Managed budgets

Project Background

The IMPACT Network on choice and control in 2022 explored personalisation for adults with mental health conditions and/ or learning disabilities.

Traditional funding models tend to involve public authorities directly funding service providers (through public procurement or reserved markets). This can dominate and limit the choice and controls of individuals with support and care needs. In contrast to this, user-centred funding models (such as Personal Budgets) allow room for flexibility when designing and providing services so they can be more tailored towards the needs of individuals. In Northern Ireland there are 4 options for Personal budgets:

1. Direct payment – money is given to the beneficiary instead of services that would have been provided, or purchased by the Health and Social Care Trust

2. A managed budget – allows the beneficiary to have flexibility and choice without becoming an employer and managing the paperwork

3. Trust arranges support – the Health and Social Care Trust arranges the support

4. The person with support needs can choose option 1, 2 or 3, or they can choose a mix of 1, 2 or 3 to best suit them

IMPACT Factfile

Project Engagement

Helga explored the barriers and enablers for Managed budgets within the current Northern Ireland (NI) system by speaking with individuals with lived experience, practitioners, service providers and policy makers.  She spoke with:

  • Senior staff in Dept of Health and SPPG including Leads in Regional learning disability policy; Adult safeguarding; Procurement; and Community care
  • Key staff in each of the 5 Trusts (e.g. Personalisation/ SDS leads, commissioning and contract leads, social work teams)
  • More than 15 senior service providers about barriers/ enablers
  • More than 30 individuals with lived experience disability and carers.

She reviewed the evidence and spoke with experts from other countries including the rest of the UK, Australia, America and Finland to understand how they have implemented SDS, and how they have tackled challenges within their systems.

Feedback

  • In NI, although discussions around SDS in NI began over 15 years ago, direct payments have been rolled out most widely.  There has been a low uptake of Managed budgets across NI with differences between Trusts.
  • Although training and resources exist in each Trust, there is still confusion about what the different elements of SDS are
  • Managed budgets tend to be limited to current Trust contracted providers
  • There is a desire to widen out the pool of providers beyond this, but workable processes still need to be developed
  • Issues raised in response to the draft service specification for Managed budgets in 2018 still need addressed
  • NI legislation lacks the detail of the English and Scottish legislation around SDS
  • There are concerns about governance requirements, staffing capacity, and potential costs
  • There are also challenges in supported planning processes and review processes
  • Cultural change is needed
  • There is a need to support the transition period for individuals taking on SDS
  • The impact on the Service provider market needs to be considered – increasing number of Managed budgets may have positive and negative effects over time.

Recommendations for Northern Ireland

  1. Undertake a holistic assessment and supported planning process at point of diagnosis/ emergence of need for both individuals with support needs and parent-carers
  2. Provide additional capacity in system to undertake supported planning for individuals with support needs
  3. Strengthen current system capacity to support transitions and access relevant support
  4. Develop a tiered approach to contracting, governance and risk that is more manageable for individuals with support needs, Trusts and service providers, whilst still maintaining quality standards and managing risk
  5. Strengthen review process for individuals with support needs so there are appropriate and consistently applied checks and balances within the system.
  6. Strengthen processes to ensure individuals with support needs can move between Trust organised and self-directed support as necessary.
  7. Strengthen the use of evidence to inform decision-making at an individual level and aggregated level.

Proposed model for managed budgets

In collaboration with SDS leads, finance leads and contracts leads, preparations have been made to pilot managed budgets in each of the 5 Trusts and test various elements of the proposed model. The aim will be to identify changes that can be made to the system in the short-term, as well as produce insights to guide development of any future business case or procurement.

  • Co-produced supported planning service user resources and staff training developed with ARC’s ‘Tell It Like It Is’ group
  • Strengthened supported planning process (statutory approach being compared with additional support from Vela Microboards)
  • Strengthened review processes for individuals at 3 months
  • Panel being trialled to approve service providers not currently contracted by the Trusts
  • Brokerage support from a third-party organisation, e.g. Managing the budget on behalf of an individual and supporting transitions
  • Exploring how to streamline admin processes by use of mechanisms such as grants, prepaid cards, etc.
  • Discussions with DLS to progress concerns around legislation/policy, contractual arrangements, procurement, etc.

IMPACT Showcase Event

In Northern Ireland, some elements of Personal budgets (also called Self-Directed support) are used, but ‘Managed budgets’ are not yet being implemented to their full potential. IMPACT ran a workshop in October 2023, together with ARC to explore the challenges, blocks and frustrations in the system. An IMPACT ‘showcase’ event shared examples from across the UK where some of these have been navigated.  Presentations from Self-Directed Futures and In-Control Scotland gave examples of what was possible. Health and Social Care Trusts developed a theory of change and did some action planning around what needed to be done.

This project is continuing with that work by providing a focus and support with evidence-based systems change and implementation. The Senior Strategic Improvement Coach, Helga Sneddon, from IMPACT is being hosted by SPPG and will look at what changes are still needed and how budgets can be implemented to make them a reality. Between September 2024-August 2025, this will focus on implementing ‘Managed Budgets’ for adults with learning disabilities across Northern Ireland. 

Meet Our Demonstrator: Helga Sneddon

Helga Sneddon

I’m a psychologist  based in Northern Ireland who is passionate about ensuring everyone can shape and enjoy their lives. I’ve spent over 30 years working alongside people whose voices often go unheard, using evidence to inform decision-making, and changing systems.
Last year I worked on the IMPACT Managed budgets project which put people with learning disabilities at the centre of creating more user-centred processes and opportunities for meaningful community participation using self-directed support.