Approximately 38,000 Finnish patients are cared for by a family member in their own homes. Most of these patients are over 65. So how could ‘Personal Budgets’ help, and what needs to be done to introduce them?
According to Leading Specialist Tuomo Melin of Sitra’s Service Voucher project, experimental legislation on personal budgets would increase the patients’ and their carers’ decision-making power, autonomy and freedom of choice for obtaining services – all designed to make their everyday life easier.
The concept of personal budgets could also be applied to other customer groups who need to purchase rehabilitation services, who may need glaucoma follow-ups, mammography services or services for the disabled.
The potential for implementing a personal budget system for family care was surveyed during a joint project between Sitra’s Municipal Programme and the City of Tampere. However the project concluded that the personal budget system can only be implemented through changes in legislation. The concept has yet to be defined in current social and health care legislation.
A personal budget – autonomy and freedom of choice
The concept of a personal budget refers to a model in which the customer chooses the service providers and services that he or she wishes to use. A personal budget is granted based on a means test carried out by public social and health officials to determine a requisite care and service plan.
The customer’s needs are converted into a budget – that is, an allotted sum of money that the customer may then use to purchase care or appliances. A personal budget would allow the customers to decide where and when to buy services. The services offered by municipalities, organisations, commercial enterprises or even neighbours could be used.
Customers can influence the content of their own care and services by choosing the services that help them retain their independence and continue as full members of the society throughout the different phases of their lives. “The money for the personal budget is not a new allocation but comes from the same budget that is currently used to pay for the services,” explains Project Manager Mari Patronen from the City of Tampere.
Stronger citizenship through personal budget
Sitra’s Tuomo Melin believes that with almost 40,000 Finnish patients being cared for by family members, the personal budget system could increase the power and autonomy of not just the patients but the carers as well: “A personal budget represents a new way of operating that emphasises the role of the public in service development and as the best experts on their own lives. The public should be encouraged to make their own decisions.
“In England and the Netherlands, the model is considered to help people gain control of their lives through decisions on which care and help to get,” says Melin.
According to Director Eija Koivuranta at the Ministry of Social Affairs and Health, the aim of government is to cement the position of its customers. Therefore more efficient maintenance of abilities needed in everyday life could postpone the need for intense formal care by years.
For example, rehabilitation carried out on the customer’s terms will help him or her return home and to working life faster. In addition to improved quality of life for the patient, a personal budget would have considerable financial significance for the municipalities.
Tuomo Melin says the personal budget should be defined as an independent method of organisation within some form of experimental legislation. In addition, the concept of personal budget should be defined in the Social Welfare Act and the Health Care Act, with the necessary changes added into the Income Tax Act and the act on customer fees.
Any experimental legislation should emphasise the significance of guidance for the implementation of a personal budget. Some customers need more support than others, and only practical experience will tell more about the need for guidance. Mari Patronen from Tampere agrees: “Family carers and patients must not be left alone with their budgets; this may result in inadequate care. International experience has shown that the elderly in particular need initial support to achieve the full benefit of the budget system.”
And Tuomo Melin says care should be taken throughout the whole process:”Experimental legislation should be implemented in small steps, actively listening to the customer along the way. It is important to gather experience of the personal budget system in many municipalities and customer groups; this way, best practices could be identified and implemented.”
The main points of experimental legislation on a personal budget system:
- The personal budget system will not remove the obligation of the municipality to offer care services.
- All citizens and customers have the right to a personal budget regardless of their income.
- The well-being of the customer must not be risked.
- The customer has the right to decline from having a personal budget.
- The customer has no subjective right to a personal budget.
- The concept of a personal budget is understood in a broad sense to enable the purchase of many different services to best meet the customer’s needs.
Mari Patronen, Tuomo Melin, Minna Tuominen-Thuesen, Eeva Juntunen, Sirpa Laaksonen and Wilhelmiina Karikko:
Henkilökohtainen budjetti – asiakaslähtöinen toimintamalli omaishoidossa (Personal budget: a customer-oriented model of operations in family care; Sciribd publication, only available in Finnish).
The book will be published by KL-Kustannus and will come out in April 2012.
Interviews on the municipal information channel, KuntaTV:
- Eeva Päivärinta, Procurement Manager, City of Tampere
- Mari Patronen, Project Manager, City of Tampere
- Tuomo Melin, Leading Specialist, Municipal Programme, Sitra
- Eija Koivuranta, Director, Ministry of Social Affairs and Health
- Sami Uotinen, Head of Legal Affairs, Association of Finnish Local and Regional Authorities
Project Manager Mari Patronen, City of Tampere, tel. +358 40 801 6008
Leading Specialist Tuomo Melin, Service Voucher project, Sitra, tel. +358 40 183 4158