The chief executive of the General Social Care Council, Lynne Berry, is on record as stating: “The world is moving towards regulating people who work for direct payments users, to protect them from abuse.” But is this a world favoured by those who use services?
I will try to explain why those employed through a direct payment must have a choice to register, not an obligation. I will also explain why people who use personal assistants (PAs) want to retain the freedom to employ someone who is not registered.
Initially, in “consultations” in 2000 they made it known that they favoured choice, not compulsion. Not all those in social care agreed, hence their need to “consult” again. Generally, the motives for imposing registration are well-meaning. Those who favour this approach genuinely fear for our safety and believe registration for all personal care providers to be the answer. However, many people who use services feel that compelling personal assistants to register runs counter to the purpose of direct payments, individual budgets, and the government white paper Our Health, Our Care, Our Say which is to give us choice and control.
Currently, service users can engage people who are not registerable. We are aware of the risk and believe it has to be weighed against the drawbacks of compulsory registration – increased bureaucracy, additional expense and loss of control in our lives. For example, I have employed two individuals with criminal convictions of a kind that would prevent them registering and so make it impossible for me to employ them. Not only were they extremely good PAs, but I could give them employment at a time when their job prospects were gloomy. We assisted each other, overcoming the social barriers that stood in our way. It was my calculated risk that took us both on this successful journey.
Many direct payments users will tell you that people who have no formal care training often make the best PAs. This is because they bring no preconceived ideas about how people should be cared for. Instead, they respond to the training from their employer, the person receiving direct payments. The notion of untrained personal care-givers is anathema to the home-care traditionalists who have always been lukewarm about direct payments and red hot on registration.
Recruiting PAs is not easy, given the poor rates that direct payment users are obliged to pay. Registration will exacerbate the task by reducing the pool to only those willing to register. PA users often need to recruit at short notice, allowing no time to go through registration. We need the widest choice of applicants, not to have it limited by bureaucratic constraints.
This mistrust of our expertise and capability is not new. It explains the low take-up of direct payments. Too many social care professionals and local authority politicians still cannot bear the principle, let alone the practice, of transferring employment functions to service users. To them it is only a matter of time before we embezzle the funds, employ abusers or just make a mess of it. The fact that most of us manage well only bemuses or antagonises the ever-growing risk-averse culture which appears to be dominating local authorities, service providers and the media.
It is plain that obligatory registration is no way to protect users from abuse. In fact it could have the opposite effect; by lulling users into a false sense of security, thinking that we can forget our own checks and balances because the person has been “vetted”. We are adults, in most cases, able to make our own decisions with information.
The support we find most effective comes from other direct payment users, from family and friends, from support workers. This is where we need to direct resources as we develop a well-balanced registration process.
Dame Jane Campbell is an independent health and social care adviser and a former head of the Social Care Institute for Excellence