National Audit Office Press Releases
Personalised commissioning in adult social care
The Department of Health now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes.
“Giving users more choice and control over their care through personal budgets and direct payments can improve their quality of life, but much of the positive evidence for personalised commissioning of adult care services is old. The Department now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes.”
Amyas Morse, head of the National Audit Office, 3 March 2016
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 improve users’ quality of life. The Department of Health, however, requires a deeper understanding of the best ways to implement personalised commissioning, according to the National Audit Office.
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. Much of the positive evidence for personalising commissioning, however, is old or relates to subgroups of users. The NAO believes there is a strong case for better use of existing surveys and evidence gathering, so the Department and its national partners understand the relationship between the different ways to commission personalised services for users, and improvements in user outcomes. 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 NAO also found that some authorities are struggling to manage and support their local care markets as well as we would expect of a well-functioning public service market.
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. The Department’s monitoring regime does not enable it to fully understand how personal budgets and direct payments improve outcomes. In addition, the Department has not investigated how services can be personalised when money is tight. It is not clear whether local authorities will achieve the spending reductions they have forecast without putting user outcomes at risk.
Latest News from
National Audit Office Press Releases
The adult social care market in England26/03/2021 11:15:00
Short-term funding and the lack of a long-term vision has hampered planning, innovation and investment in adult social care.
Investigation into government funding to charities during the COVID-19 pandemic24/03/2021 12:05:00
This report from the National Audit Office (NAO) finds that as at 19 February 2021, the Department for Digital, Culture, Media and Sport (the Department) had disbursed £454 million of £494 million it made available to support charities during the COVID-19 pandemic. It did so through seven schemes and a network of nearly 200 partners, and intends to award and disburse funding until 31 March 2021.
Public Service Pensions19/03/2021 12:15:00
Today’s report from the National Audit Office (NAO) finds that government’s reforms to public service pensions have helped contain the rise in future costs to the taxpayer. However, the government could do more to consider how pensions can help recruit and retain staff.
Support for children’s education during the early stages of the Covid-19 pandemic18/03/2021 11:15:00
The Department for Education (the Department) took action to support schools and pupils in response to COVID-19, including ensuring that schools remained open for vulnerable children and funding online resources for those learning at home.
Timeliness of local auditor reporting on local government in England, 202016/03/2021 11:25:00
The National Audit Office (NAO) today reports that less than half of local councils, local police and local fire bodies’ 2019-20 audits were completed by the revised deadline of 30 November 2020, despite this having been pushed back to take account of the impact of the COVID-19 pandemic.
Investigation into the Culture Recovery Fund15/03/2021 11:15:00
In July 2020, the Department for Digital, Culture, Media & Sport announced its £1.57 billion Culture Recovery Fund to help the UK’s cultural, arts and heritage institutions survive the pandemic.
Local government finance in the pandemic10/03/2021 11:25:00
Today’s report from the National Audit Office (NAO) finds that while effective action from government has assisted local authorities in surviving financially during the COVID-19 pandemic, many authorities face significant funding gaps and the financial outlook for the sector is concerning.
Reducing carbon emissions from cars01/03/2021 11:15:00
The government has set an ambitious target for almost all cars to emit zero carbon by 2050.
Environmental tax measures15/02/2021 11:15:00
The recent (12 February 2021) report from the National Audit Office (NAO) has found that HM Treasury and HM Revenue & Customs (the exchequer departments) have a limited understanding of how far the tax system supports government’s environmental objectives.