Opening Doors

A scheme being trialled in Nottinghamshire is extending the ethos of direct payments by allowing some service users to do their own assessments of their needs. Simon Creasey reports

E arlier this year, care services minister Ivan Lewis launched 11 pilot schemes to allow people with long-term conditions to undertake self-assessment of their own needs. The pilots were hailed as the ultimate do-it-yourself package but how will the pilots work in practice and what impact will handing over one of the core functions of modern social services department have?

One local authority taking part in the pilot, Nottinghamshire Council, received £60,000 from the funding pot and has three occupational therapists pulling the project together, which is being led by Pete McGavin from its social services department. The focus is on the distribution of cheap, easy to use equipment that can help the county’s service users, such as tap turners and gadgets that allow people to open doors more easily.

“We are primarily looking at straightforward items that can be identified over the phone and be delivered and fitted without much expert intervention,” explains McGavin. As part of the self-assessment service, clients can either complete what McGavin describes as “simple” forms over the internet or the phone. A decision is then made as to the user’s suitability for the item they have requested although McGavin says that the council will not be applying rigid eligibility criteria.

He explains self-assessment is difficult to do “if eligibility criteria are being used by a local authority to ration resources”.

The pilot scheme is being rolled out in a rural and semi-urban area. A proportion of the DoH grant is being used to employ specialist service advisers, some will pay for additional expert advice from occupational therapists and the rest will go towards meeting the anticipated rise in demand for new equipment.

But what do service user support groups feel about the scheme? David Pink, chief executive of the charity Long-term Medical Conditions Alliance, believes it could bring several advantages, such as the ability to reach people who would not have engaged with assessment services before. But he does have some reservations. “With self-assessment there could be a risk that people do not realise what services they should be asking for, because the assessment system is less interactive than an assessment by a practitioner.

“For people whose needs are not complex, we think that selfassessment pilots could be useful, but pilots should be accompanied by high-quality evaluation if they are to be useful to other services across the country,” he adds.

McGavin is quick to allay these fears and speaks of a need to strike a balance that ensures symptoms of a more serious problem are not missed as a result of self-assessment. “If someone has a problem turning a tap and requests a tap turner then we have to find out if the real reason they’re struggling is that they’re developing multiple sclerosis. We have to ask the right trigger questions so that if their problem is more complex we don’t just offer them a simple item but we also get them assessed by an occupational therapist.”

McGavin is also aware that self-assessment could leave the system open to abuse, which is one of the reasons that for the pilot scheme at least, only the inexpensive aids can be accessed. “We’re happy with the idea for some items to be distributed in this manner but if it was for more expensive items then the local taxpayer might start asking questions,” he says.

SELF-ASSESSMENT PILOTS

● Service users can assess their personal support needs from a range of services, such as equipment that might help them live independent lives, and can apply directly to their local authority for these services.
● Funding of £850,000 is split between 11 participating councils. The schemes started in October and will run until September 2007 when an independent evaluation will determine whether or not self-assessment is feasible.