Social Care - Health Committee Contents

Examination of Witnesses (Question Numbers 760-779)



  Q760  Charlotte Atkins: That is helpful, thank you very much. I will open up with some general questions first, and this is addressed to all you. What do you make of the funding options set out in the Green Paper? Which, if any, do you favour—and why?

  Professor Glendinning: From my experience of being involved in the consultation exercises but also looking at the experiences of other countries, I would say that it is a shame that the taxation-based option has been dismissed. In other countries taxation-based funding for long-term care is common. Scandinavia, Australia and France all use a combination of local and national taxation and user co-payments to fund social care and, indeed, some elements of long-term healthcare as well. I think it is also important to remember that older people are taxpayers as well and that they contribute to the overall tax base. In terms of the other options that are proposed, the partnership model proposes that a proportion of your total needs will be met. My concern about that is that I think it may be very difficult to operationalise with people who have very significant fluctuations in their conditions, or deteriorating conditions, where the amount of money that would be contributed may well change from time to time and, indeed, on a very frequent basis, and I think that conflicts with the kind of commitments and concerns in the Green Paper that people should know what their contributions will be. In the case of fluctuating needs for care, I think that may be very difficult. My concern about the optional and the compulsory insurance schemes, the two options for insurance, are that it risks a two-tier system in which some people can afford contributions but then there are complex arrangements for people who cannot afford to make the premiums that are required. I would just like to point, finally, to the experience of Germany and the assumptions in the Green Paper that we cannot ask for increased contributions from the working age population towards the costs of care. In Germany there is a long-term care insurance scheme. There have been recent increases in contributions to that scheme from the working age population as well as from employers and there has been relatively little controversy over those increases, but I think that is because it is based on an assumption of trust, an implicit assumption that if people make contributions they will receive help when they need it. I think that issue of trust and certainty about future needs being met is absolutely essential in underpinning any requests or expectations for greater contributions.

  Professor Beresford: I was commissioned by the Joseph Rowntree Foundation to carry out a consultation on a national basis with a diverse range of adult service users in different situations using different services late in October this year. The key views of that wide, well networked group were, first, that there were problems since the options were not costed, and we still do not know what the costings are. It was felt that the sums identified were unrealistically low, like the first estimates for a new jet aircraft or aircraft carrier. People felt that none of those three options would offer a reliable, sustainable, inclusive equitable basis for social care for all groups. An underpinning concern of the people we consulted with was that the Green Paper was framed very much, going back to what Caroline has just said, in terms of seeing service users as a burden and dependent rather than recognising that by providing appropriate support they might be able to be better contributors, so there is a real concern. People were almost unanimous in the view (1) that general taxation should definitely have been included as an option, and (2) in thinking that it was the preferred, more viable option for the future funding of social care.

  Mr Waters: I would echo much of what Peter and Caroline have said. I suppose there are two key elements to this. One is the issue that has been touched on in terms of where does any more money come from, but, secondly, how should that money then be administered, and some thought in terms of the fact there does not seem to be great logic to saying that it is unfair to just draw on the working age population for support to meet the social care needs, for the reasons that Caroline has said. But the issue in terms of where the money is administered in terms of the two main areas—either local authorities or the benefits system—if there is movement between those, that needs to be done with some thought in terms of the money that currently is in the benefit system, once it reaches people, is genuinely under their control and is in their hands and they can do with that as they determine. Local authorities, because of the historic pressures and rationing systems, tend to ration through service types. Thus that issue would need to be deal with very clearly if there was a move away from a national benefits system into a more local system.

  Q761  Charlotte Atkins: Could you tell us a bit more about your organisation's ten-step plan for reforming social care funding and how that relates to the Green Paper options?

