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Article
Publication date: 30 March 2022

Elizabeth Welch, Karen Jones, Diane Fox and James Caiels

Integrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the…

Abstract

Purpose

Integrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the centre of decision-making and are part of a wider long-term initiative working towards personalised and integrated care. Personal budgets began in social care with the national pilot programme of individual budgets, which aimed to incorporate several funding streams into one budget, but in practice local authorities limited these to social care expenditure. Personal budgets then moved into the health care sector with the introduction of a three-year personal health budgets pilot programme that started in 2009. The purpose of the paper is to explore the post-pilot implementation of personal health budgets and explore their role in facilitating service integration. We examine this through the RE-AIM framework.

Design/methodology/approach

During 2015 and 2016, eight organisational representatives, 23 personal health budget holders and three service providers were interviewed, 42 personal health budget support plans were collected and 14 service providers completed an online survey.

Findings

Overall, personal health budgets continued to be viewed positively but progress in implementation was slower than expected. Effective leadership, clear communication and longer-term implementation were seen as vital ingredients in ensuring personal health budgets are fully embedded and contribute to wider service integration.

Originality/value

The paper highlights the importance of policy implementation over the longer-term, while illustrating how the venture of personal health budgets in England could be a mechanism for implementing service integration. The findings can serve to guide future policy initiatives on person-centred care and service integration.

Details

Journal of Integrated Care, vol. 30 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 2 December 2014

Caroline Norrie, Jenny Weinstein, Ray Jones, Rick Hood and Sadiq Bhanbro

The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in…

Abstract

Purpose

The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011.

Design/methodology/approach

Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users’ experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life.

Findings

xService users (n=7 older people and carers; n=7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups.

Research limitations/implications

Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty.

Practical implications

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

Originality/value

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

Details

Working with Older People, vol. 18 no. 4
Type: Research Article
ISSN: 1366-3666

Keywords

Article
Publication date: 2 August 2013

Vidhya Alakeson

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care…

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Abstract

Purpose

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme.

Design/methodology/approach

This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA.

Findings

Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole‐person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care.

Originality/value

This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS.

Details

Journal of Integrated Care, vol. 21 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 17 June 2011

Sarah Carr

This paper aims to present a digest of the main discussion points and key findings from a recent Social Care Institute for Excellence report on risk enablement and safeguarding in…

5931

Abstract

Purpose

This paper aims to present a digest of the main discussion points and key findings from a recent Social Care Institute for Excellence report on risk enablement and safeguarding in the context of self‐directed support and personal budgets.

Design/methodology/approach

The paper explores how the personalisation agenda and adult safeguarding can work together in policy and practice and addresses some of the frontline concerns about empowerment and duty of care.

Findings

Evidence on how self‐directed support and personal budgets can be used to enable people to take positive risks while staying safe and emerging practice is examined. It suggests that person‐centred working in adult safeguarding, along with the mechanism of self‐directed support planning and outcome review, can support the individual to identify the risks they want to take and those they want to avoid in order to stay safe. It is clear that if frontline practitioners are overly occupied with protecting organisations and individuals from financial abuse, this will impact on the capacity of those practitioners exercising their duty of care at the front line. This means that practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk taking. Defensive risk management strategies or risk‐averse frontline practice may then result in individuals not being adequately supported to make choices and take control and, therefore, being put at risk. Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement in their relationship‐based, person‐centred working. Good quality, consistent and trusted relationships and good communication are particularly important for self‐directed support and personal budget schemes.

Originality/value

The use of “risk enablement panels” and “personalisation and safeguarding frameworks” are two ways to address some of the issues in practice.

Details

The Journal of Adult Protection, vol. 13 no. 3
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 10 October 2017

Karen West and Catherine Needham

The purpose of this paper is to examine the current policy of extending personal budgets to older people.

Abstract

Purpose

The purpose of this paper is to examine the current policy of extending personal budgets to older people.

Design/methodology/approach

In developing this explanation, the paper draws upon a species of de-centred, post-foundationalist theory which draws attention to the way in which certain narratives can sustain a longing for the implementation of policies that are ultimately unachievable. The paper also draws upon original data from an evaluation of a national ageing charity’s project to increase take-up of personal budgets.

Findings

The paper draws attention to, and seeks to explain, the paradoxical discursive positioning of older adults as “the unexceptional exception” within the general narrative of universal personalisation.

Research limitations/implications

This analytical approach can secure a different vantage point in this debate by paying closer attention to the ideological and ethical dimensions of personalisation than has been the case until now.

Practical implications

The paper contributes to the critical interrogation of the personalisation agenda, in which debate (both in academic and practitioner circles) has become highly polarised.

Social implications

The paper contributes to discussions in critical social gerontology which point to a bifurcation of later life into, on the one hand, an ageless third age and a frailed fourth age, on the other.

Originality/value

The paper makes clear that the discursive positioning of older people as “the unexceptional exception” risks an inadvertent ageism.

Details

International Journal of Sociology and Social Policy, vol. 37 no. 11-12
Type: Research Article
ISSN: 0144-333X

Keywords

Article
Publication date: 7 August 2017

Song Yang, Songshan (Sam) Huang and Gang Shen

This study aims to identify key factors influencing Chinese domestic travelers’ behaviors in hotel selection from a pool of budget hotel attribute-based factors and customer…

1621

Abstract

Purpose

This study aims to identify key factors influencing Chinese domestic travelers’ behaviors in hotel selection from a pool of budget hotel attribute-based factors and customer personal characteristics and determine the extent to which these factors impact on domestic Chinese travelers’ hotel selection preferences.

