News

We asked:- Are local authorities doing enough to encourage the take up of direct payments?

These are some of the comments we received:-

“The Commission for Social Care Inspection's report 'When I Get Older' published on 1 April clearly indicates that councils should step up their promotion of direct payments.

 Our report was based on MORI survey of public attitudes to social care services that people might receive in older age. We found that 73% of people thought ‘an individual needing social care should be given money by the government/council to choose and buy the services they want.

Yet only 9,600 people were receiving direct payments at the end of March 2003 and take up remains low, despite councils now having to offer them to all who are eligible and want them.”

Denise Platt
Chair of the Commission for Social Care Inspection

 

“I work in a social care team and we have many direct payments users. We are told that legally we must offer them so we do. 

But they are often misused so it may be that it is unequally distributed. Many do not fulfil their responsibility in terms of producing accounts to document how the money is spent which also has an impact.

It is my opinion that younger disabled people have excellent recourse to direct payments but I cannot comment on learning disabilities or mental health.”

Anonymous

 

“My concern is that some local authorities are putting such a narrow interpretation on the rules regarding consent to receiving and managing a direct payment, that they are excluding and discriminating against many people who have the label of severe learning impairment, and are therefore not offering direct payment as a viable option.

My 26-year-old daughter has been given such a label and finds the concept of a direct payment too abstract to understand   She also has no understanding of money nor how to manage it, yet it is clearly evident that she loves and enjoys what it provides. She understands nothing about employing people and the responsibility which goes with it, but again, loves having her own team of personal assistants which enables her to live in her own home and be part of her community.

All these things have been made possible through an Independent Living Trust, whose trustees take on the responsibility of being accountable for the direct payment and other sources of direct funding, as well as being responsible employers of a small team of committed personal assistants.

My daughter's lack of understanding of such abstract issues has not prevented her moving out of the vagaries of impersonal group living, out of the scourge of block funded contracts, and away from the tiers of management in service-providing organisations that had no real understanding of what group life was really like for her or how distressed and unhappy she was. If they did, they did little or nothing to change things without a big challenge from us as family.

We live in Essex and our local authority is possibly further ahead than many authorities in the country regarding direct payments, which is good - though there is always room for improvement!  We have an excellent Personal Assistance Scheme which runs a payroll service and takes care of any the other administrative things involved in employing a small team of PA's. This service is invaluable to us.

We as trustees take on a lot of the responsibility and worry of finding compatible PA's who suit my daughter's personality and needs. But compared to the worry we have felt over the years at her been looked after and abused by staff we had no say about, and some, who frankly I would not have chosen to have left my dog with, all in the name of 'care', it is minor.

Finally and most importantly, it is worth remembering that my daughter did not consent to any of the impersonal, segregated services she has received for most of her life.  We as family did not choose them either, as all we wanted when she was small was intensive, practical, hands-on help coming into our home to assist us. Sadly, that was not meant be, as our local authority services did not extend to that and direct payments were a million miles away. We were also new parents and ignorant of the system. So instead had to take the so called 'special' services on offer or break under the strain because we had no choice, no power and no control in our inflexible, unresponsive service system.

It would be disastrous if direct payments and other sources of direct funding fail, or are not provided, because a strict legal interpretation is placed on the need for consent by the person needing such payment, instead of realising that consent, can be given in other ways.”

Jan Thurlow
Parent/Trustee
Independent Consultant

“I am a direct payments manager for Gateshead Council and have been implementing Gateshead’s strategy to develop and expand direct payments .The council and senior managers have commitment to direct payments as part of promoting independence and as part of modernisation agenda.

We want to offer person-centred services that are rights based, not building-based services that are welfare-led. For the eligible client groups, we are making the "duty to offer and make a direct payment" a normal part of the assessment process.

We have effective and proactive partnership board that enables all stakeholders to be part of the planning and prioritising of direct payments .We have good support services in the voluntary sector and making excellent use of Direct Payments Development Fund by providing potential direct payment users with accessible information .