  Mr Waters: There is a lot of overlap and there is a lot in the Green Paper that, hopefully, draws on some of these ideas. What we have tried to do with the ten-step plan is to identify some of the key issues that face local authorities as they move forward, to inform the debate with some of the progress that has been made and to try and give a practical model to say it is possible to get money into the hands of older and disabled people in a way that defines clearly the conditionality. Why is it that certain people should have a certain level of money and what are the restraints around the use of that money and to focus the restraints, not, as is currently the case, on paying for services, as maybe with direct payment, but in terms of greater clarity in terms of outcome. What is it that is being achieved here? It is a helpful shift to be able to say to people, "Here is a framework of a level of needs. These are your circumstances, the support you can draw from the family, and here are the outcomes that this money is going to help you achieve." That is quite a powerful thing to be able to do, and our ten-step plan really flows from that idea; that it is helpful to give people a clear entitlement to resources based on both their level of disability but also their social circumstances and, then, what you would need to do to make that a reality, and it begins to explore more fully, and with greater ambition than the Green Paper, some of the integration of funding streams that might need to be taken forward. For example, currently the focus of the rationing of use of the Independent Living Fund is around task and activity—I can spend particular money, but only in certain ways—and it kind of undermines the attempt to get control close to people when really the focus needs to be on the outcome here, and the outcome in that instance is that I get to live in my own home.

  Q762  Charlotte Atkins: Caroline, you told us something about the conclusions of your studies into social care funding, but is there a particular system which you think we should copy?

  Professor Glendinning: No. I think it is very difficult to make recommendations about a particular country, a particular approach, because other countries have got their own institutions, their own structures, their own cultures and traditions, but I do think it is possible, from looking at a range of other countries, to draw some general conclusions about the principles that seem to underpin care arrangements and funding arrangements in other countries, and I just want to highlight four of them. The first is the principle of universal access based on levels of need regardless of income or assets. Having said that, that universal access dependent on level of need can be linked with and combined with progressive means-tested co-payments; so you have a principle of universality that people, nevertheless, can and do contribute where they are able to. The second principle is equity. Across Europe, across federal systems, where regional governments and provincial governments have very considerable autonomy, nevertheless there are very clear moves to ensure equity across the country to reduce the geographic variations between provinces, between regions. There are also attempts and pressures to create equity for people with different types of disabilities as well, and particularly equity between, say, older people with cognitive impairments, who often get less than people with physical impairments. The third area of equity is around age groups as well. Many other countries have the same arrangements for a disabled child of the age of five up to an older person of the age of 95. That equity principle is important. The third issue is around cash or services: do we give people cash payments or do we give them help in the form of services? Many countries are experimenting with cash payments, and they have different underpinning rationales, but I think one of the conclusions from the experiences of other countries is that giving people cash on its own does not necessarily stimulate the growth of a provider market. It does not mean that providers respond with a wide range of flexible responsive services. The fourth issue, which is linked to that, is the role of family carers. All countries recognise that carers are absolutely crucial to the long-term sustainability of social care systems, and arrangements and support for carers are often built into the wider social care arrangements. Many countries, nevertheless, offer what we might term a "carer blind" assessment, so that the help that you get is entirely dependent on your needs for help and it does not take account of whether or not there is a carer there, a family member, who can provide some of it. The other thing (and this is where it comes back to the cash payment issue) is that reliance on cash payments, care allowances, as the main form of support can very often trap families and trap carers, because there are no services as an alternative to their labour. I think the cash payment issue and the impact on carers is a very big one that needs to be thought about very carefully. Indeed, in some countries, like Italy and Austria, some families have opted out of providing very heavy amounts of care and are using care allowances to employ "grey" migrant care workers who live in the home of the older person. Cash versus care is an important debate, but my view is that where cash options are available they need to be underpinned by services as well.

  Q763  Charlotte Atkins: Scotland has had free personal care since 2002. What is known about how well that is working? Is it affordable? Has it proved to be affordable?

  Professor Glendinning: It has been politically very popular, and it remains politically very popular. It is not clear that demand for services or demand for personal care has increased; there have been wider policy changes and demographic changes that have affected costs anyway. The research that has been done, particularly from the University of Stirling, has shown very marked variations between local authorities in the level of additional costs that they have had to bear but, also, there are some big weaknesses and shortcomings in the data that is available both at local authority and at national level that would enable the future costs of free personal care to be properly estimated. Indeed, the Scottish Executive has been criticised for introducing the policy without a clear understanding of the long-term costs. There is still a shortfall in the data that is available to help understand the current and longer-term costs.

  Q764  Charlotte Atkins: You were suggesting that some local authorities had greater costs than others. What was that based on: the nature of their populations?

  Professor Glendinning: It is partly based on demography, partly based on the number of people who were previously funding their own care who came into scope for free personal care. Of course, free personal care is offered to people in residential care as well as in their own homes. To the extent that local authorities are able to shift the balance of care into the community and away from residential care, there is the potential to contain some of the costs of free personal care.

