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Health and Social Care (Adults)
The IBSEN project - National evaluation of the Individual Budgets Pilot Projects

Researchers: Professor Caroline Glendinning, Nicola Moran, Parvaneh Rabiee
Personal Social Services Research Unit (PSSRU): Professor David Challis, Sally Jacobs & Mark Wilberforce (University of Manchester); Professor Martin Knapp & Jose-Luis Fernandez (London School of Economics); Professor Ann Netten & Karen Jones (University of Kent)
Social Care Workforce Research Unit, Kings College London: Professor Jill Manthorpe; Martin Stevens

Funder: Department of Health

Duration: April 2006 – March 2008

Final report

Evaluation of the Individual Budgets Pilot Programme: Final Report

Further publications available at the bottom of this web page: summary report, research findings etc.

Please note that the IBSEN website has now closed and been replaced by this web page - hosted by the Social Policy Research Unit.

Questions or comments are always welcome. Don't hesitate to contact Dr. Martin Stevens at: martin.stevens@kcl.ac.uk

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 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 (see details below).

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.

Publications and presentations

Show Abstract...


2013

The personalization of care services and the early impact on staff activity patterns, 2013
Jacobs, S., Abell, J., Stevens, M., Wilberforce, M., Challis, D., Manthorpe, J., Fernandez, J-L., Glendinning, C., Jones, K., Knapp, M., Moran, N. and Netten, A., Journal of Social Work, 13, 2, 141-163.
Older people's experiences of cash-for-care schemes: evidence from the English individual budget pilot projects, 2013
Moran, N., Glendinning, C., Wilberforce, M., Stevens, M., Netten, A., Jones, K., Manthorpe, J., Knapp, M., Fernandez, J-L., Challis, D. and Jacobs, S., Ageing & Society, 33, 5, 826-851.
2012

The impact of individual budgets on the targeting of support: findings from a national evaluation of pilot projects in England, 2012
Jones, K., Netten, A., Fernandez, J-L., Knapp, M., Challis, D., Glendinning, C., Jacobs, S., Manthorpe, J., Moran, N., Stevens, M. and Wilberforce, M., Public Money & Management, 32, 6, 417-424.
Personalisation through individual budgets: does it work and for whom?, 2012
Netten, A., Jones, K., Knapp, M., Fernandez, J-L., Challis, D., Glendinning, C., Jacobs, S., Manthorpe, J., Moran, N., Stevens, M. and Wilberforce, M., British Journal of Social Work, 42, 8, 1556-1573.
Revisiting the causes of stress in social work: sources of job demands, control and support in personalised adult social care, (forthcoming)
Wilberforce, M., Jacobs, S., Challis, D., Manthorpe, J., Stevens, M., Jasper, R., Fernandez, J-L., Glendinning, C., Jones, K., Knapp, M., Moran, N. and Netten, A., British Journal of Social Work, (Available online from 31 October 2012).
2011

Personalisation and personal budgets in England: achievements and challenges. Invited.
Glendinning, C., National Disability Authority Seminar, Dublin, Ireland, 12 October 2011.
Personalisation and partnership: competing objectives in English adult social care? The individual budget pilot projects and the NHS, 2011
Glendinning, C., Moran, N., Challis, D., Fernandez, J-L., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Netten, A., Stevens, M. and Wilberforce, M., Social Policy and Society, 10, 2, 151-162.
Individual budgets and adult safeguarding: parallel or converging tracks? Further findings from the evaluation of the Individual Budget pilots, 2011
Manthorpe, J., Stevens, M., Rapaport, J., Challis, D., Jacobs, S., Netten, A., Jones, K., Knapp, M., Wilberforce, M. and Glendinning, C., Journal of Social Work, 11, 4, 422-438.
Joining up government by integrating funding streams? The experiences of the Individual Budget pilot projects for older and disabled people in England, 2011
Moran, N., Glendinning, C., Stevens, M., Manthorpe, J., Jacobs, S., Wilberforce, M., Knapp, M., Challis, D., Fernandez, J-L., Jones, K. and Netten, A., International Journal of Public Administration, 34, 4, 232-243.
Assessing the role of increasing choice in English social care services, 2011
Stevens, M., Glendinning, C., Jacobs, S., Moran, N., Challis, D., Manthorpe, J., Fernandez, J-L., Jones, K., Knapp, M., Netten, A. and Wilberforce, M., Journal of Social Policy, 40, 2, 257-274.
Implementing consumer choice in long-term care: the impact of individual budgets on social care providers in England, 2011
Wilberforce, M., Glendinning, C., Challis, D., Fernandez, J-L., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A. and Stevens, M., Social Policy & Administration, 45, 5, 593-612.
2010

Choice for users of long-term care services - evidence from England
Glendinning, C., Evidence in Long-term Care International Conference, London School of Economics, London, 9-10 September 2010.
User choice in social care: evidence from the national evaluation of the individual budget pilot projects
Glendinning, C., New Developments in Public Services Professional Workshop, Manchester Business School, Manchester, 5 November 2010.
Gearing up for personalisation: training activities commissioned in the English pilot individual budgets sites 2006-2008, 2010
Manthorpe, J., Stevens, M., Rapaport, J., Jacobs, S., Challis, D., Wilberforce, M., Netten, A., Knapp, M. and Glendinning, C., Social Work Education, 29, 3, 1470-1227.
2009

