Adult social care Personal Budgets Policy
About personal budgets
Policy statement and legal framework
Wandsworth Council is committed to enabling people with eligible care and support needs, and carers with eligible support needs, to have choice and control over how their assessed needs are met. A personal budget is central to this. It identifies the amount the Council considers sufficient to meet eligible assessed needs and agreed outcomes in the care and support plan.
This policy applies to adults aged 18 and over, carers aged 18 and over, and young people preparing for adulthood where adult social care responsibilities apply. It should be read alongside the Care Act 2014, the Care and Support Statutory Guidance, the Adult Social Care Direct Payments Policy and the Adult Social Care Contributions Policy.
The purpose of this policy is to provide a clear and consistent framework for setting indicative and final personal budgets in Wandsworth. It aims to support lawful, transparent, person-centred and financially responsible decisions, while ensuring that personal budgets are sufficient to meet assessed eligible needs.
Personal budgets must be based on the person’s assessed eligible needs, agreed outcomes, individual circumstances, available support options, and the reasonable cost to the Council of meeting those needs.
The provision of intermediate care and reablement are excluded from this policy in line with the Care and Support (Personal Budget: Exclusion of Costs) Regulations 2014.
Eligibility
A personal budget must be provided where the Council is responsible for meeting an adult’s eligible care and support needs, or a carer’s eligible support needs, under the Care Act. The personal budget must be included in the care and support plan, or support plan for carers, and must show the total cost of meeting eligible needs, the amount the person is assessed as needing to contribute, and the amount the Council will pay.
This policy applies whether support is arranged by the Council, taken as a direct payment, managed through a third-party arrangement, or delivered through a mixed package of care.
Where the person is not eligible for Council-funded care and support or is required to pay the full cost of their care, the Council’s duties to provide information and advice, and any duties or powers to arrange care, will be considered under the relevant local policy and legal framework.
Where responsibility for meeting needs depends on ordinary residence, the Council will consider the relevant legal framework and local ordinary residence guidance. For adults with care and support needs, responsibility will usually rest with the local authority where the adult is ordinarily resident. For carers, responsibility will usually rest with the local authority where the adult they care for is ordinarily resident. Any uncertainty or dispute about ordinary residence must not delay action required to assess or meet eligible needs.
What is a personal budget
A personal budget is defined as the sum of money that the Council has confirmed a person should be allocated for the sole purpose of meeting the eligible social care needs as set out in the care and support plan. The personal budget represents the cost to the Council of meeting the person’s eligible assessed needs and agreed outcomes. It gives the person clear information about the funding available and supports meaningful involvement in planning how needs will be met.
The personal budget should be transparent and understandable. It should explain what the budget is intended to achieve, how it will be managed, and any conditions, responsibilities or review arrangements linked to the agreed support.
A personal budget may include ongoing support, short-term support, one-off costs, respite or replacement care, equipment, technology, community-based support, care home costs, or other lawful support where these are necessary, proportionate and agreed as part of the care and support plan.
For carers, the personal budget must reflect the amount the Council considers sufficient to meet eligible support needs identified through the carer’s assessment and support plan.
Some services may be excluded from the personal budget where they are provided free of charge, funded through another statutory route including by the NHS, or are not part of the Council’s duty to meet eligible care and support needs. Where the Council is arranging accommodation as part of after-care under section 117 of the Mental Health Act 1983, relevant choice of accommodation and additional payment requirements may apply.
How personal budgets are determined
Indicative budgets
An indicative budget is an early estimate of the likely cost of meeting eligible needs. It is used to support care and support planning and to help the person and any representative consider realistic options for meeting agreed outcomes.
The indicative budget should normally be identified after assessment, and eligibility decisions have been made. It should be informed by the person’s assessed needs, strengths, risks, informal support, community resources, available support options, local cost assumptions, commissioning and brokerage intelligence, and professional judgement. This supports consistent and transparent planning while ensuring that final decisions remain person-centred and sufficient to meet assessed eligible needs.
