Individual Budget Scheme and Its Effects on Hospitals - Essay Example

INDIVIDUAL BUDGET SCHEME AND THE POTENTIAL EFFECTS OF IT ON LOCAL NHS HOSPITALS Introduction Individual budget scheme is a problem that was started by the government in order to take care of the health of the old people, people with disabilities, those who have physical sensory disabilities and those with particular mental needs. This program which is being implemented in England is An individual budget is a system which involved streamlined assessment of the agencies which are responsible for a number of supplying funding streams. This results to transparent allocation of resources to every individual, which may be in cash or in kind to spend in the way that suits them. Therefore there is less control of the way in which individual decide to spend their money. The scheme has been developed after the Care Services Improvement Partnership (CSIP) conducted 13 individual pilot schemes which were commissioned by the Department of Heath, Department of Communities and Local Government, Department for Work and Pensions, and the Office for Disability Issues. These pilot studies were commissioned in order to come up with a scheme that would help to improve the welfare and the health status of the section of the population that may feel more marginalized like the old, the disabled and others. Currently the program is covering only the old people and the disabled. (The Individual Budgets Evaluations Network, 2007) The scheme has been described as a step from direct payment. Currently the scheme is taking care of more that 50,000 old people which include careers. They are enabled to buy services using cash that is allocated to them by the local authorities. However the scheme is redistributed to conventional services. It has been declared a priority for the government. It has been one way in which the government is determined to drive up the quality of social care of the people. The scheme is all about unleashing a high level of creativity of the people in order to meet their needs in the best way that suits their life. The system has been seen as a possible way to replace the direct payment system. It has also readily been found very popular with the users. However the system does not fully replace the direct payment scheme but rather it helps to province more choice and extends the level of autonomy for the users. (Department of Health, 2006) Under the scheme an individual may positioned the allocation that one has been given on any reasonable means o that will enhance their wellbeing. They are allowed to pay for the health services of their family member or employee worker who are not allowed under the direct payment schemes due to their age or background status. The implementation of the scheme has also been found to be very successful in other counties where it has been implemented. It has a high level of effectiveness since it involves user-led organization which helps in promotion of the scheme. Therefore it gives the users of the scheme more options of choose from and the level of their autonomy is extended compared to the direct method which had been very rigid. Therefore we can say that the idea behind the development of the individual budgets had been to enable people who need social service and social care with other associated service to come up with a design that supports them and which gives them the power to decide the nature of series that they are going to receive. It is a more autonomous process which is controlled by the users of the services. There are some key features which are associated with the individual budgets like: A transparent way of allocation of resources which gives individual a clear cash or another package that helps them to meet the needs that they are having. There is a streamlined assessment process across all agencies which mean there is less time that is spent on giving information for one to access their allocations. The scheme brings together a number of supports and funding from more agencies which ensure that there are more funds for the allocation to individuals. It gives autonomy to individual so that they can use the budget in the best way that they think fits their needs. It advocates for a support from a broker or an advocate, family, or friends which rests on the wish of the individual user of the services. There are some of the basic characteristic that are associated with the development of the individual budget schemes. There has been the development of the initial model that has also taken into consideration some of the most important aspect of funding that has been central to the development of the scheme. The starting individual budget model withdrawal consists of the following income streams: Council -provided social cares service which will be provided to the entire individual who have been using the service before. Independent living fund Supporting people Disabled facilities grant Integrated community equipment services Access to work There is some of the integrated service that has been put in the new starting mode. As it appears the individual scheme is a complex integrated approach to the social care of the people. It takes into confirmation the broad demand of the people. Development of the scheme Sine the 1980s the UK government had a policy in retaliation of the provision of the social care in the country which involved a number of initiatives. All these initiatives were based on the idea that the needs of each and every person who required services should be used as the base for provision of closely tailored, responsive and very flexible personal package. Therefore the development of his policy is a step towards achieving the goal of the above described service. It has been an important step towards ensuring that individuals are given the best of the service that suits their demand. It is a step towards ensuring that there is a scheme in place that is tailored towards the needs of the individual person. (Fletcher, 2006) In order to come up with a system that was more responsive to the needs of the people, there was definition of the benchmark which would be used to evaluate the effectiveness of any scheme. There were some basic requirements that had to be met by any scheme in order to qualify to be an effective one that met the needs and aspiration of the users. The following are some of the benchmarks that have been used to evaluate the effectiveness of the social welfare scheme: (i) Care management The initial goal in development of a care scheme was to have a scheme that provided the development of the individuals. This would be a management system that would meet the care plans, on the bases of a detailed assessment by the