Published: 26 June 2016
Individualised budgeting for social care services for people with a disability: International approaches and evidence on financial sustainability
This evidence review addresses two key questions:
1. What models or approaches to individualised or personalised budgeting in response to needs assessment for social care services for people with a disability are used in other jurisdictions?
2. What is the evidence on the financial sustainability of different approaches? Approaches to introducing individualised budgets for social care for people with disabilities have evolved rapidly since 2006 or thereabouts, and this process of change is still ongoing. A new equilibrium has not been reached in any of the jurisdictions examined in this evidence review. There are indications, however, that policy thinking is tending towards the concept of ‘self-direction’, by means of which people are enabled to have choice and control and to be empowered in relation to most if not all aspects of their care and support, including financial management. Three different approaches to legislating for individualised budgets have been discerned – legislative frameworks enabling a brand-new and ideologically driven policy approach, a consolidation of different pieces of relevant legislation (e.g. in the Netherlands), and an incremental approach within broad legislative parameters (e.g. in New Zealand and Canada). With regard to eligibility, four key factors are commonly used across all of the jurisdictions examined to determine eligibility for individualised budgets. Those factors are age, the nature of the disability, the severity of the disability, and its likely trajectory and long-term effects. Because the implementation of personal budgets is still very much a ‘work in progress’, there are almost no data on which to build an evidence base regarding their financial sustainability or otherwise. In a review of what helps and hinders the move to individualisation, research shows that lack of information and lack of legal clarity can work against successful implementation. Scottish authorities suggested ‘light touch’ regulation in their pilot projects to reduce bureaucracy, but research concludes that such an approach gives rise to risks on a number of levels, including administration burden and cost overruns. The new Australian insurance-based model, which is still being rolled out, explicitly requires that the scheme be financially sustainable. To this end, a sustainability plan was developed at the outset, modelling financial sustainability from 2019 to 2045. Regular quarterly and annual financial sustainability reports, which are a statutory requirement, are intended to help ensure that adjustments can be made in real time and that the sustainability plan is adhered to.