During 2021, the Nordic Welfare Centre and the Finnish Institute for Health and Welfare (THL) conducted a joint project on personal budgeting as a model for personalised support. The project was funded by THL and conducted as part of the Finnish Government’s pilot project on personal budgeting for persons with disabilities. The project has studied how models for personalised support, such as personal budgeting, can contribute to the implementation of the United Nations Convention on the Rights of Persons with Disabilities, in particular Article 19 on the right to live independently and be included in the community. Article 19 applies to all persons with disabilities, irrespective of the extent of their disability and need for support. In General Comment No.5 (2017) on Article 19, the Committee on the Rights of Persons with Disabilities highlights the importance of the individual having control over the support provided.
The project has surveyed available models in the Nordic countries and experiences of their implementation. This survey was conducted through questionnaires and workshops with researchers and experts, as well as through desk research. The survey will form the basis for a proposal to reform support and services for people with disabilities in Finland.
Personal budgeting is used by healthcare and social services in a number of countries. It is, however, a broad concept with no uniform definition. The ongoing Finnish project has defined personal budgeting as a method for organising assistance, support and interventions so that the individual is at the centre of the planning, choice and implementing of support.
The increasing personalisation of support for people with disabilities has been characteristic of developments over the past 30 years, the primary example being personal assistance. Various forms of free choice have also been tested and incorporated into healthcare and social services in the Nordic region, in the form of systems of choice and increased opportunities for users to choose service providers. This development has been driven by both demands from the disability movement and the influence of new public-sector governance models, primarily through the impact of New Public Management from the 1990s onwards. Inspired by the private sector, these methods are based on quasi-market solutions implemented in the welfare sector.
In the Nordic region, the prime example of support and service based on personal budgeting is personal assistance. Today, all Nordic countries have some form of personal assistance that offers the individual user significant influence over how their assistance is designed. There are, however, national differences in the scope of assistance and who is entitled to support. There are also differences in the leeway to choose private service providers and thus what percentage of the overall assistance is implemented by the private sector.
Another area in which personal budgeting has been implemented is disability aids; One example is that experienced users are offered greater opportunities to choose aids than those with less experience. Another solution is to offer the user a cheque to purchase aids, allowing them to pay the difference should they choose a more expensive aid than would be covered by public funds.
In other areas of social services, such as assisted living, several countries have introduced systems that allow users to choose their service provider. There are also examples from other social areas of projects in which socially disadvantaged individuals have been offered the opportunity to design their own rehabilitation from a personal budget, based on their own goals and wishes.
Adapting the design of support to the individual can be achieved in several ways that do not involve personal budgeting or specific fixed amounts. One common method is to prepare an individual plan to coordinate the support and services the user needs. This is useful if, for example, the individual receives support and services from several units or providers, as it reduces the risk of the support being fragmented.
As the opportunity to make individual choices increases, so too does the need for advice and support. This is particularly important for those whose ability to make decisions is impaired. Advice is available from both the public sector and civil society.
To a large extent, solutions based on personal budgets are inspired by solutions developed in English-speaking countries where public welfare as a rule does not have the same tradition or structure as in the Nordic Countries. It is not uncomplicated to introduce solutions from other systems or traditions. There is also no consensus between organisations representing people with disabilities on whether a system where a person with disabilities becomes a customer or consumer is an advantage for the individual.
The Nordic welfare model faces many and varied challenges in implementing Article 19 of the Convention on the Rights of Persons with Disabilities, one being the fact that a large part of the responsibility for providing support and services to people with disabilities rests with local authorities. In comparison to many other European countries, the organisation of Nordic society is more decentralised and fragmented. When the economy contracts, there is a risk that social and health inequities will increase as municipalities each make their own interpretations of national regulations. Generally speaking, the experts that the project has come into contact with are agreed that most Nordic countries have the necessary legislation in place for support and services to people with disabilities. The challenge lies in implementing the objectives of and rights conferred by that legislation and in living up to undertakings given when ratifying the Convention on the Rights of Persons with Disabilities.