In 2008, Essex County Council (ECC) commissioned ecdp and OPM to follow people over 3 years as they use cash payments for adult social care within Essex. This study provides a unique opportunity to fully understand the experiences of people living with a personal budget over this time - a perspective that is often overlooked. This is one 5 briefing papers that contain findings from the third and final round of research with service users, frontline practitioners and providers in Essex who are working to facilitate self-directed support across the county. You can read the full, final report, the 4 other associated briefing papers and 3 videos that provide the lived experience of users over the last 3 years on ecdp's website: www.ecdp.org.uk.

1. Briefing paper 2: Factors that
facilitate Personal Budgets to
have a positive impact
Findings from the third round of a three-year
longitudinal study in Essex
September 2012
OPM
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2. Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact
Introduction
OPM and ecdp (formerly Essex Coalition of Disabled People) were commissioned by Essex
County Council (ECC) in October 2008, at the time of introducing Personal Budgets for adult
social care, to conduct a three-year, longitudinal study into the system of Personal Budgets.
The study aimed to:
1. Capture the impact of self-managed Personal Budgets on the lives of people who
use them, including evidence of how and why impact is being achieved over time;
2. Assess the effectiveness of practices and processes being used by ECC and its
partners to support the delivery of Personal Budgets, including evidence of how the
market is evolving over the study period.
This is one of a series of briefing papers containing findings from the third round of research
with service users, frontline practitioners and providers in Essex. These brief papers have
been produced to share key findings with audiences involved in personalising social care,
including practitioners, managers, commissioners, service providers and policy makers.
Other papers in this series include:
• Briefing paper 1: Positive impacts of Personal Budgets on service users
• Briefing paper 2: Factors that enable Personal Budgets to have a positive impact
• Briefing paper 3: Ways to improve the impact of Personal Budgets
• Briefing paper 4: Family, friends and Personal Budgets
• Briefing paper 5: Impact of Personal Budgets on providers
For copies of any of the above or for a copy of the full report, which contains details of
our findings, please email Sanah Sheikh at OPM. (ssheikh@opm.co.uk)
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3. Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact
Key points
• The support provided by family members and friends in the direct provision of care and
as a source of advice, information and advocacy has to date played a significant role in
ensuring that Personal Budgets have a positive impact on service users.
• Those service users that have been able to draw on their own financial resources to
supplement the care they receive under a Personal Budget have inevitably had a more
positive experience of being on Personal Budgets.
• Those service users and their family members who are more confident, assertive and
determined have been better able to ensure that their Personal Budget covers all their
care costs and can be used flexibly and creatively.
• The availability of a range of providers has meant that many service users have been
able to exercise choice by changing providers if they have been dissatisfied with the
standard of care they are receiving.
Overview
The positive impacts associated with Personal Budgets that have been found through this
research are associated with a range of factors. These factors have been identified in this
research and are as follows:
“Internal” factors “External” factors
In this briefing, we describe some of ways in which these factors appear, and the difference
they make in the outcomes service users achieve.
(Please note: since ECC processes are specific to the local area, these are not included
here.)
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4. Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact
“Internal” factors that facilitate positive impacts
1. Family and social networks
The support provided by family members and friends in the direct provision of care, as a
source of advice, information and advocacy and in taking on the responsibilities of managing
the Personal Budget has to date played a significant role in ensuring that Personal Budgets
have a positive impact on service users.
For example, service users very strongly feel that being able to employ people they are close
to has really improved the quality of care that they receive, because as carers they tend to go
over and above what is expected of them.
"Because she's a friend as well and if we need her then she will come. She does lots
more than what is essential to do, but that's down to her, you know." (PSI service user)
Friends and family members also often play an advocate role and work hard to ensure that
service users are able to maximise the benefits associated with Personal Budgets. This can
involve ensuring that the Personal Budget covers the full costs of care needed by service
users, or ensuring that the budget can be spent creatively and in a way that meets broader
wellbeing outcomes. This kind of advocacy and support is particularly useful when service
users or those who manage their budgets do not feel they have the knowledge or confidence
needed to effect change.
Additionally, sourcing recommendations about providers from family and friends meant that
service users were likely to be very satisfied with their providers and the quality of care they
were receiving.