The indicative budget is not the final personal budget, a fixed allocation, a spending entitlement or a cap. It may increase or decrease through support planning where evidence shows a different amount is needed to meet eligible needs appropriately.
Where an indicative budget is shared, the person must be given clear information that it is an indicative or estimated figure and that the final personal budget will be confirmed once the care and support plan has been developed, costed, quality assured and authorised.
Determining the final personal budget and contribution
The final personal budget will be based on the amount the Council considers sufficient to meet the person’s assessed eligible needs and agreed outcomes, having regard to the reasonable cost of securing appropriate care and support and value for money.
The Council will start with the assessment, eligible needs and outcomes, not with a preferred service, provider or amount and will consider what the person can do for themselves, what informal support is willing and able to provide, and what community, preventative, reablement, equipment or technology options may help meet needs.
The final budget must reflect the support required to meet eligible needs in a lawful, safe, proportionate and sustainable way. It should take account of the type, frequency, duration, timing and location of support needed, as well as any specialist requirements, risks or contingency arrangements.
Where the final personal budget depends on commissioned provision, placement costs, market availability or specialist support arrangements, the Council will take account of relevant commissioning, brokerage or finance information before the final budget is confirmed.
Where there is more than one suitable way to meet eligible needs, the Council may take account of cost and best value when deciding the amount of the personal budget, provided the proposed arrangement remains sufficient and appropriate to meet assessed needs.
A financial assessment is required to determine how much, if anything, the person must contribute towards the cost of meeting their eligible care and support needs. The final care and support plan and personal budget must show clearly the total cost of meeting eligible needs, the amount the person is assessed as needing to contribute, and the amount the Council will pay.
If the person chooses not to provide the information needed for a financial assessment, or does not engage with the process, the Council may treat them as able to pay the full cost of their care and support until the assessment can be completed.
Failure to pay an assessed contribution may lead to review, debt recovery action, or changes to how the personal budget is managed, including the Council arranging services directly where this is necessary to secure care and support.
Where services are provided as Section 117 aftercare under the Mental Health Act 1983, the personal budget and any direct payment for those aftercare services will be provided without charge. Any contribution arrangements set out elsewhere in this policy do not apply to services funded under Section 117 aftercare.
Sufficiency, best value and choice
The personal budget must always be sufficient to meet the person’s eligible assessed needs and agreed outcomes. In determining sufficiency, the Council may take account of best value, provided the agreed support remains lawful, safe, effective and sustainable. Best value does not mean the cheapest option; it means avoiding unnecessary cost, duplication or over-provision while still meeting eligible needs.
People should be supported to exercise choice and control over how their needs are met. Where there is more than one suitable and sufficient way to meet eligible needs, the Council may determine the personal budget by reference to the reasonable cost of the suitable and sufficient option.
Where a person chooses a higher-cost option for reasons of preference, the Council is not required to pay more than it has assessed as sufficient to meet eligible needs. Further information about top-up payments is set out in section 8.
Managing a personal budget
How personal budgets may be managed
A personal budget can be managed in different ways, depending on the person’s preferences, circumstances and the agreed care and support plan. This may include services arranged by the Council, a direct payment, an individual service fund or other third-party arrangement, or a mixed package. The person will be supported to understand the options available, the responsibilities attached to each option, and the support available to help them make an informed choice.
Where a direct payment is requested or agreed, the Direct Payments Policy and associated guidance will apply. Direct payments must be used in line with the agreed care and support plan, direct payment agreement and monitoring arrangements.
A mixed package may include a combination of a direct payment and services arranged directly by the Council where this is the most appropriate way to meet the person’s eligible needs and agreed outcomes. Any mixed package must be sufficient to meet assessed eligible needs, clearly set out in the care and support plan, avoid duplication or over-provision, and represent value for money. The plan must identify which elements of support will be funded through the direct payment, which will be arranged or commissioned by the Council, the total cost of the package, any assessed contribution, and the responsibilities linked to each arrangement. Where part or all of the personal budget is taken as a direct payment, the Direct Payments Policy applies to that part of the budget.
