Personal budgets, where people needing care and support are trusted to self-manage their allotted budget and support, are a vital and much in demand form of home care in numerous countries throughout the world. They play an important role in providing increased choice and also in making care and support much more personalised.
The principles of the European Pillar of Social Rights and the UN Convention on the Rights of persons with disabilities both encourage the transition towards quality person-centred, inclusive and community-based services, as well as more person-centred funding models such as personal budgets.
Unfortunately in Ireland, this transition has been slow and disorganised. Yes, we have a National Personalised Budget Pilot Programme for the disability sector but it’s roll out has been slow, terribly underfunded and as far as we can see, set up to fail. For older people there is no such pilot programme, only a very watered-down scheme under the existing home care tender called the Consumer Directed Home Support Pilot. This basically gives families the right to select a provider from an approved list of companies that all offer the exact same service. A bit like Henry Ford’s idea of choice when he said “you can have any colour Model T so long as it’s black”. It also allows them to have a say over when support is delivered. This is a far cry from what real personal budgets look like.
The three major problems with the roll out of personal budgets in Ireland as we see are;
Unbundling of Funds
In general, at least within the disability sector, if someone wants to go down the personal budget route, there is no new funding for that. What they have to do is get access to or unbundle, the funds being used for their existing traditional service provision, so that they can use them as their personal budget. The problem here is, that firstly the traditional provider is very often reluctant to give up that funding and secondly when they do, it is nearly always a minimum amount of funding related directly to actual hours of service provision and not the actual amount that these service providers invoice the HSE for delivering the service. For example, the company might be invoicing the HSE say the equivalent of €40/hr to provide a traditional service for person A but when person A wants to go down the personal budget route, they are only offered maybe €18/hr to recruit and manage their own team of personal assistants while the company pocket the difference. Patently unfair.
Lack of an Appropriate Service Level Agreement
Where a person gets does access to a proper level of funding for a personal budget, the next problem is that the HSE have only one type of service level agreement, which is only suitable for a full agency type of service where control and responsibility sits with the corporate provider and not with the person themselves. They do not presently have a service level agreement that reflects what a real personal budget is. A service level agreement that sets out clearly the extra responsibility that the person needing support is taking on as well as the fact that they are in control and the responsibilities of the HSE and where applicable the responsibilities of a broker or intermediate.
This seems incredible considering there is a national pilot programme in place for personal budgets and harks back to my point of the pilot having been set up to fail.
HSE Reluctance to Cede Control
The third reason for the slow roll out of personal budgets is the HSE’s reluctance to cede control and accept that in many cases it is the people needing support who are experts in their own care and that they are capable of self-managing their own support. This goes to the excessive hand holding that is inherent in much of the HSE’s provision of support and results in huge wastage, top down rather than personalised care and a huge amount of frustration for many.
We are not talking about financial oversight of public funds, that has to be present. We are talking about the need to have the appearance of control over the quality of provision and what is best for people. I say appearance, because in reality the control the HSE like to think they have is in practice not there, due to a lack of resources for supervision and checking.
Personal budgets have a huge roll to play in delivering better and more personalised care and support for people. They can also play an important role in getting better value for money with less funds being lost to corporate overheads and profits and more getting to the people needing support and the carers and PAs delivering it.
Importantly, by getting more funds into carer and PAs hands they can also directly affect the present capacity crisis in home care by making caring a kore attractive career.
However, if personal budgets are to play these roles, the HSE need to address the issues holding back their use and make a decision to really foster their availability and growth rather than stymie it.