budget holding care managers. The scheme would be developed taking into consideration the wishes and the needs of the service users. An effective scheme would also help the service users to enjoy a degree of autonomy and freedom. (ii) Direct payment Any competitive social package would be the one which helps the individual to access their benefit directly. In this regard it would be a scheme where people after the assessment would be given the money to take care of their own social care. This would however be achieve along the lines that they have proposed and discussed with their care managers. Direct payment scheme has been used in the UK for along time now but it has not been giving the people the needed freedom and autonomy to make their own decisions (iii) Individual budget This is a system in which there is streamlined assessment across the agencies that are mandated for a number of support funding streams which results to a transparent allocation of resources to every individual which is given in kind or in cash and in which there is not limitation of the way in which it is going to be spent. This means the there is a more freedom and authority in the way the allocation is going to be implemented. (Duffy, 2007) Care management or case management was implemented in the early 1990s. It was a very important step in the course of development of an effective social care management scheme which has evolved to include direct payment and individuals budgets. However this care management did not last for long as it was replaced by direct payment in 1997. However, direct payment was seen as just a step in the improvement of the care management system and not as whole replacement of the care management. While the two system have been running parallel, taking an approach with is more consumer oriented can be taken as a complete remodiffication rather than a compel break with them since they form the bedrock of provision of social care in the country. The new approach has just been a way of reforming them in order to respond to the needs of the consumers. Therefore the new scheme can be taken as a framework in which all the three approaches are implanted side by side. It is framework of rights with a continuum of choice and existed of inclusion with the key decision the process being under the control of the consumers of the services. In most countries there has been the development of new social care framework with are more directed towards achieving consumer-directed care of self-directed support or personalized-allocation and many other approaches. All these frameworks have been aimed at ensuring that the consumers have a more say in the type of social care that they will receive. It is a kind of commercialization for the process where like in the production of commercial service, the consumer has a say on what kind of services they will receive. It is a process which is aimed at giving the end consumer a control of the whole scheme. Most of these schemes have been developed as are supposed to demand autonomy from the users of the services. The process may however be driven by traditions, politics and the policies which may be different from those which are employed in the UK. But the process is the same and the aims are the same. For example in North America the social care system is characterized by the provision of support to those individual who wish to use them. The support may come in various ways. The focus may be different leaving in the access to information about the service while the management and final issue may also be different. In this as there are brokers in North America who provide the service as compared to the method of direct payment that is used in the UK. This broker may be doing this work for a fee or they may be doing it voluntary. What was the base of the development of the project There are not models that were taken by the government to base the development of the individual budget scheme but from its own experience of the success of direct payment. The government also derives experience from other operating models in the European Unions and North America and from other places like the New Zealand and Australia which have put in place a model of the same kind. The success and the challenges that have been experienced by these models were used by the government in order to come up with a new comprehensive scheme that would help to deliver the expectations of the people. The development of the scheme has been based on a number of internal and external imperatives which has been calling for an effective scheme that meets the needs of the consumer. It cannot be said that the earlier system failed because it has been serving the people fro along time and has helped them to meet their need. But the market was changing and there was need to change with the market. Many analysts have noted that there were a number of imperatives that forced the government to come u with such a comprehensive policy that would help to address the needs of the people. The impetus fro the development of the scheme could have been derived from a blend of imperatives such as voice that was aimed by the independent living and other inclusion movements, the demand to have the end of social exclusion which was a concern of the society and the government, stigma and discrimination that was associated with being classified as a second-class citizens. There was a sense among the European unions' governments that the tradition European welfare state had failed to cope with the demand of the new millenniums and therefore needed a complete overhaul. There has been an increasing demand of services for the social care and the welfare system has failed to meet the increasing demand. This as a call for the government to think of a new system that would replace the welfare state in order to meet the increasing needs for the people. There was also an increasing trend towards personals, tailored response in meeting the needs of the people. The wave of globalization has led to social exclusion in the context of a wider social inclusion concept. There is an increasing trend towards individualization of the services in the commercial sector and in other areas. Therefore the government had to come up with a framework that was in line with the changing that were taking place in the world. The government wanted to come up with a framework that ensured that it met the demands for the consumer and helped to empower the consumer and perhaps help the save the money for the state. In this case the trend has been moving away from a state reliant consumer to more self reliant consumers. The direct payment scheme in the UK and other consumer directed payments in other parts have been sued as