KEY POINTS

  • Indicative Budgets provide a guide to what might need to be spent and are calculated using the Resource Allocation System (RAS).
  • The actual personal budget is determined by the proposed cost of a care and support plan designed to meet eligible needs and achieve outcomes in a cost effective way.
  • Where needs and outcomes can be met with a sufficient amount, that should become the amount of a personal budget, and people may top up their budget where they want to make more expensive choices.
  • If the services we may expect to provide would not meet the person’s needs and outcomes, and a more expensive service option needs to be considered, then it may be appropriate to agree a higher personal budget.

December 2018: This chapter has been revised as a result of local review.

1. Indicative and Actual Budget

The indicative budget is an approximate indication of what it may reasonably cost to meet a person’s needs according to their individual circumstances. It is generated by using the Resource Allocation System (RAS) for all people who are eligible for ongoing support. The indicative budget is not an allocation or entitlement to an amount of money. It provides a guide to what might need to be spent to enable the person’s eligible needs and their outcomes to be met. This is to be used to help the support planning process.

The actual personal budget is determined by the proposed cost of a care and support plan designed to meet eligible needs in as cost effective a way as possible. This may be more or less than the indicative budget (see Agreeing the Personal Budget and Care and Support Plan chapter). The personal budget is the actual figure agreed between Adult Care and the customer as required to deliver the proposed support plan. It is the actual personal budget amount that must be sent to the person in a letter along with their assessment and care and support plan.

The Care and Support Statutory Guidance states that …”the most important principles in setting the personal budget are transparency, timeliness and sufficiency. This will ensure that the person, their carer, and their independent advocate if they have one, is fully aware of how their budget was calculated, that they know the amount at a stage which enables them to effectively engage in care and support planning, and that they can have confidence that the amount includes all relevant costs that will be sufficient to meet their identified needs in the way set out in the plan.” Chapter 11.24

Practitioners need to be clear with customers that the personal budget will usually differ from the indicative budget once the support planning process has considered the options available to meet the assessed need and outcomes. Agreeing the plan and proposed costings also enables the financial assessment process to confirm what the person’s contribution to their personal budget will be. Customers should be informed of their actual personal budget amount in writing along with a copy of their assessment and care and support plan.

2. Sufficiency of Personal Budgets

The Care Act requires us to ensure that the personal budget is sufficient to meet eligible needs. The budget must be an amount that is the cost to the local authority of meeting the person’s needs. In establishing the ‘cost to the local authority’, consideration should therefore be given to local market intelligence and costs of local quality provision. This ensures that the personal budget reflects local market conditions and that appropriate care that meets needs can be obtained for the amount specified in the budget.

Care and support plan costings should be developed based on the most cost effective ways available of meeting needs – which may lead to costs being more or less than the indicative budget. For example, if someone chose to meet their needs with a personal assistant (PA) we would expect a lower personal budget to be sufficient than someone choosing or having to meet those same needs from an agency.

The concept of sufficiency is particularly important where agreeing a personal budget for people intending to take their budget as a direct payment. We should support, not limit, people’s creativity in planning to meet their needs with a direct payment. We should also recognise that direct payments enable people the flexibility to choose more expensive provision and top up their personal budgets. In agreeing a sufficient personal budget it may be helpful to base conversations with customers around what the council would expect to have to pay to meet the eligible needs, should the person wish us to arrange the care on their behalf.

Where we can demonstrate that we can meet needs and outcomes with a sufficient amount that should become the amount of a personal budget, and people may top up their budget where they want to make more expensive choices. Where it is assessed that services we may expect to provide would not meet the outcomes, and a more expensive service option needs to be considered, then it may be appropriate to agree a higher personal budget.

Practitioners should refer to Chapter 11, Care and Support Statutory Guidance.

3. Direct Payments used to buy Care through Agencies

Where people intend to use a direct payment to buy care and support through an agency, the personal budget amount will be determined by applying the unit cost of care and support through our prime providers to the equivalent amount of care. In most cases this should give a sufficient personal budget to ensure needs can be met. Where people wish to choose more costly options they can do this by topping up their personal budget.