  Q765  Mr Scott: Perhaps I will start with John. What are your views on the policy set out in the Queen's Speech about providing free personal care for those with the greatest need? Could you see any unintended consequences of this policy?

  Professor Glendinning: Shall I go first? You go first.

  Q766  Mr Scott: Do not fight over it!

  Professor Beresford: No, no, I think we are of similar minds on many issues here. The real concern that I have personally is if we have ruled out as an option considering general taxation in a Green Paper to which there have been 24,500 responses, a significant number of which have supported the idea of general taxation at least to be included, then it feels like it is policy being made on the hoof to introduce a new idea which contradicts that. We carried out our national consultation after the announcements had been made, both about the Government's proposals and the Opposition's proposals, and I think what people said is really the way I would feel about this. For example, what is "critical"? Who decides and how, and what if your needs fluctuate? I think it is difficult to answer. One of the things that concerns me is when you make an intervention in one part of the system, you can have unintended consequences in other parts of the system. I think if you say we are going to provide free domiciliary care, my question would be: what happens to the rest of the system? I think what people are saying is: does that mean that to offset costs fewer and fewer people will be seen as having appropriate qualifying needs, and would that mean that there will be perverse incentives, for example, for people either not to receive support that could prevent things getting worse or, alternatively, for people to be seen only as candidates for residential care? I think, unfortunately, if you do touch one piece you need to look at the whole, and that is the worry about this proposal.

  Professor Glendinning: I think there are some interesting lessons from Scotland here, because it is very similar to the proposal in Scotland, apart from the fact that in Scotland free personal care is also funded for people in residential care. Scotland has got some interesting new boundary disputes about what is personal care and what is domestic help. 20 years ago we were arguing: is it a health bath or a social care bath? In Scotland there are now debates, for example, around eating and feeding, so you get into situations where helping people to eat is personal care, food preparation in some local authorities is regarded as domestic help and, therefore, is a charged-for service, so you are creating new boundaries in the system. I think, also, that means the potential for some really complex financial assessments and to the extent that non-personal care will still be charged for we will have local authorities trying to assess what proportion of a care package is non-personal care and, therefore, subject to means-tested user charges. I think that kind of division is incompatible with other policy objectives, particularly the policies of personalisation which are based on assumptions about flexibility and user control. You are looking at a package of support that somebody gets and beginning to put up boundaries round, "You can use this for this and that for that", and I think that is incompatible with the broader policy of personalisation.

  Q767  Dr Taylor: This is really addressed specifically to Peter. You have picked out some splendid words that service users want to be cared for by workers with vital human qualities, and you have listed them: warmth, empathy, honesty, respect and competence, which I think is a brilliant summary. You go on to say that too often they are not treated by these sorts of people. Why is that? What can be done about it?

  Professor Beresford: This article in The Guardian was based on a report commissioned by the then Minister for Care, where we spoke to 110 or 112 service users, a very wide range, and over a quarter of them came from black and minority ethnic communities, across people with learning difficulties, older people, people who use mental health services, physically and sensory impaired people, and I think what you will notice, if you read the article, is the concern and support that people register for the workforce as well as their concerns about bad practice, and I think this is a complex issue. We carried out another consultation which was published earlier this year, again relating to the more recent agenda, again talking to about 100 people, and there are remarkably similar findings. The two things that people emphasise when they are trying to get to grips with why it is not working are (1) the issue of funding, which is seen as problematic, and (2) the issue of culture, which is seen as problematic. It is the wrong culture in place still. However, if we are talking about the quality of the workforce, there do seem to be negatives at work. We are expecting of a workforce (and amazingly we often get it) amazing levels of human skill and understanding, a workforce that is treated, in terms of their reliability and quality and rewards for the employment, very meagrely, at the level of check-out staff, as that article said, working in supermarkets. This is a very difficult occupation and it has been reflected, of course, in high rates of turnover, low retention and difficulties in recruitment in the social care work force which are expected to get far worse as the population needing social care support is expected to grow bigger. I think that is part of the problem, but there are other problems too. For example, the way in which commissioning is undertaken, the purchase of services. We know the Government understands that because the whole shift to personalisation expresses a concern to move away from that, but people so often talk about the fallibility and unhelpfulness of domiciliary care—repeated mantras from people that we talk to that you get a troop of people you do not know, one after another, always different, coming into your home who may not treat you with understanding, may not know you, may not treat you with respect, who will undertake very personal intimate tasks with you not necessarily in the best way possible—and we also know, of course, that there are real problems with that workforce. Apart from the poor conditions in terms of income, people may be expected to do a task within 15 minutes, no allowance may be made for the transport time that there is between one person and another, and people may be expected to pay for that time and the cost of travel themselves. We know from some further work that we have undertaken, again commissioned by the Joseph Rowntree Foundation, about person-centred support, a big national project which is reporting next year, that people may not receive training or supervision except in their own free time, and they will not be paid to undertake that, and so there are real essential problems in the work force which, I have to say, it feels to me that policy-makers are reluctant to recognise and face up to.

