When Personal Budgets were first introduced in the early 2000s, they were designed for small, straightforward social care packages, typically supporting low-complexity needs, with an average value of around £3,000 per year. Fast forward to 2025, and the Health Secretary Wes Streeting is actually saying much the same as his counterpart did two decades ago – that “care should happen as locally as it can … in a patient’s home if possible.”
So yes, health and social care services certainly still recognise the value and necessity of supporting people to live at home. Yet the type, complexity and size of personal budgets has changed so dramatically since the early 2000s, that well-meaning words simply aren’t enough.
Put it this way. It’s no longer unusual to see homecare packages worth hundreds of thousands of pounds a year. And yet commissioners still manage a £300k package in the same way they did a £3k one, by requesting bank statements and timesheets.
This approach is outdated, inefficient, and – crucially – reactive. It provides insight only after the money has been spent. For increasingly complex and high-cost care, this isn’t just unsustainable; it’s unacceptable. As the system stands, commissioners have no real-time visibility into whether the care plan is being followed, whether it’s delivering outcomes, or whether it’s even affordable.
So for all Streeting wants the quantity of home care to increase and to “co-create a personal care plan so your care is done with you, not to you”, without reforming the underlying commissioning and contract management models, these ambitions risk falling at the first hurdle.
And that’s because the crucial money allocated to care packages is currently spent entirely on trust. That is simply unacceptable. We’d go so far as to say commissioners cannot continue to expend public money in this way.
Of course the systems do actually exist to support more visibility. The end-to-end care management software package we have designed and have installed up and down the country – Rostrata – is made for the change Streeting wants to see when he talks about data offering “a golden opportunity to deliver better care at better value.”
But as we’ve begun to roll out Rostrata, we’ve come to realise the culture is still stuck in the 2000s. Commissioners are still focussed on transitions and not the care itself, having little or no idea whether the care plan is working or is affordable.
Back to Streeting one last time. He talked of “funding tied to outcomes”, which is why it’s absolutely critical that commissioners procure, structure and contract their care processes in a way that determines successful delivery of quality, consistent care. Not simply handing over money and hoping it goes to the right place before checking a bank statement a year later.
So much has to change. If we want a sustainable, person-centred care model, we need to ditch the yearly paper-chasing and bank-statement audits. We need real-time data, care-plan accountability, and commissioning practices that reflect the complexity and scale of modern home-based care.
All of which can be achieved with Rostrata. Give us a call today.