We are open to learning more about how to offer support for decision making for people with learning difficulties and working hard at making direct payments an option for people with mental health needs.

Gateshead feel that partnership and creative development work is the way forward.”

Liz Bruce Direct Payments Manager
Disabilities
Gateshead Council

“As a care manager working with adult service users with physical and sensory disabilities, mental health problems and older people, I always try and promote the take up of direct payments amongst my clients. However, the path is rarely smooth and can be complicated by bureaucracy all the way.

I regard the Direct Payment support group as advocates for the client and assume that the self assessment that they will have enabled my client to produce will be a true picture of their needs.  Why am I expected to challenge this assessment? Is it because the cost may exceed what is reckoned to be acceptable from a service centred budget and we should not be seen to be creating a two tier system?

If I then return to my client and try to cut costs, I am then focusing on what services we can't deliver, rather then what we can. The result is that I am then seen both by service user and support group as the bad guy, despite the fact I have probably tried to stand my ground and uphold the service user’s assessment. I was even advised recently that the support group were the "Rolls Royce" and local authority the "Mini"!    

Direct Payments are proven to increase independence, aid choice and client satisfaction and be cost effective - a fact that the majority of social workers accept. The reality is that we are often so overwhelmed and weary from fighting so many other battles on a daily basis it can be tempting to encourage the user down the path of conventionally arranged service provision.  Not very empowering I agree, but until resources grow in line with need I feel that take up figures will remain low in relation to eligible users .”

Anonymous

 

“I have found that Newham Council is a good example of a local authority which is being as difficult as possible about offering direct payments.

My friend has been asking for direct payments for years and had experienced nothing but problems. I have asked for help and been turned down or ignored despite the fact that I have multiple disabilities.”

Kevin Fleisch

 

“We were encouraged by social services to accept direct payments to pay for twice daily visits/care for my mother-in-law at home. We naively accepted the task, employing an excellent local woman who two months later needed a prolonged stay in hospital followed by a two-week holiday a month later.

Trying to replace her was a nightmare in a rural area and we ended up employing an agency who charged extortionate prices and did not keep to agreed arrangements. Their excuses ranged from flat tyres to hail-storms to traffic jams.

We wish we had sought independent advice before accepting the responsibility of direct payments as it has been a nightmare. Holiday and sickness cover are something we just had not considered, although one very positive thing is that the Inland Revenue business support team are extremely helpful regarding pay slips, payment of tax.”

Diana Corrick

“While based at Essex social services a few years ago, I attended many training workshops on direct payments. The training, which was undertaken by Katy Murray, was very informative and easy to understand.

I wonder if the reason many local authorities are not using direct payments in any real way is due to care managers/service managers’ lack of knowledge. I for one would welcome the idea of being offered refresher courses and action learning sets in this area.”

Susan Purkiss

“I work for an organisation which supports and informs people about direct payments and we have four full-time staff dedicated to doing this.

The local authority supports direct payments in so far as it saves them money and we have found that it is the service users who are most likely to be seen as 'difficult' when they are told about direct payments.”

 Karen Christie

  

“Nine years ago, I worked as a day services officer in Fareham, Hampshire with adults with learning disabilities. In this capacity someone from the Self-Operated Care Scheme (SOCS) in Hampshire came to explain their work to the staff. 

I was impressed with the direct payment scheme but was shocked by the attitude of my managers and colleagues, almost all of whom felt that it was not appropriate for "our people", despite empowerment and anti-discriminatory practice allegedly driving our work.

I sincerely thought services had by now caught up and embraced the idea of direct payments. However in my current job as a social worker in a children with disabilities team, I have again been gob-smacked by general attitudes.  Many of my colleagues seem threatened by the idea of 'handing over control' directly to families and seem to harbour a great deal of mistrust.  I have even heard management state that "it may work for another county but it wouldn't work here with 'our families' "! 

