Going Again – using 15 years of learning about self-directed support to help close the Care Act rhetoric-reality gap

John Waters – In Control


At the #socialcarefuture gathering in November in Manchester, In Control helped convene a major session on closing the Care Act rhetoric-reality gap. There are many elements of this, but we have been recently encouraged to be approached by a number of localities ready to “go again” with self-directed support. They want to use the learning from the last 10-15 years to really realise the potential that personal budgets can offer people. We now have very clear knowledge about what works best in implementing personal budgets and this knowledge can quickly be put to effective use in localities.

What do we know?

For many years now we have used the Personal Outcomes Evaluation Tool which surveys personal experience and outcomes relating to essential aspects of the care and support process described in the 2014 statutory guidance and uses outcomes aligned to the domains of wellbeing. The tool has been embedded into local authority review tools and information systems where it is used to routinely collect people experiences and outcomes. Using the data collected it is possible to determine both individual and system level experiences and outcomes. From extensive use of the tool over many years we know what elements and approaches to delivery impact on outcomes. Importantly we know that some particular aspects of the care and support process are more regularly and most robustly associated with good outcomes and that we need to improve these areas. From our analysis we have clearly identified three broad areas that should inform our approach when thinking about improving our social care system. These three areas can be thought of as forming essential building blocks for better outcomes.

Listen to people and making sure they feel heard.

There seems to be little difference in terms of reported outcomes between the various professions who may be involved in planning. No one group of professionals appears to be more helpful than any other. But people reporting that their views were fully included, particularly in budget setting and support planning process, was firmly associated with better outcomes.

Keeping things clear and simple is essential;

People knowing the amount of their personal budget was robustly positively associated with many of the outcome indicators we looked at. The personal budget process being felt by people to be easy, was associated with all of the outcomes we looked at. Those people who reported all aspects of the personal budget process to be easy were most inclined to report good outcomes.


Allow people to control their support, avoid restricting creative use of budgets and look beyond core services.

What people spent their budget on was associated with a range of better outcomes. Spending on traditional services was not associated with better outcomes, people who spent their budget on community/leisure activities were more likely to report a positive impact of their budget on several areas of wellbeing.

People who spent their budget on personal assistants were more likely to report a positive impact of their budget on: quality of life, self-esteem, relationships (paid & family) feeling safe, arranging support, independence, control over life.

Practical use

Using these criteria, (building blocks of great support) it is possible, at very low cost, to undertake a high level review of current systems and tools used to shape approaches to the main steps in the care and support process, including;

  • Assessment and the identification of outcomes
  • Determination of eligibility
  • Allocation decisions
  • Support Planning
  • Plan approval process
  • Review arrangements
  • Information

From this you can start to create a simple and fair understanding among all parties (managers, practitioners, family members, people who need support, local providers and policiticians) of how personal budgets can be used to promote better outcomes and ensure efficient use of resources.

It is relatively simple then to support key performance and practice managers to embed the P.O.E.T. into the review process and where appropriate IT systems, ensuring routine capture of critical performance information. This allows the production of regular live reports detailing performance against each of the building blocs of great support. You will then know are they in place locally and what difference are they making to the lives of local people who need support.

Thinking beyond individual support arrangements local commissioners and other relevant people can also be supported to develop an approach to community development that transfers the building blocs for great support from an individual to a community level.

We are really pleased that some localities are starting to use this practical learning from the last few to help take social care forward and make a reality of the Care Act – we do feel many more could do the same – its time to go again!


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