the based for the development of a number of care workers or personal assistant. However there have been little regulation on the skills, working condition and other labor related factors under which these care groups are established but one thing that is clear is that they have been important in beginning a new working care system which can be considered as a revolution in the social are system. Piloting studies that have been used in development of the budget schemes Like any other process before the implementation of the budget scheme there have been appropriate studies which have been carried out by the government in order to come up with way in which they could be made more effective. The pilot studies were carried out in order to test the viability of the scheme. In 2006 the ministry of Health announced that 13 pilot studies would be carried out in order to asses the viability of individual budgets. These pilot studies were to be carried out in Manchester, Barnsley. Coventry, Gate shed Oldham, Kensington and Chelese, Barking and Dagenham, Essex, Lincolnshire, West Sussex, Norfolk, Bath and North East, Leicester, and Somers. The pilot studies were programmed to run for 18 months and the results of the pilot studies would be used to implement the individual budget scheme from 2009 or 2010. In designing the pilot studies, there were a number of factors that were to be considered in order to test the effectiveness of the scheme. First the pilot studies were implemented in order to test where the schemes would help individuals to have more control over the assessment process and the arrangement to have the social care. Second the pilot studies were also set to assess the additions that could be made to the direct payment received from the social services or the changes that would be made. In this case it was to a look at whether the existing income is pooled together will be able to help the user to identify the total resources that are available the to plan the most effective way that can be sued to spend the resources. Third the pilot was to test how individual control would be exerted on the resource. According to the government this would be archived through the use of the broker or advocate services or any other parson with whom the service use is free and trusts. In this case the family will not have a say in the process but it will be the individual person who will have a say on how the resources are to be used. This was the factor that the pilot study was set to asses. Although most of these studies are still continues, there have been positive result from the pilot studies which shows that in deed there is ability of the studies. There are positive results which show that the schemes can success. The pilot studies were expected to be completed by April but the preliminary results shows that there is overwhelming support for the implementation of the project. Legislative framework The government has already made it clear that the framework will be implemented in light of the existing council coffers. This means that there will not be additional money that will have to be provided for the scheme. This shows that there may be economical constrain that will be experienced in the course of delivery of the services. Individual budget as such have not been referred to any community care legislation as they exist in the UK the present unless there will be new legislation that will be put in place in the future. Therefore it may not be correct to reefer to the process as a policy but the viability of its implementing will be based on the results that will be given by the studies starting from next year. The while paper that developed the scheme take of radical changes that were to be made in order to implement the individual budgets but it does not provided for the laws that will need to be changed in order to make the plan effective. The white paper explains that the scheme can be accommodated within the existing legal framework following that individual budgets are a special direct payment which are provided by the statutory regime since they have an element of community care monies which is one of the species of direct payment in the constitution. Direct payment for adults is available when an individual has a care assessment carried out. This is proved under the Care and Disabled Children Act 2000. In the assessment process the needs of the period will be deemed as eligible needs by referring to the assessing authority eligibility criteria. There is need to have an effective review of the individual needs since it would be inequitable and an amount of unlawful discrimination of individuals how to receive individual budgets to be given preferential entitles to the local authority community care and support in accessing resources if the same is not given to those individual who deserves more. Therefore there is need to have a binding policy guidance which will give direction on how the policy is to be carried out. This has been issued by the secretary of state and it creates a presumption which shows that Carers will be fully involved in the process of community assessment of the person. In addition cares are also given the statuary right to carry out a separate assessment in order to sustain the caring relationship with the service receive. In the planning phase of the program it seems there have been little attention that have been paid to the law aspect of the program in preparation of the biding guidance which will help to regulate the whole operation. This shows that the scheme will be operation in entirely different environment from the existing community care arrangement which is used to govern the policy announcement. The announcement of the policy by the government therefore seems not to have taken a consideration of the various aspect of law that it ought to have taken into consideration. While there are concerns that have been raise on this issue, the department of health which has been held responsible for the policy continue to keep shut on the issue. On the website of the scheme it has been expressed that the scheme is within the operation of the law but on the other hand it is reverse of the provisions of the community care laws. In view of the local authority, individual budgets are seen as a natural progression which helps the community to move from the existing high direct payment performance. According to the local authority it has been shows to be an experience of in control but in others the whole scheme is seen as a way of change and an overall change to the existing practices and a modernization of the tradition social care provision system. There is also a difference in the provision of the approaches that are used according to