Design/methodology/approach

This study uses a discrete choice experimental design and a multinomial logit model to examine the key influential factors contributing to Chinese domestic travelers’ choice behavior to budget hotels. Both hotel attribute-based and personal trait factors were tested.

Findings

Results indicate that location, price and business functions were factors influencing guest choice behavior. For budget hotels, being located in the traditional central business districts and having a restaurant would leverage guest preference to stay. Among consumers’ personal characteristics, income, occupation, purpose of travel, personal attitude and past experience were found to be determinants of guest choice behavior.

Practical implications

This study contributes to the understanding of Chinese domestic travelers’ choice behaviors toward budget hotels and offers insights for industry practitioners to better design budget hotel products and service.

Originality/value

This research is the first that integrates hotel attributes with travelers’ characteristics and quantitatively evaluate the determinants affecting hotel choice behavior in China. The insights are of value academically to our understanding of cognitive mechanism underlying choice behavior.

Details

International Journal of Culture, Tourism and Hospitality Research, vol. 11 no. 3
Type: Research Article
ISSN: 1750-6182

Keywords

Article
Publication date: 1 October 2008

Martin Routledge and Zoe Porter

Personal budgets are part of the Putting People First agenda in England and are at the heart of the biggest change in social care for decades. This article discusses the rationale…

232

Abstract

Personal budgets are part of the Putting People First agenda in England and are at the heart of the biggest change in social care for decades. This article discusses the rationale and evidence base behind their introduction and focuses on the challenges to moving from small scale pilots to nationwide implementation.

Details

Tizard Learning Disability Review, vol. 13 no. 3
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 20 September 2011

Lili‐Anne Kihn

The purpose of this study is to further our understanding of how and why interpretations of budget targets differ from one person to another even in the same business unit.

3912

Abstract

Purpose

The purpose of this study is to further our understanding of how and why interpretations of budget targets differ from one person to another even in the same business unit.

Design/methodology/approach

A qualitative case study research approach is adopted, involving a review and analysis of the literature and interviews conducted among controllers and managers of a highly successful business unit.

Findings

Both the theoretical and empirical results suggest that organizational budgetary processes do not provide a similar understanding of budget targets for each person. While some shared interpretations are evident, individual‐level variations occur in the personal and subjective meanings that controllers and managers give to budget targets in their own consciousness, situationality and corporeality. A personal historical basis for understanding may impact a manager's interpretation of budget targets, but the interpretations can also be dynamic and change over time.

Research limitations/implications

The study is both facilitated and limited by its basic assumptions and approaches, and the findings may be most relevant to companies with similar profiles. Nevertheless, the study furthers our understanding of the characteristics of controllers and managers and their perception of the meaning of this important feature of accounting in practice.

Practical implications

It could be highly useful to jointly discuss the intended primary purposes and nature of organizational budget targets. Otherwise, people may understand targets in different and perhaps even contradictory ways, which could in turn impair the functioning of control systems.

Originality/value

This paper contributes to current budgeting research in that it interprets individual‐level differences.

Details

Journal of Accounting & Organizational Change, vol. 7 no. 3
Type: Research Article
ISSN: 1832-5912

Keywords

Article
Publication date: 1 June 2008

Guy Daly, Annette Roebuck, Jennifer Dean, Fiona Goff, Martin Bollard and Clare Taylor

This article presents the findings of an evaluation of the impact on service users of a local authority's individual budgets pilot. The local authority has pursued an…

Abstract

This article presents the findings of an evaluation of the impact on service users of a local authority's individual budgets pilot. The local authority has pursued an outcomes‐focused approach to care planning. The research findings suggest that these service users and their families see individual budgets as a very positive development. Service users have been able to gain greater control over their lives, not least in that they are able to determine to a much greater extent how they have their needs met. This facilitates service users' general growth and development, such that they are able to engage more fully and on a more equal footing as part of their families and communities. However, there remain a number of challenges that need to be addressed if individual budgets, or personal budgets generally, are to be rolled out successfully across adult social and health care.

Details

Journal of Integrated Care, vol. 16 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 1 August 2008

Ann James

This paper considers cash for care as reflected in direct payments and the more recent development of individual budgets in England. While the momentum to roll out individual…

Abstract

This paper considers cash for care as reflected in direct payments and the more recent development of individual budgets in England. While the momentum to roll out individual budgets gathers pace in England, Wales has embarked on a more cautious approach in wishing to evaluate the impact of individual budgets on social services. The paper identifies some of the far reaching implications of cash for care in general and individual budgets in particular, for service users, carers ‐ both paid and informal ‐ and for the social work profession. The policy incoherence in relation to risk and safeguarding is highlighted. This paper supports the approach currently adopted by the Welsh Assembly Government in relation to the ‘rolling out’ of individual budgets. The Assembly's 10‐year strategy for social services focuses on the rights of citizens and the needs of communities. This paper argues that fulfilling that vision should not be wholly contingent upon an unproven extension into the field of individual budgets.

Details

The Journal of Adult Protection, vol. 10 no. 3
Type: Research Article
ISSN: 1466-8203

Keywords

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