From NAS.

While the NAS supports the principles behind the push for individual/personal budgets, we have a number of key concerns about how individual/personal budgets can be made to work for people with autism, namely:

1) There is a lack of data showing that individual/personal budgets improve outcomes for people with autism
2) Will Resource Allocation Systems sufficiently take into account the needs of people with autism?
3) What support brokerage will be put in place?
4) How will risk be managed, under the new system?
5) Who will be responsible for ensuring that services are available to buy?

1. Individual/personal budgets are untested for people with autism
• Despite promises from DH that the evaluation of the individual budgets pilot would be sufficiently detailed to pick up specific conditions such as autism, the final evaluation failed to do this. Moreover, the evaluation report reveals that in a number of pilot sites, those with particularly complex needs were not, at the initial stages at least, selected for inclusion in the pilot, because they were too complex . There is therefore a real need for the Department of Health to meet its commitment and commission additional research to examine how individual budgets can work for people with complex needs. The evaluation itself recommends further research into the relative merits of IBs for different groups of service users .

2. Resource Allocation Systems
• The way that an individual/personal budget is allocated is absolutely fundamental to its success. There is little point in people being given control of an inadequate budget - this does not give a person the power to shape services to meet their needs. Local authorities must ensure that individual/personal budgets are used to give choice and control to people and not to cut the costs of support. Yet much of the literature on IBs reports that their introduction can result in significant cost savings and further research reveals that the overall losers are people with "higher and more complex needs" . This is concerning and we want to make sure that any system for allocating resources can fully take into account the needs of each individual.
• Along with other organisations we have therefore developed an audit tool for local authorities on developing resource allocation systems.
• The CSCI review of eligibility criteria calls for the development of a national RAS. This would help put an end to the inequities created by the ordinary residence rule and increase transparency.
• However, any debate on a national RAS should, as laid out in the IB evaluation report, consider the outcomes approach developed by Coventry as part of the pilot .

3. Support brokerage
• For some people support brokers will be an essential support in a new system, where individual/personal budgets are the norm. If people are expected to pay for brokerage from their individual budget, additional funds will need to be provided for in the original allocation to pay for this, so that the most vulnerable, who are more likely to need a broker, are not penalised for their vulnerability.

4. Risk
• We have concerns about the way that services bought by individual/personal budgets are to be inspected.
• Vulnerable individuals could be open to abuse if adequate safeguards are not put in place to ensure that personal assistants are properly trained and that the services they provide are properly assessed.
• There is also some risk of abuse from carers and families who are helping the individual to manage their individual budget. Adult protection lead officers within local authorities, who were interviewed as part of the Evaluation of the Individual Budgets Pilot had "anecdotal evidence of users of direct payments and possibly IBs being subject to financial abuse from family members or paid carers" . However, safeguarding must not be used as a reason to prevent some service users from accessing self-directed support.

5. Market place development
• The social care market is distorted through supply side imbalances for people with complex needs .
• Effective and person centred packages of support can only be developed, where appropriate services are available to buy. Local authorities therefore need to look at developing ‘personalised procurement' to ensure that as personal/individual budgets are rolled out risk is not automatically transferred from the state to the individual .

Case Study: A caller to the NAS helpline explained that she had spent hours on the phone and internet trying to find appropriate provision for her son with his Direct Payment. The service that she did find was 8 hours away and cost more than the allocated budget. The quality of domiciliary care agencies that she had investigated was "dire to dreadful", she said. She felt that there was big money to be made from "the autism market", yet none of the profits made were being spent on training. Representatives from provider companies that she had met tended to be accountants rather than professional carers able to judge her son's needs. "Sometimes, I feel I have asked a double glazing salesman if I need new windows..." she commented.

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