the local authority they are a wider of approaches that are used in assessment of the needs which involves the users, carer, and the social worker with each playing a different role. There is a more conservative approach which involves the care management guiding the assessment process but in the process consult the users. On the other hand the other approaches are all dependant on the self assessment questionnaires. Individual budgets and the Carers There are fears that carer may be left out of the whole process. Such an approach of the importance of law in the formulation of the scheme may at the end leave a large segment of the Carers who have been pivotal in the operation of the care system in the country. For the Carers there are a number of obligations that have been placed on them by the statutory regime. For along time there have been obligations that have been placed by law on those who have been taking care assessment which have been fought by many bills. There have been more that three private bills that have brought before the house which are aimed at ensuring that some of these obligations have been deal with. (Clements, 2008) Unless there are directives that will have to be given by the government the role of Carers in the process of the assessment may be entirely bypassed or ignored by the emerging self assessment and resource allocation systems. Carers are facing the risk of being sidelined in the process because the pilots have not taken a great consideration into the role that they can play. They have been playing great role in the process and with the new emerging scheme, their role could be bypassed. It is feared that this may end up brining a lot of chaos in the process. Emerging issues in the scheme There are a number of issues that have been emerging out of the pilot studies that have been carried out. This has been the purpose of the pilot study to indentify some of these constrains that have been expressed by many people. Therefore these issue needs to be addressed before the program is implemented. One of such emerging issues has been the development of the a new process that will be sue d to determine the funds which should be made available to individuals who are seeking to have their community care support in the form of individual budget. The new process which is used to quantify individual budget has been classified as Resource Allocation System (RAS). There has been very little information that has been given concerning how the whole system will be used to determine the whole budget for the individual. Following this system, it has been shown that the funds will be determined using three means as follows: the level of need of the individual which can be expressed as low, medium or high the situation of the family which is expressed whether e living in the family home or not living in the family home the complexity of the situation which can be expressed as yes or no According to this criterion, those who are living in the family home are likely to be given half the amount of those not living in the family home. For example for a person who is living in a family home with high level of needs like 24 hours need of support would be entitled to receive 15000 pounds under the scheme while the person living outside the family home who have less needs like minimum level of support would be entitle to receive 30 000 pound under the scheme. There is a great assumption here as the family home is pegged as the determinant factor that would be used to gauge the amount that will be given to the individual person. The complexity of entrench a funding structure that would help to reduce the level of discrimination in the process. There have also been concerns that have been raised about how the scheme would be harmonies with the NHS. This is because most of that those who are entitled to receive the individual budgets have also been receiving medical carer service under the NHS through the local authorities. These concerns have already been raise din the process of the pilot studies. There have been concerns that individual care budgets will result to the destabilization and fragmentation on the working of the NHS. Under the new proposal it has been proposed those individuals who have chronic illness may be allowed to purchase their own care after being given control of their individual heath budget. Under the arrangement those patients suffering from multiple sclerosis, motor neuron disease, asthma and diabetes will be given autonomy to spend millions of pounds. They will have the freedom to shop around for an effective health services which they want to access to uphold the rule of autonomy under the new scheme. They will be given freedom to access private heath services. Although patients would not be given money to spend directly, they would be given allocated funds to access treatment which they want. Doctor have criticized this saying that it would led to closer of some of the most important ward in the hospitals which would have negative effects on those how are not benefiting under the scheme. In this case the hospitals have been depending on the amount of revenues that is generated from the services and therefore those services which are not fully utilized will probably be axed out which will lead to closure of some important wards in the hospital. This would severely those patients who have mental illnesses who cannot make their own decisions on the most appropriate medical services to aces. (Drury, 2008) Conclusion The individual budget is a good scheme that is likely to improve the delivery of social services. The scheme is designed to give those who access social care more freedom on the way that they will be using their allocations. However there are some serious issues that need to be addressed. There is need to put in place a legal framework that will ensure that the scheme is put within the legal framework. The effect of the scheme on the operation of NHS should also be studied closely. There is need to carry out more research on the effects of the scheme before it is put to practices. References Clements, L. (2008): Individual Budget and Carers. Department of Health, 2008 Department of Health (2006): Our Health, Our care, our say: a new direction for community services, CM 6737 Drury, I. (2008): Patients will get an NHS budget of their own under the new proposal. Individual Budge Pilot Projects Duffy, S. (2007): Individual Budgets: Transforming the allocation of resources for care. Journal of Integrated Care, Vol. 13(1) Fletcher, C. (2006): Development in direct payments. Bristol: The Policy Press The Individual Budgets Evaluations Network (2007): Individual Budgets Evaluation: Summary of early findings, June 2007 Read More