The Care Act: Understanding self-directed support and personal budgets
Updated: Mar 2
Self directed support originates from the disability rights and independent living movements from the 1960s, which campaigned for the rights of people with disabilities. Its basic principle is to allow recipients of social services funding to participant in their entitlement rights and how they apply them. It is based around choice, flexibility and creativity to enable people to progress with their lives. This has been written into law through the 2004 Care Act in England, though It has been part of common practice since the publication of Putting People First (HM Government 2007). It is also applicable to the Care Act applied in Wales, which has similar provisions. This article will discuss characteristics of self-directed support, and the practical implications of putting it into practice.
A key element of this system is the personal budget, which forms part of a statutory care and support plan. Although this could be a direct payment or executed on their behalf by a local authority, the recipient will always be involved in how the money is spent. The local authority should be satisfied that the money is being used to meet the individual’s needs and is encouraging their autonomy.
In order to arrange their self-directed support, a specific process should be followed. Firstly, a support plan should be designed and agreed. The money and support should then be organised and put into practice. This process is then reviewed and assessed.
The initial assessment is key and is best carried out face-to-face. Individuals should feel at ease and respected. Techniques such as asking permission to ask more questions, speaking to other members of the household, asking supplementary questions and using open questions can help practitioners to identify the specific needs of an individual. In general, the assessment should be strengths-based and person-centred.
The focus should be on the core issues which can be addressed in isolation. For example, an individual with specific mobility needs would need these to be addressed first, allowing them to lead a more autonomous life in other areas.
For self-assessment the person has greater input into the process but is not left to assess themselves alone. The social worker is available with their own experience and expertise while allowing the individual to identify their own need for support. The assumption is that individuals are the principle experts on their own lives and may have in-depth knowledge of local support systems such as family or other community members. Though the system is not obligatory it must be offered by local authorities.
Claimants will complete the assessment themselves though the local authority must be confident that it accurately reflects an individual’s needs and outcomes. Before helping with this assessment, the social worker should review the case, taking into account communication issues, previous reports and referral information, including any significant gaps which need to be clarified. Bear in mind that circumstances can change quickly and may not reflect what is recorded in the files.
A personal budget should be established based on local care market costs and conditions. In practice this means that a person may receive a direct payment which is higher than the equivalent personal budget managed by the council, as they cannot take advantage of the local authority’s bulk-purchasing arrangements with providers. The Resource Allocation System (RAS) may be calculated using an algorithm which assigns points for each aspect of need, or a ‘ready reckoner’ approach which bases a personal budget on the costs of services an individual is already using. Any RAS should be transparent in the way it is calculated.
A Care and Support Plan must be approved by the local authority. It should include the personal budget, information about reducing, delaying or preventing needs, details of direct payments, what needs have been identified and how they meet the eligibility criteria, how this support will help the person, and any other personal elements which are important to the person.
If the individual in question is to complete the assessment, perhaps with the help of those closest to them such as family, friends or spouse, they will need to know what their budget is, whether there are any restrictions on spending, where they can get help from, and where they can find information about how much things costs. Free templates are available to help, such as Create My Support Plan from West of England Centre for Independent Living.
Whenever possible, using a social worker for support planning should be a last resort, as the individual is considered the real expert on their life and needs. In practice, however, it will often be a social worker who leads the process. In this context, person-centred tools can be used, such as thinking through ideal scenarios with the individual, asking them to describe a good and bad day, and asking about people they already know such as family and friends who can provide help.
It helps to ask about their desired outcomes, who is helping them at the moment, and what they want to change. The social worker should ask clarifying questions and listen carefully to an individual’s perspective. They should be aware of body language and facial expressions as clues to how they really feel. As much information should be gathered as possible, as many social workers are expected to complete a support plan in one or two visits due to time constraints. One-page profiles with a person-centred description are particularly useful in this situation, and can be completed by the client on their own or with support.
It remains unusual for people to complete their own support plans, undermining the purpose of self-directed support. It can be a challenge for social workers to ensure that it is truly the views of individuals forming the basis of these plans, and professionals run the risk of being prescriptive about care packages. We should stop to think about how an individual’s choice and control is being promoted and recognise that some people need more time to reflect on their own needs. Another option is for individuals to employ an independent ‘broker’ to help create a support plan, and a budget for this is sometimes included in a support package. This has been criticised by some as adding another element of cost to the social care industry.
When a support plan has been agreed with the budget-holder and the local authority, it should be reviewed at least once in the first 6 months and then every year, according to the Care and Support (Direct Payments) Regulations 2014. An initial, light-touch review should be taken after 6-8 weeks. A bank account can be set up to specifically receive the money, and it should be clear what evidence of expenditure needs to be kept.
Direct payments cannot be used to pay a spouse or civil partner, or any family member living in the same household, unless this has been deemed necessary by the local authority. The aim of the plan is for individuals to live as full a life as possible, where barriers to activities and employment are reduced, and they can participate in the design and delivery of a support system allowing them to live their life in a way that suits them best.
When a review of the plan is made, it should consider: whether outcomes have been achieved; whether circumstances have changed; what has worked or not worked; what improvements could be made; whether there are new outcomes needed; any changes in delivery such as direct payments; if the personal budget is still adequate; changes in support networks; and whether the person, carer or advocate is satisfied with the plan.
This system could be criticised for favouring more educated and articulate people who may be better able to recognise their eligibility. There have also been complaints that it is overly bureaucratic, involving an excess of reviews, leaving people feeling patronised. There are worries over a lack of choice for services, especially in rural areas where greater expense may not be reflected in the level of payment. Some also fear a neo-liberal erosion of publicly provided support which may not effectively provide for all. There is also considerable administrative responsibility, as claimants effectively become employers. This is coupled with concerns about the working conditions of these ‘staff’, in particular family members who could receive a low rate of pay. Because responsibility is being moved away from local authorities, some worry about misspending of public money.
The effectiveness and efficiency of this system compared to previous top-down models remains to be seen. While controversial for some, it is still optional. Local authorities are working to adapt the model to their own particular circumstances, and services users are becoming increasingly accustomed to taking the driving seat when it comes to their own care provision.
 “Putting People First: A shared vision and commitment to the transformation of adult social care” In Control (2010)
 In Control (2011) “Seven principles of self-directed support”