The Individual Budget pilots: Issues for policy and practice
Glendinning, C., Social Care Research Conference, University of Greenwich, 25 February 2009.
The Individual Budget pilots: the unfinished business
Glendinning, C., The Evaluation of the Individual Budgets: Messages for policy and practice, Bridgewater Hall, Manchester, 3 February 2009.
The national evaluation of the social care individual budgets pilot projects
Glendinning, C., Local Leadership: A National Service, NHS Confederation National Conference, Liverpool, 12 June 2009.
Joining up government by integrating funding streams? The experiences of the Individual Budget Pilot Projects
Glendinning, C., Moran, N. et al., Annual Conference of the Joint University Council's Public Administration Committee, University of Glamorgan, 8 September 2009.
Training for change: early days of Individual Budgets and the implications for social work and care management practice: a qualitative study of the views of trainers, 2009
Manthorpe, J., Jacobs, S., Rapaport, J., Challis, D., Netten, A., Glendinning, C., Stevens, M., Wilberforce, M., Knapp, M. and Harris, J., British Journal of Social Work, 39, 7, 1291-1305.
Safeguarding and system change: early perceptions of the implications for adult protection services of the English Individual Budgets Pilots - a qualitative study, 2009
Manthorpe, J., Stevens, M., Rapaport, J., Harris, J., Jacobs, S., Challis, D., Netten, A., Knapp, M., Wilberforce, M. and Glendinning, C., British Journal of Social Work, 39, 8, 1465-1480.
Individual Budgets: lessons from early users' experiences, 2009
Rabiee, P., Moran, N. and Glendinning, C., British Journal of Social Work, 39, 5, 918-935.
2008

National evaluation of the individual budget pilots
Glendinning, C., Mental Health and Personalisation Conference, ORT Conference Centre, London, 8 December 2008.
National evaluation of the individual budget pilots
Glendinning, C., Local Government Information Unit Presentation, London, 8 December 2008.
What next for individual budgets?
Glendinning, C., Individual Budgets National Evaluation Conference, Kings College, London, 14 November 2008.
Evaluation of the Individual Budgets Pilot Programme: Final Report, 2008
Glendinning, C., Challis, D., Fernandez, J., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. and Wilberforce, M..
Evaluation of the Individual Budgets Pilot Programme: Summary report, 2008
Glendinning, C., Challis, D., Fernandez, J., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. and Wilberforce, M., Social Policy Research Unit, 51 pages.
The national evaluation of the Individual Budgets Pilot Programme, 2008
Glendinning, C., Challis, D., Fernandez, J., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. and Wilberforce, M., Research Findings, Social Policy Research Unit.
The national evaluation of the Individual Budgets Pilot Programme: Experiences and implications for care coordinators and managers, 2008
Glendinning, C., Challis, D., Fernandez, J., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. and Wilberforce, M., Research Findings, Social Policy Research Unit.
Individual budget projects come under the microscope, 2008
Manthorpe, J., Stevens, M., Challis, D., Netten, A., Glendinning, C., Knapp, M., Wilberforce, M., Jacobs, S., Jones, K., Moran, N. and Fernandez, J., Mental Health Today, December, 22-26.
2007

Individual Budgets Evaluation: A summary of early findings, 2007
Challis, D., [et al.] inc. Glendinning, C., and Wilberforce, M., Social Policy Research Unit.
Evaluating the individual budget pilot projects, 2007
Glendinning, C., Challis, D., Fernandez, J.-L., Jones, K., Knapp, M., Manthorpe, J., Netten, A., Stevens, M. and Wilberforce, M., Journal of Care Services Management, 1, 2, 123-8.
2006

The evaluation of the Individual Budgets Pilot Projects (IBSEN)
Glendinning, C., Department of Health Social Care Research Showcase, Department of Health, London, 10 November 2006.
The national evaluation of the Individual Budget pilot projects
Glendinning, C., Coventry Social Services Department Stakeholder Conference, Coventry, 15 May 2006.
Individual budgets: on the launch pad, 2006
Stevens, M. and Glendinning, C., Journal of Integrated Care, 14, 6, 23-31.

Further IBSEN publications

Jones, K. and Netten, A. (2010) The costs of change: a case study of the process of implementing individual budgets across pilot local authorities in England, Health and Social Care in the Community, 18, 1, 51-58.

Manthorpe, J. (2008) Individual budgets - the story so far, Community Care, 1746, 6 November, 32-3

Manthorpe, J. (2008) Individual budgets on the frontline, Community Care, 1747, 13 November, 30-1

Manthorpe, J. (2008) A work in progress, Community Care, 1748, 19 November, 30-1

Media coverage

The Guardian, 12 January 2011, 'Reablement' savings wiped out by costs, says report, David Brindle

The Guardian, 29 October 2008, Joe Public Blog: Personal Budgets May Prove a Burden, David Brindle, The Guardian's Public Service Editor

Professional press

Community Care, 9 July 2009. Proven Practice: Individual and personal budgets: The Social Care Institute for Excellence gauges research findings behind the development of personal and individual budgets.

Community Care, 13 March 2008, In Control: we are in uncharted territory

Community Care, 28 June 2007. Proven Practice: Individual budgets and tailored services - putting service users in control


Extension study - impact and outcomes for carers

The changes in budgets and care arrangements for service users will have a correspondingly large effect on the care provided by their friends, family and other informal carers. Choices may be made to: pay informal carers for their care; to use the IB to relieve informal carers of some caring duties; or the IB could be assigned to the carer and not the service user. Carers may also become heavily involved in the organisation and processing of the budget and new care arrangements. In order to fully asses the impact of IBs on everyone concerned the views and experiences of carers must be evaluated. A project to do this is underway as part of the Department of Health Research Programme within SPRU, please follow this link to find further details of this project:

Individual budgets: impact and outcomes for carers

For further details about SPRU's role in the evaluation, contact Caroline Glendinning email Caroline Glendinning

 
 
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