  Q768  Dr Taylor: Thank you; that is very helpful. Bad commissioning: what should commissioners be doing about the quality of staff that they include and these problems with the staff?

  Professor Beresford: I think there are micro issues and what you might call macro issues in relation to commissioning. You can see, as we have seen in the big project I have just referred to, the standards we expect where locally people make supreme efforts to make the very best of the resources that are available but, if there is only so much money allowable to pay, whether it is domiciliary care or residential care, and that does not match what it actually costs to provide good care and support, if there are cultural problems in terms of the kinds of people you are recruiting—and domiciliary and residential care is not an area which is constructed and envisaged in career terms as a positive role, although many people, nonetheless, carry it out in that way—then we have problems. There are essentially built-in problems at a macro level is what I would argue.

  Q769  Dr Taylor: What can the regulator do? How can the Care Quality Commission going into a home pick up the quality of the workforce, whether they do have the empathy and the warmth that you describe?

  Professor Beresford: I think there is a problem in seeing regulation as an appropriate means of dealing with a problem whose origins may lie elsewhere, may lie in problems of supervision, training and particularly of funding and resources, and, of course, regulation can sometimes be a blunt and crude instrument. I think it is very difficult to expect a regulator, especially a regulator like the new Care Quality Commission, which in a sense is required to have a less hands-on role than was previously the case, to compensate for other more substantial difficulties. If, for example, I say to you, checking out a residential service where one knows that the report from the predecessor of the Care Quality Commission was very positive but that when you speak to a resident there they do not even realise that they are permitted to go into the garden, you realise, of course, that there is a big gap, many a slip `twixt cup and lip, between what it is possible to do by a regulatory system (and that too much is expected as such) and what needs to be achieved in terms of other change. One of the things that service users feel very strongly is that to rely on regulation and registration as a cure-all is not going to work. They recognise that there are problems of a more face-to-face fundamental issue than a regulator should be expected to resolve.

  Q770  Dr Taylor: So low pay, poor training and time for doing tasks are really the vital things?

  Professor Beresford: I think that they are, and I think also that there is a low value placed on such work in our society. I think it is interesting that very recently we have been able to read in The Guardian—and we know this is the case—the way that immigrants are being exploited to undertake such work. It is because it is not a job that, unfortunately, people can see as offering an adequate career for the future, it is an entry job, and I think for that to be true is an appalling indictment of our society; the value it places on the human and personal needs of people who are having difficult times or who are at difficult ages.

  Q771  Dr Taylor: Certainly in my area at home, care workers in residential homes are Filipinos, and they do a splendid job.

  Professor Beresford: Absolutely.

  Dr Taylor: Thank you.

  Q772  Stephen Hesford: Mr Waters, your organisation In Control claims to have conceived and developed the concepts of personal budgets and self-directed support. Can you tell us how you came up with these ideas and what shape they take?

