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Personalised Commissioning in Adult Social Care

This report looks at the practical challenges and opportunities associated with implementing personalised commissioning given the current financial environment and the extension of personal budgets into healthcare. It covers only social care that is fully or partly paid for by authorities.

Commissioning adult social care services through personal budgets and direct payments is an important way of giving care users more choice and control over their services. When implemented well they can improve users’ quality of life.

Local authorities spent £6.3 billion on long-term community care in 2014-15. Around 500,000 adults in England received personal budgets in 2014-15, varying between 10% and 100% of users across authorities. The Care Act made personal budgets mandatory for all eligible users from April 2015. The Department is extending personal budgets in healthcare and has an ambition that between 50,000 and 100,000 people will have a personal health budget by 2020

The NAO found that some authorities have transformed their care and support processes to ration their resources fairly, share information about a broad range of local services, and monitor and manage spending on personal budgets efficiently, while others are finding personalising commissioning a challenge as they seek to save money, and are constrained in how they can personalise care by the need to reduce overall spending.

There are circumstances under which personalised commissioning can reduce the costs of care. For example, around 120,000 users with direct payments employ personal assistants to provide personal care, which is generally a cheaper option than homecare. The Care Act guidance, however, acknowledges that responding to users’ needs and their desired outcomes can increase the cost of care. The Department expects the value-for-money of personalised commissioning to come from improved outcomes for users, not necessarily from savings, which differs from local authorities’ expectations that savings can be made by personalising care.