How commissioners can support the use of personal budgets for meaningful short breaks
By Anna Gardiner, Council for Disabled Children
How can commissioners support the use of personal budgets for appropriate and meaningful short breaks at a time of increasingly smaller budgets?
Commissioners across health services and local authorities are tasked with commissioning outcomes and with a focus on personalisation. Personal budgets allow a move from previous 'one-size fits all' models and give individuals, and their families, choice and control over the support they receive.
Short breaks are a fundamental part of any support package a child or young person receives as not only do they give carers a break from caring, they allow young people to meet friends, take part in activities, develop independence and have fun. Aiming High for Disabled Children showed the positive effects of short breaks on children, young people and their families.
The impact of short breaks on the life of young people and their families cannot be underestimated and with the choice and flexibility offered by personal budgets, young people can access activities that meet their needs, contribute to the outcomes they want to achieve and are based around their interests and wishes.
Tom and his family live in Wigan and were part of the SEND Pathfinder site, where they have a personal budget as part of Tom's Education, Health and Care (EHC) plan. Using the personal budget, Tom was able to employ personal assistants (PAs) to support him to go to school, attend a youth club and to complete a Duke of Edinburgh award, including an overnight camping trip.
The freedom offered by his personal budgets meant that the pay for PAs could be differentiated to allow more highly trained PAs (who could perform more complex medical tasks related to Tom's tracheostomy) to accompany him overnight, thus enabling him to take part in the Duke of Edinburgh scheme.
Embrace Wigan and Leigh supported Tom with his Duke of Edinburgh award and also offer other short break activities to young people and brokerage support to families with personal budgets.
Commissioners in Wiltshire have worked closely with the local parent carer council to understand how families would like to access short breaks. The resulting short breaks offer includes an option for a family to have a direct payment of up to £600 per year to access short breaks of their choosing.
For example, they may decide to use it to pay for swimming or riding lessons, trips out, play equipment or they may even choose to employ a support worker to help their child access activities in the wider community. It's entirely up to the family how they choose to use this payment, just as long as whatever they decide to spend it on, provides a fun and enjoyable experience for their child.
Compass Disability Services administers the Short Breaks Scheme Payments on behalf of Wiltshire Council. Payments will be made in two instalments and up to a maximum total amount of £600. Parent carers must have a bank account for the funds to be paid into. Parent carers must return a simple monitoring form to let us know how the funds have been spent as this helps us to plan for services in the future. Subsequent instalments will not be released until the monitoring form has been returned.
Jess is ten years old and lives at home with her mum, dad and three siblings. She enjoys spending time with her family and friends, going to school and being outside, especially playing on the trampoline.
Jess attended a respite unit for short breaks for 48 nights per year, usually for a couple of nights at a time but once a year for two weeks while her family went on holiday. Over the last twelve months, Jess became increasingly distressed during her visits to the unit, she had assaulted staff members and other children, run away and told staff she wanted to go home.
Her family were frightened and reluctant for the package of support to change. They felt that whilst Jess' behaviour can be challenging at home, they have strategies to manage this. The last time Jess became distressed at the respite unit she physically assaulted two staff members and a decision was made that the risk was too great of this happening again for Jess to continue accessing the unit.
An outcomes based support plan was drawn up, including a personal budget in the form of direct payments, which meant that her family could buy in support of a PA who could meet her complex health and behaviour needs whilst enjoying time with her family and in the community.
Jess and her family describe the change as incredible:
"We never thought it would be possible to spend such lovely time together as a family. Jess now takes part in lots of family activities including going to church, spending time with her older sister and has even had a supported sleepover at her friend's house."
Considerations for commissioners
- If PAs are employed to support young people while they are accessing short breaks, they need to be appropriately trained to complete any medical tasks required. This training cannot be cascaded from parents to PAs but provided by competent and appropriate professionals.
- Work closely with providers and contractors to develop new commissioning model for the future which will ensure greater choice and control for children and young people.
- Ensure strategic engagement of children, young people and families in planning and development of short breaks services which offer more 'real-life' community based short break opportunities which foster independence.
- Building relationships with organisations which offer brokerage services to families in receipt of personal budgets.
- Short breaks should be listed in the Local Offer alongside information on how to request personal budgets.
- Resource Allocation Systems and block contracts: understanding unit costs to understand how much support costs in real terms. Often current commissioning arrangements lean towards commissioning for whole populations, which are complex and bring challenges in identifying actual spend on individual children.
- Start small but think big. Develop a strategic plan/intention of where you envisage the local short breaks offer in the future with timelines and action plans detailing the requirements.
Useful resource for commissioners
Three films have been produced that share the experience of Tom, his family and the health and local authority commissioners in Wigan.