised 2014
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