"A friend recommended it, because we had tried everywhere and there were lots of
places that my daughter and I went to see and we didn’t like." (Wife of older service user)
2. Financial resources
Those service users that have been able to draw on their own financial resources to
supplement the care they receive under a Personal Budget have inevitably had a more
positive experience of being on Personal Budgets.
For example, they have been able to cover the costs of care when the budget does not cover
all care needs. Some service users reported that they did not have any personal
development or leisure activities built into their support plans and that they therefore had to
cover these costs themselves. Other service users report that their budgets do not cover the
transport and travel costs associated with PAs or carers accompanying service users on
leisure or other personal development activities.
"We've always said we would pay extra for the transport if she was going out, if she –
you know, if they took them somewhere, they go to Peter Pan’s down the seafront, and I
don’t mind, I would give her the extra money myself." (Mother of service user with LD)
Other service users have been able to draw on their financial resources to cover the cost of
care when there are delays associated with reviews. For some this has been because of the
time taken for a revised budget to be approved after a review and for others it has been
because health needs have worsened but a review has yet to be arranged.
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5. Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact
3. Knowledge and skills of service users
Those service users and their family members who are more confident, assertive and
determined have been better able to ensure that their Personal Budget covers all their care
costs and can be used flexibly and creatively. For example, one service user’s family
member described how she has had to be ‘assertive’ and ‘pushy’ in her communication order
to convince decision makers of the need to increase the budget:
“If I wasn't one of these people that couldn't speak up for Chloe I don't know where we'd
be, I really don't know.” (Mother of service user with LD)
Being confident, persistent and assertive has also meant that service users are better at
dealing with delays associated with Personal Budgets, for example with regards to delays in
revised budgets being approved after a review. One older service user’s daughter
commented that it was important to ‘be on people’s case’ because she recognised the
workload that local authority staff have. Another service user’s parents reported that they
have had to rely on their own determination and persistence to get the cash flow problems
addressed:
"In the end I was going up there every other day … And then my husband would get on
(the phone) and he kept saying “I'm not getting off of the phone until I talk to…”.” (Mother
of service user with LD)
Additionally, those service users who were used to administrative and record keeping work
as well as managing budgets and running their own businesses, found it easier to manage
and navigate the Personal Budgets system.
"See Emma used to work in the cash office in Morrisons, she was supervisor, so figures
and money – if she didn’t have it in her then it would probably be ten times harder."
(Husband of PSI service user)
“External” factors that facilitate positive impacts
4. The role of the local market
The availability of a range of providers has meant that many service users have been able to
exercise choice by changing providers if they have been dissatisfied with the standard of
care they are receiving. This ensures that service users are able to purchase services from
providers who offer the highest quality of care. Service users gave a range of reasons for
changing providers including: a lack of consistency in carers; carers coming at inappropriate
times of the day; carers being late or not turning up; carers not being professional or not
delivering appropriate care; and service users not developing a good relationships with
carers.
Some service users reported specifically had moved from a private agency to a freelance
carer when they were dissatisfied with their care agency. They felt this resulted in: value for
money, due to not paying agency fees; a better quality of and more flexible care because
they could negotiate directly with providers about what care was required; and also meant
they could develop trusting and personal relationships with their carers.
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6. Briefing paper 2: Factors that facilitate Personal Budgets to have a positive impact
5. The role of frontline staff
Service users keenly felt that having one consistent social worker as a point of contact is
associated with lots of the positive impacts associated with Personal Budgets. In particular,
they felt that having one contact meant that they were able to start receiving payments
quickly, have a review of one’s needs when necessary, receiving an adequate level of
Personal Budget and also being able to access advice and guidance when necessary.
Some service users who did have a single point of contact emphasised how important this
was for accessing support and advice.
"In the end she allocated Rebecca a social worker and so I had one person to speak to
and that helped... when you have just the one person you don’t have to keep going over
and over and that did it." (Mother of service user with LD)
Some service users have also been able to work with their social workers to develop
Personal Budgets that do not only focus on traditional social care needs, but also on wider
wellbeing and independence outcomes. On the other hand, some service users are
frustrated because they feel their Personal Budgets have been quite inflexible and restrictive.
Those with more creative and flexible budgets therefore tend to benefit more – benefits seen
more generally for service users with learning disabilities and those with physical or sensory
impairments.
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