It will be interesting to see whether such attitudes will change over time, particularly as direct payments are now encouraged by government, and the numbers of families requesting this service in my locality continues to rise.”

Tina Chard

 

“I am currently working for Newcastle social services as a social work student in my second year and from my experience, the authority is doing everything possible for service users to take on direct payments.”

Anonymous

 

“We would like to bring attention to the issue concerning the wide discrepancies in provision of direct payments for disabled people with similar needs. We have witnessed the devastating effect this had on a close friend.

Our friend, June Maelzer, who died in January was assessed in Manchester as needing 24-hours-a-day assistance and received a direct payments of £60,000 per annum.  Prior to the existence of direct payments, June had been funded through a grant she negotiated with Manchester Council to employ her own workers.  Her care plan evolved over the years with Manchester social services, enabling her to find the best way of living independently.

When June decided to relocate to Cornwall a few years ago, she approached the local council for a similar package, but was formally informed that they would pay no more than £200 per week.  For about two years before moving, June argued her case with Cornwall social services.  At the same time, she was lobbying unstintingly at government level making a stand not just for her own right to choose where she lived without sacrificing her standard of living but also to change the situation for other severely disabled people in her situation.

Eventually Cornwall social services undertook an assessment in Manchester of June's needs.  According to June, the first consultation draft (produced a few months later in March 2003) "wants to surround me with hoists, environmental machines and continence devices, assessing my human contact needs as three hours a day.  This will save them money but shows no regard for my needs as a human being and a part of society.  It is institutionalisation in my own home." 

Given that June was physically able to move only her head and one finger the options proposed were entirely unrealistic. Manchester social services offered to continue direct payments for six weeks after June moved, but this was rejected by Cornwall council who eventually agreed to a transitional arrangement to pay for personal assistants for up to eight weeks whilst a new care package was being arranged.

Tremendous stress resulted from all the uncertainty over these protracted negotiations and took its toll on June's mental and physical health.  After moving, June had numerous meetings with social services staff for assessment, manual handling and care planning purposes.  Just as the eight week period was due to expire, with no amended assessment report or proposed care plan in view, June was admitted to hospital.  She had to continue her battle from her hospital bed. 

Eventually on account of June's terminal illness being diagnosed, after much pressure, concessions were made by social services when June came home and she continued to be able to employ full time personal assistants on the same basis as in Manchester.  June never saw this as a satisfactory solution: social services were conceding on the understanding that the Primary Care Trust would be responsible ultimately for all her care needs in the community.  The campaign June had been waging, and she felt must continue, was for everyone to have the same rights, no matter where they live.

Paragraph 56 of Fair Access to Care Service guidance on eligibility criteria for adult social care  (relating to a service user moving from one council area to another) merely recommends that the "receiving" council should take account of the services that were previously received when they do assessments and make decisions.  This is not binding and clearly urgently needs to be made so if  disabled people, who live independently, are to be able to move from one part of the country to another with the same ease as their non- disabled peers."

Margaret Behrman and Margaret Trotter

“One problem has been that the government brought out two schemes and called them the same name, publicising one and leaving local authorities to try to publicise their own. As a result, much confusion has ensued. 

Would the government now do a national campaign for direct payments quickly, highlighting the difference between the two and letting all the general public know that if now, or anytime in the future they find a need for social care - there is a different way to receive it. 

It is perceived that only disabled people need to know of this enabling route to providing care, but wider families, friends, neighbours, communities should have the chance for involvement. 

It is not viewed by the majority that disabled issues are actually strong news stories and worthy of interest by the general public. However, to make a service 'user-led' it needs to be known about in the wider market place. Central government should cross over the boundary of whose responsibility it is to tell the UK about direct payments and put the word out for local authorities. 

Those areas that have possibly been dragging their heals (and bodies) over advertising this scheme would be forced to adequately answer the ensuing enquiries.”

Fern Routledge
Direct Payments Support Worker