In exceptional circumstances, where this personal budget is not going to be sufficient to enable needs to be met, a Risk Enablement Group (REG) request should be made outlining the circumstances and risks, and the REG will determine whether a higher personal budget should be agreed, pending a review to ensure needs are met.

4. Care and Support Plan Costings

A Care and Support Plan is not complete without the inclusion in the customer record of the projected costs of supporting the person for the coming year. The Adult Non-Residential Contributions Policy is used in financially assessing elements of a personal budget intended to provide community services, rather than the flat rate which is used to financially assess elements intended for residential or respite support. It is important that the information is entered correctly into the purchasing services part of the plan.

5. Risk Enablement Group

Risk Enablement Group (REG) is the process for reviewing proposed support plans where either the risks or nature of the plan require additional consideration, or more frequently, where the proposed costs of meeting someone’s assessed eligible needs are greater than the indicative budget generated when the person was assessed.

Practitioners should present cases to the REG using the REG form in the customer record.

The levels of budgetary sign-off can be found in the Adult Care and Community Wellbeing Scheme of Authorisation.

6. Advising Customers of their Personal Budget

The customer must receive a copy of the Care and Support Plan stating the agreed and appropriately authorised personal budget along with a copy of their Assessment and Personal Budget Letter.

7. Care and Support Plan Sign Off

Care and Support Plan sign off is how Adult Care agrees that the person’s budget and how they propose to spend it are acceptable in accordance with the following seven criteria:

  1. the plan is person centred;
  2. the plan has clear outcomes;
  3. the planned support is fully described;
  4. the plan shows how the person will stay healthy and safe, including contingency considerations;
  5. the plan shows how the person will stay in control of their life;
  6. the plan shows how support will be managed;
  7. the plan should show the cost of the support.

The procedure for signing off Care and Support Plans and authorising personal budget expenditure is managed within the customer recording system. Any copies of Care and Support Plan documents or media produced by the customer should be scanned or indexed to the customer record and referenced in the Care and Support Plan.

8. Case Examples

Case study: Using discretionary powers to meet needs

Mrs Pascal, who is frail and elderly, was admitted to hospital after a fall. The hospital has established that Mrs Pascal currently has no care and support plan in place and made contact with the local authority to arrange a needs assessment. The local authority assesses that she has eligible needs which will be best met in a care home setting.

The local authority undertakes a financial assessment which finds that Mrs Pascal’s finances are above the limit for financial support from the local authority. The authority provides her with information and advice about her options. Mrs Pascal expresses extreme nervousness about seeking a placement on her own as she has struggled with managing her personal finances in recent times and does not have any family who are able to support her.

After a consultation, both Mrs Pascal and her local authority agree that support with arranging and managing a care placement would be beneficial for her wellbeing and would adequately meet her eligible needs. The authority arranges for Mrs Pascal to meet a trusted brokerage organisation which discusses her needs and arranges a contract with a care home on behalf of Mrs Pascal that she is very happy with.

Case Study: Miss S, who has fluctuating needs

Miss S has Multiple Sclerosis and requires a frame or wheelchair for mobility. Miss S suffers badly with fatigue, but for the majority of the time she feels able to cope with daily life with a small amount of care and support. However, during relapses she has been unable to sit up, walk or transfer, has lost the use of an arm, or lost her vision completely. This can last for a few weeks, and happens 2 or 3 times a year; requiring 24 hour support for all daily activities. In the past, Miss S was hospitalised during relapses as she was unable to cope at home. However, for the past 3 years, she has received a care and support package that includes direct payments which allows her to save up one month’s worth of 24 hour care for when she needs it, and this is detailed in the care and support plan.

Miss S can now instantly access the extra support she needs without reassessment and has reassurance that she will be able to put plans in place to cope with any fluctuating needs. She has not been hospitalised since.