  Mr Waters: I suppose they have evolved over a number of years and they came from a recognition of some of the problems that we have been talking about this morning. The intention really has been to say how is it possible to fairly share resources that are available to local people and to place the decisions about how resources should be spent as close to people as possible, whether that is the person themselves or, if they do not have capacity, their family member or, in some circumstances potentially, a social worker or somebody advocating on the person's behalf. It was the intention to say how do we get control close to people when previous systems had struggled to do that. We have heard Peter talk about some of the difficulties with the way services and the workforce operate at the minute. We worked initially with six local authorities for a couple of years and we said here are some core ideas about what a personal budget might be and some ideas building on the work that then happened around person-centred planning to say, "Is it possible to get control close to people? What are the tensions in there? How do you solve some of the debates around what is good use of public money?" and we have done that by working together with families, people themselves and particularly with local authorities and challenging them really to change their systems within the parameters to which they operate. That work has moved forward over six or seven years now and we have produced a couple of significant reports that have said: this is the emerging model, this is the effect that we think this approach can have in terms of getting control close to people. The key issue, I think, is this idea of partnership—getting control of resources close to people but sharing out resources fairly to people using a transparent framework that allows people to identify their own level of need and what for them is a fair allocation of resources—and to tie into that a clearer idea of what is the outcome here. For example, one of the outcomes might be to maintain family relationships. Quite clearly, the Green Paper says one of the things that services should do is support maintenance of family relationships. We have taken a step back from that idea of services and said overall the system should be doing this and that the financial resources should be under the control of the person and, so long as they are used in a way that can be agreed to achieve those outcomes, then it should be the person who decides and not the commissioner or the local authority who decides.

  Q773  Stephen Hesford: There is a term that we have got from you called "total transformation". Can you tell us a bit more about that?

  Mr Waters: That is just the name that we gave to a piece of work that we took forward. This started off before the Green Paper had set out any of these ideas, before Putting People First had said that personal budgets were a helpful way to organise social care, but we had a lot of interest from local people and from local authorities, who were saying, "We recognise the value in this approach and we recognise that we cannot just operate in small-scale pilots. We cannot make it available to somebody with a learning disability but not to an older person, or somebody in this area and not in this area." So we responded to that and we said, "We will work with you and figure how do you begin to change your whole system" and we called that total transformation. We worked with about 20 local authorities to support them to begin to think through the bigger systemic changes they need to take through.

  Q774  Stephen Hesford: One former government minister, in simple terms, described your organisation as being fantastic.

  Mr Waters: That is very kind.

  Q775  Stephen Hesford: What exactly is your relationship with government and to whom are you accountable?

  Mr Waters: We are a charity, so we are accountable to a board of trustees. Our main funding comes from a subscription from local authorities and we provide a support service to local authorities, figuring out how to meet the demands that are being placed upon them. So we are accountable to a board of trustees but, also, we would not exist if local authorities did not think it was worth supporting our work.

  Q776  Mr Scott: Direct payments have been made since 1996, but the take-up has been very low. Why do you think that is?

  Professor Beresford: I think it would be helpful for us to contextualise the terms "individual budget" and "personal budget" with "direct payments". Direct payments were an idea that came from the disabled people's movement, and what they were crucially about was making it possible for people to have more control over the support that they had and more control over their life, and, sadly, this is still a problem for many service users, many people have not experienced. I can remember one of the first things that my organisation did was a project concerned with measuring outcomes and trying to develop user-defined outcomes. Not just what professionals thought outcomes should be, but service users. When we put that together in a video, we discovered that the only people who could talk about outcomes and for them to have any meaning for them were people who were accessing direct payments. Only they were seeing appreciable change in their lives from the support that they were receiving. There is so much evidence to show how well direct payment can work, but we know that there have been obstacles, in the sense that their take-up has always been different in different parts of the country, different local authorities have been more or less enthusiastic, that many social workers have not had the support to understand them or have been able to implement them well, and, of course, what was the case with direct payments was that few promises were made that this would be a cheaper way of offering support. It was made very clear that this should be, and could be, a better way of offering support. One of the things that we have seen with the more recent discussions, which is why they have gained so much political support, has been claims made that they can be much cheaper, and I think that those claims need to be subjected to far more careful scrutiny. What was said about direct payments was that they could make it possible for people to live a fuller more contributory life, and that was in accordance with values of a philosophy that the disabled people's movement developed called "independent living", not meaning standing on your own two feet, but having the support to be a contributor—to be able to go to work if that is what you wanted, to get an education, to sustain relationships, to be a parent, rather than have someone coming in and getting you up at the time of their choice, putting you to bed at six o'clock, and so on and so forth. I think there were problems in the way the process was implemented, and I think disabled people have often felt that local authorities were not the ideal implementer, and I think many of the gains that we have seen come with individual budgets have been because there has been the opportunity to get back to the true spirit of direct payments, which was: you should know what resources are available and truly have control over them and, of course, have the support to run the system. That is what was seen as the most important: there should be an infrastructure of support—advice, guidance, management, knowledge—from local service user organisations, something which the Prime Minister's Strategy Unit said we need to go ahead and have a network of nationally in this country, but that has not always, unfortunately, been in place. I think we are seeing an extension of continuity and to some extent a rebranding and, I think because there is now more political will there is much more chance of this working.

