Accessibility statement

Personalisation in health and social care

Personal budgets for social care have been generally welcomed by users of services because they offer more opportunity for choice and control over their support arrangements compared to conventional methods of service provision. Our research primarily shaped and contributed to the implementation of personal budgets policy at local and national levels in England. In 2012-13 1.3 million people received these services, the official target is for 70% of these people to have a personal budget.


REF case study individual budgets, caroline glendinning research impact

Summary of major impacts on policy by social policy and social work research 

Our research:

  • helped shape the agenda for national and local organisations striving to successfully implement personal budgets, particularly for older people.
  • influenced the content of the Department of Health’s (DH) good practice guidance for personal budgets
  • affected the DH’s approach to piloting and evaluating NHS Personal Health Budgets, taking personalisation of services into the health arena from social care.
  • influenced the Department for Work and Pensions (DWP) piloting and evaluation of ‘Right to Control’ trailblazer projects
  • affected the agenda for an Audit Commission investigation into financial management of personal budgets.

How the system changed

Instead of being offered a limited choice of existing services run by the authorities, people with health and social care needs can now be given an amount of money to buy the services that suit them best as individuals. Our innovative research tested whether this was cost effective for services, as well as the best way to handle the large organisational changes required to implement personal budgets. We also looked at different categories of social care users and carers. We tested whether PBs worked for each of them and provided guidance on the issues and differences between them. This information was then used by services to ensure that everyone benefitted from the best route into services for them.

The research

The research

The IBSEN study was the first robust UK evaluation of the implementation of personalised approaches to social care and the impact on users, support processes, workforce, commissioning and providers. The study generated extensive data on the challenges for central and local government and the social care workforce in implementing Individual Budgets (IBs - the original name for what is now known as personal budgets - PBs).

IBSEN included a Randomised Control Trial (RCT) - rare in English social care research - that compared outcomes for (IB) users against conventional methods of allocating and using social care and other resources. This was complemented by the more detailed qualitative investigation of the processes and perspectives of this wide range of users and stakeholders. The study included:

  • almost 1000 in-depth interviews with IB users
  • interviews with front line staff and senior managers
  • analyses of practitioners’ time use
  • used well-respected and internationally recognised instruments for measuring social care outcomes.
  • met regularly with DH research customers and a reference group of representatives from other government departments with interest in the pilots
  • had close links with the implementation team supporting the pilot projects and attended meetings with the pilot sites throughout the project.

Read more about the National Evaluation of the Individual Budgets Pilot Projects here.

SPRU researched the effect of PBs on older people and those with mental health problems as these two groups were shown to have more difficulties with the system than other users.

Read more about the Personal Budgets: learning from experiences of older people and people with mental health problems here.

SPRU also designed and led a linked study of the impact of IBs on carers. Receipt of IBs was significantly associated with positive impacts on carers’ reported quality of life and also, when other factors were taken into account, with carers’ social care outcomes.

Read more about the Individual Budgets: impact and outcomes for carers project here.

Impact on policy decisions

The Individual Budget approach was made Government policy and rolled out in England and Wales as ‘personal budgets’ (PB).

The detailed IBSEN findings and the linked carers study primarily shaped and contributed to the future implementation of the PB policy at local and national levels in England. The findings revealed which systems were most effective for implementing IBs and what to look out for as problems with changes in funding streams.

  • DH published a detailed 37 page report specifically addressing IBSEN’s findings with the Appendix including details of the actions taken by DH in response to 26 elements of the recommendations from IBSEN.
  • IBSEN findings on the poorer experiences of older people were particularly problematic. The Social Care Institute for Excellence (SCIE), on behalf of DH, commissioned further research from SPRU to identify good practice in delivering PBs to older people and people with mental health problems; this further study is also widely cited in policy and practice guidance. IBSEN also prompted the English Association of Directors of Adult Social Services (ADASS) to commission a further review of evidence and practice in delivering PBs for older people.
  • The IBSEN research was used to inform guidance on how best to implement IBs in relation to improving outcomes for carers.
  • IBSEN shaped the DH approach to the design, piloting and evaluation of NHS personal health budgets (PHBs) between 2009-12. SPRU played a key role in the evaluation of PHBs.
  • IBSEN evidence on the pilot projects’ difficulties in integrating funding streams shaped the design of the Department for Work and Pension’s (DWP) Right to Control ’trailblazer’ pilot projects introduced by the Welfare Reform Act 2009. Before commissioning its evaluation of the ‘trailblazers’ DWP commissioned a feasibility study to learn from the experiences of the IBSEN evaluation.
  • Professor Glendinning contributed to policy debates by using examples from IBSEN in oral evidence to the House of Commons Health Committee’s 2010 investigation into social care.
  • The new Coalition Government’s Vision for Adult Social Care Green Paper cited both the main IBSEN evaluation and the linked carers study in support of its proposals to ‘make personal budgets the norm for everyone who receives ongoing care and support’.
  • The Audit Commission report on PBs 9 cited evidence from IBSEN on the costs of IBs to justify the expectation that personal budgets should be cost-neutral.

There has also been considerable international interest from countries and regions interested in adopting the IB approach.

  • A review of the published literature on self-directed support for the Scottish Government, commissioned to aid policy decisions in this area, drew attention to IBSEN as a core report in this policy area in England. It recommended the principles underpinning IBs, as set out in the ‘influential and detailed’ IBSEN evaluation. 
  • The South Australia State Minister for Disability and the Head of the Disability Service visited SPRU in 2011 to learn about the UK’s experiences of implementing personal budgets and to discuss our recommendations. Australia was starting to look at its disability provision in order to reform it and bring it up to date. In 2013 Australia launched a new disability insurance scheme Disability Care Australia, with an emphasis on independence and control for the service user and including personal budgets to spend on care. South Australia is one of the launch sites for this policy and fed into the debates about its creation. There has been subsequent research collaboration between researchers in SPRU and Australia to compare aspects of personal budgets in each country.
  • International presentations of the findings included policy makers and academics from Canberra, Budapest, Dublin and Seoul.

Full case study

This impact case study received the highest grade in the recent Research Excellence Framework assessment exercise.

The full case study submitted to the REF 2014 panel is available here. REF-case-study-individual-budgets (PDF , 172kb)

Recent research

Risk, safeguarding and personal budgets: exploring relationships and identifying good practice

How to keep people safe while also enabling them to choose their own care from friends and relatives, or in an unregulated care market.

Find out more