Putting the cart before the horse: resource allocation systems and community care

Series, Lucy; Clements, Luke

doi:10.1080/09649069.2013.800288

Cited by 20 publications

(30 citation statements)

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“…Second, there has been concern that the transparency which was supposed to be a key element of the move to personal budgets has been compromised by the adoption of opaque Resource Allocation Systems (RAS) to calculate budget entitlements. Analysis of RAS used in 20 local authorities found: ‘No local authority contacted by the authors appeared geared up to share the inner workings of their RASs with service users, or to be able to explain in clear and simple terms their underpinning assumptions...’ They concluded, ‘far from leading to more transparent, fair and equitable allocation of resources, RASs obfuscate discretionary care planning processes and make it harder for service users to challenge unfair or inequitable allocations’ [25]. …”

Section: Resultsmentioning

confidence: 99%

Personalized commissioning, public spaces: the limits of the market in English social care services

Needham

2013

BMC Health Serv Res

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BackgroundThe article explores the implications of personal budgets within English social care services, which position the individual as market actor. Rooting the research in the broader personalization agenda, the study looks at the limitations of the market in relation to individual purchase of private goods (e.g. home care), in the pooling of funds to purchase group services and in the provision of public goods such as building-based services.MethodThe article takes a multi-method approach, combining an interpretive focus on the framing of the personal budget-holder by advocates of personalization with national evaluation data, and data from a small survey of day centre workers.ResultsThe article identifies three framings of the individual budget-holder articulated by advocates of personalization. The first is that personal budget-holders will be empowered market actors, commissioning the services they need. The second is that budget-holders will pool resources with others to purchase group services in order to broaden the range of options available to them. The third is that services which cannot be disaggregated into individual or group budgets – such as day centres – are not valued by service users. The article looks at the evaluation data on these three claims in turn. It identifies four limitations to the capacity of people to purchase care goods on an individual basis: lack of transparency in allocating budgets, complexity in managing a budget, excessive auditing of spending and lack of responsiveness from the provider market. Pooling of budgets to purchase collective services is found to be underdeveloped, and hampered by the complexity which is a broader limitation on personal budgets. Day centres are found to be closing not in response to commissioning decisions by individual budget-holders but because of decommissioning by local authorities, minimising the scope for individuals to express a preference for this type of care. The survey highlights patterns of day centre closure, rising fees for attendance and reduced eligibility, and the underdevelopment of mechanisms to facilitate commissioning of new collective spaces.ConclusionsThe paper concludes that the transition to personal budgets – in the context of the accompanying financial crisis in local authorities – has led to inadequate attention to the potential for an undersupply of collective and public goods. The loss of day centre provision will be felt by personal budget holders but also by self-funders and people in residential accommodation who may no longer be eligible for, or able to afford, to access shared spaces. Local authorities are actively taking on the role of decommissioners without sufficient responsiveness to how and what individuals want them to commission.

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Section: Resultsmentioning

confidence: 99%

Personalized commissioning, public spaces: the limits of the market in English social care services

Needham

2013

BMC Health Serv Res

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“…Research finds a major discrepancy overall between indicative and final budget figures agreed by RAS panels (Series and Clements ; Slasberg et al ). This was borne out to some degree by the experience of the Scottish test sites, though our data is derived from small participant numbers and is not strictly comparative with these other studies.…”

Section: Limitations Of Resource Allocation Systemsmentioning

confidence: 99%

Is Personalization the Right Plan at the Wrong Time? Re‐thinking Cash‐for‐Care in an Age of Austerity

Pearson

Ridley

2016

Soc Policy Adm

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As personalization has dominated the policy agenda for reform in social care, its roll-out as a mainstream option has coincided with global programmes of austerity which have targeted services for disabled people. Was this simply bad timing or was its implementation always part of the agenda for reform? Whilst the principle of cash-for-care schemes drew strongly on promoting the independence and autonomy of disabled people, early incarnations of direct payments policy in the UK were initially at least in part rolled out in light of potential cost savings to social care budgets. This article explores these and other issues in light of evaluations of the Scottish government's self-directed support (SDS) test sites (2009-11) and implementation of subsequent legislation enforcing models of SDS in Scotland from April 2014. Discussion draws on the authors' recent book (Pearson et al. 2014) to reflect on what the evidence can tell us about radically transforming social care at a time of global austerity.

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“…The main challenge to professionally-led systems was that resource allocation decisions, controlled by local authorities, could be highly subjective as to which needs were supported (Duffy, 2005). However, self-directed systems have been criticised for lack of clarity, robustness and transparency in their methods for calculating financial support (Clifford et al, 2013;Series & Clements, 2013;Slasberg et al, 2012). These issues mean there is contention around which needs should take priority in resource allocation decisions (Tyson et al, 2010;Series & Clements, 2013).…”

Section: Introductionmentioning

confidence: 99%

Priorities for long-term care resource allocation in England: Actual allocation versus the views of Directors of Service and older citizens

Clarkson

Davies

Hughes

et al. 2018

JLTC

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Context: Decisions about resource allocation in long-term care are a perennial issue. The basis for deciding between different needs in prioritising allocation is contested. In England, this debate has crystallised with the advent of selfdirected support, where individuals' expressed preferences drive resources. Objectives: To compare perceptions of the priority given to needs for resource allocation in long-term care of older people by two stakeholder groups, compared with actual resource allocation. Methods: Survey data, eliciting perspectives of senior service managers and older citizens, were used to rank the perceived importance of eight needs-related outcomes. Actual resource allocation from 17 local authorities was also modelled against these outcomes. A variable importance metric was used to rank the importance of these outcomes in determining actual resource allocation. Findings from each data collection were compared. Findings: Differences in prioritisation of needs emerged between stakeholders compared with actual allocation. Older citizens and actual allocation prioritised basic and instrumental activities of daily living (ADLs). Directors' rankings were more distinct, still prioritising basic ADLs, but ranking psychological well-being higher and instrumental ADLs lower. Limitations: The model of actual allocation could not account for political and bureaucratic factors influencing resource allocation, nor the complexity of certain needs that might incur greater resources. Implications: Discretion continues to influence resource allocation, which remains a contested area. Directors must account for overall spend and other extrinsic factors to maintain sustainability, whereas older citizens prioritise instrumental ADLs, despite these being considered lower priority in eligibility decisions. Overall, ADLs remain important drivers of allocation.

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Putting the cart before the horse: resource allocation systems and community care

Cited by 20 publications

References 1 publication

Personalized commissioning, public spaces: the limits of the market in English social care services

Personalized commissioning, public spaces: the limits of the market in English social care services

Is Personalization the Right Plan at the Wrong Time? Re‐thinking Cash‐for‐Care in an Age of Austerity

Priorities for long-term care resource allocation in England: Actual allocation versus the views of Directors of Service and older citizens

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