Anne Rabbitte (Galway East, Fianna Fail)
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The remit of the Task Force on Personalised Budgets[1] was to make recommendations on a cost-neutral approach on a personalised budget model that will provide individuals with disabilities more control and choice in accessing health funded personal social services. Different approaches to the provision of personalised budgets are currently being piloted, and any decision to extend personalised budgets to a greater number of individuals, and the form that would take, will depend on the outcomes from the pilot project underway across all CHO areas and its evaluation.

A purely cost-neutral approach would not involve additional expenditure in terms of the actual Personalised Budgets themselves. It is estimated that around 37,000 people receive either a residential or a day service, Personal Assistance or Home Support, at a cost of around €1.95bn. Providing 540 Personalised Budgets could involve the conversion of approximately 1.5% of that element of the Disability Services to Personalised Budgets, or a redeployment of around €30m of those funds. In a cost-neutral scenario, the ongoing costs of operating a Personalised Budget for the individual, such as dealing with matters like hiring, rosters, payroll administration, insurance, tax, and HR, would come from the individuals Personalised Budget.

However realistically any widescale deployment of Personalised Budgets would entail some overhead costs to the HSE in terms of staff to support applicants through the application process, use of a standardised Assessment Tool to assess the support needs of the individual, and transition and set-up costs to develop new systems. International experience, and Irish experience to date, suggests that many applicants may not proceed to a Personalised Budget, if they consider that the benefits of a personalised budget arrangement may be outweighed by factors like the ongoing administration involved for themselves in organising such arrangements. To reach 540 Personal Budgets in operation would involve processing significantly greater numbers of requests as a number of people may decide to opt out at various stages along the path.

Internationally, research across a number of jurisdictions suggests the uptake on Personalised Budgets is approximately 8%.

Pending the conclusion and evaluation of the existing Personalised Budgets pilot programme, it is not possible to say with any accuracy what the overhead costs of a more widespread provision of this option would be. However, it is likely to involve a national programme office, plus dedicated staffing in each CHO area to support applicants through the application and transition process and carry out needs assessments; licensing for a national standard assessment tool and software, and training in the use of same; support around unbundling of current funding; and communication support including a website, Easy to Read materials and ISL interpretation. Preliminary estimates suggest that such overhead costs could be of the order of €1.5m for a minimum national and local support service for supports to the applications process and making transitions to personal budgets, however the higher the volume of applications to reach a target 540 users, the higher those overheads would become.

[1] Towards Personalised Budgets for People with a Disability in Ireland – Report of the Taskforce on Personalised Budgets (2018)