  Q777  Mr Scott: Caroline and John, would you like to say anything?

  Mr Waters: My thoughts are that I agree entirely with Peter's comments. I think there is a significant issue in terms of direct payments have operated almost as a bolt-on to the main way that local authorities conduct their systems. A social worker supporting one of their clients to take up direct payments would have to be following a completely different set of processes and procedures. They would have to find the time in their work to sit down and develop a good person-centred plan with somebody, and that takes time; it takes energy. It is often what folk want to do and is the right thing to do but they are faced with the choice of saying there is a pre-commissioned, ready-made solution here where I can pick up the phone and I can move on to my next piece of work. So it is partly because it has been a bolt-on.

  Professor Beresford: Could I add to that because I think that is a helpful comment and I would not disagree. I do not think that is a statement actually about good social work. If one looks, for example, at specialist palliative care social work—and there are cases of individual budgets and direct payments in specialist palliative care, where there is a much more informal, thought through partnership approach to assessment—you can see exactly what John has described taking place. I think what the problem has been is that the care management introduced in the 1990s has not sat comfortably with these ideas of self-directed support.

  Mr Waters: The other difficulty, in terms of uptake, was clarity around the level of resources that any one person should have available to them, and that often was decided at the end of an assessment process once a service had been costed and, in order to control and manage and ration local resources, local authorities would place quite clear restrictions on the things that direct payments could and could not be spent on, starting perhaps down to a list of preferred providers, but then, even more tightly, down to certain tasks and activities, because there was a lacking of any sense of how much of a fair allocation should be made available.

  Professor Beresford: Could I pick up on that one because again that is a very valid point. One of the troubles we are seeing now is exactly the same happening with local authorities interpreting personal individual budgets in just the same way. I could point to an inner London borough which has made it clear to people that if they want to spend some of their personal budget on cleaning, it will deduct that amount from their personal budget, and it has only been in the case of some people who have taken that to all forms of complaint and appeal that they have managed to reverse that decision. There has been a cultural problem, which continues, of local authorities' understanding of an open menu, I think, here.

  Professor Glendinning: I would add one point, and it is drawing on evidence from the Netherlands, where there is a similar personal budget scheme in operation. Again, take-up tends to be higher amongst younger disabled people but, nevertheless, older people do use personal budgets. The crucial difference is that the Netherlands allows personal budget holders to employ close family members, including spouses, and I would not want to say that employing close relatives is always easy—it can bring its own problems—but for older people being able to pay a close family member to provide care is sometimes more acceptable than employing a personal assistant in a much more formal employer relationship.

  Mr Scott: I think employing family members is something that Members of Parliament can relate to!

  Q778  Stephen Hesford: Professor Glendinning, can you summarise briefly for us the findings of the individual budget pilot?

  Professor Glendinning: Yes. To some extent this supports the points that have already been made about the difficulties and the challenges of transforming a system. I think all the pilot sites extended the scope of their pilots during the two-year pilot project and, indeed, some of them had decided to introduce individual budgets across the whole of adult social care during the course of the pilot. They found it was very difficult to run the two systems in parallel so the pilot sites were beginning to move towards this kind of total transformation. The outcomes for older people were not as positive as for other groups of people. The outcomes for people with mental health problems were very positive and there was actually some suggestion there that people with mental health problems were opting for personal budgets, or individual budgets, where they had previously refused to use or not been willing to use conventional day care services, day centre services, and so on. There was some evidence of increased demand there and people with mental health problems tended to use their personal budgets, individual budgets, for leisure activities—adult education classes and those kinds of things. Part of the reason, I think, for the less than positive outcomes around older people was that—

  Q779  Stephen Hesford: I think we have got a question on that, so if we can just park (a rather inelegant phrase) older people for a second, we will come back to that.

  Professor Glendinning: Okay. I think one of the important points and one of the important findings of the evaluation that I do want to highlight was the failure to really tackle the issue of integrating funding streams, and this is where individual budgets differ from the personal budgets that are now being implemented by local authorities. Individual budgets were intended to bring together the resources.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2010
Prepared 12 March 2010