Where the Council arranges services directly, the personal budget will reflect the reasonable cost to the Council of securing the agreed support, including commissioned services, placements or other agreed provision.
Choice and control and top-up payments
Where a person wants to use a support option that costs more than the amount the Council has assessed as sufficient to meet eligible needs and agreed outcomes, the Council will consider whether the higher cost is necessary to meet eligible needs, manage risk, promote independence or prevent greater cost. Where it is necessary, the additional cost should be reflected in the personal budget and authorised in line with local governance requirements.
Where the higher cost reflects personal preference rather than assessed need, the Council is not required to fund the additional cost if a suitable and sufficient alternative is available. In these circumstances, a top-up or additional payment may be considered where the law and local policy allow this.
Where the Council arranges accommodation to meet eligible needs, the person must be offered at least one suitable, available and affordable option that is capable of meeting assessed eligible needs within the personal budget. A top-up or additional payment must not be used to remedy a failure to identify such an option. The person may choose alternative accommodation where it is suitable, available, able to meet assessed needs, the provider accepts the Council’s terms, and any additional cost is lawfully met through a top-up or additional payment.
A top-up or additional payment must be confirmed through a written agreement before the higher-cost arrangement is made. The agreement must set out the amount, payment arrangements, review arrangements, consequences of non-payment, and what will happen if provider costs or the payer’s financial circumstances change.
If the cost of the higher-cost option increases, the Council will consider the increase in line with the written agreement and the person’s assessed eligible needs. An increase in cost will not automatically increase the Council-funded personal budget unless the higher cost is necessary to meet eligible needs.
Authorisation and quality assurance
Ongoing funding will not normally be released until the care and support plan and final personal budget have been authorised, except where urgent interim arrangements are needed to manage immediate risk.
The Council must be satisfied that the final personal budget is evidence-based, sufficient, proportionate, lawful and clearly linked to the assessment and care and support plan.
The Council must record the rationale for the final personal budget, including any significant difference from the indicative budget, the options considered, relevant risks, the financial assessment outcome where available, and how the budget will be managed.
The person must be given clear information about how the personal budget has been calculated and what to do if they disagree with the amount or the way it will be managed.
Budget reviews, complaints and policy review
Reviewing personal budgets
The Council has a duty under the Care Act to keep care and support plans under review. Reviews will consider whether the personal budget remains sufficient, proportionate and appropriate to meet eligible needs and agreed outcomes.
A personal budget may be reviewed where needs, risks, circumstances, informal support, provider costs, availability of services, financial circumstances or agreed outcomes change.
Where a review identifies that the current personal budget is no longer sufficient to meet eligible needs, the Council will consider what adjustment is required. Where the budget is higher than required, the Council may reduce future funding where there is clear evidence that needs, risks, outcomes, use of support, informal support or care arrangements have changed, or that the current budget is no longer required to meet eligible needs. Any reduction will be clearly explained and supported by a revised care and support plan.
Complaints and disputes
If a person disagrees with a decision about their personal budget, including a decision made during assessment, support planning, financial assessment, or how the budget will be managed they may use the Adult Social Care appeals process. Where possible, concerns should be resolved early through discussion and review of the decision. If the matter is not resolved, a formal appeal may be made in line with the Adult Social Care appeals process. Appeals should normally be made within 15 working days of the decision and may be submitted online or by email:
Where a person remains dissatisfied after an appeal decision, the Council will explain the next available route. This may include the Adult Social Care statutory complaints process, where appropriate, or referral to the Local Government and Social Care Ombudsman. Information will be provided in an accessible format, and independent advocacy will be considered where the person would have substantial difficulty being involved and has no appropriate person to support them.
Policy review
This policy will be reviewed at least every three years, or sooner if there are changes in legislation, statutory guidance, local practice, financial procedures, safeguarding requirements or learning from audits, complaints or operational delivery.
This policy will be supported by operational guidance, including an indicative budget process map, local cost assumptions, worked examples and assurance tools. These materials will be reviewed regularly to ensure they reflect current practice, market conditions and legal requirements.