Special report on direct payments and individualised budgets

Working often seems difficult but being an employer is also
fraught with complications. Tax returns, payroll systems and
employment law are a few of the obstacles that have to be tackled,
writes Amy Taylor.

For many people it is the prospect of taking on the employer role
that puts them off using direct payments. But help could be on the
horizon. Individual budgets, outlined in the adult social care
green paper, remove this barrier and still allow people to choose
the services that they think will meet their needs.

Under the proposal, an assessment of a person’s needs
would be carried out by social services and the user would then be
told how much the care they are entitled to is worth. They could
then choose to have this as a cash direct payment or in provision
of services. The services that they choose or buy can be anything
that they feel will appropriately support them. These could be
outside the realm of services offered by social care, such as going
on holiday.

Choice

The idea is that people that choose not to take a cash payment will
still be given choice over the services they receive without having
to actually manage the money.

The system is currently being piloted through the In Control
project which is funded by the government and learning disabilities
charity Mencap.

David Congdon, Mencap’s head of external relations, says the
charity would like to see a variety of different options being open
to people that would enable them to take on the employer role if
they wish or let somebody else do this and just be responsible for
choosing their services.

 “It’s a flexible system that enables peoples to
manage the individual budget as their own,” he says.
“The crucial thing is that you could either give the pot [of
money] to the individual or it can stay as a nominal budget where
you could say I want to have a support worker to take me out five
days a week.”

A new broker role was outlined in the Strategy Unit report,
Improving the Life Chances of Disabled People, as
someone that could help people who need assistance to work out how
to spend their budget. 

“We would alll like to see the boundaries pushed.”

Nic Rowland-Crosby, a learning difficulties consultant with the
consultancy and development agency Paradigm, says that taking
control of the money and setting up a payroll system might be part
of this role if people don’t want to do it themselves. He
adds that alternatively a broker could put the client in contact
with a service that would do this for them.

The adult green paper states that while individual budgets could
be used solely for social care services, either to replace or
co-exist with direct payments, it will also consider whether a
wider range of funding streams, such as for minor equipment, could
also be pooled. “We would all like to see the boundaries
pushed of what’s put into the pot. Why can’t all the
disability benefits be put in?” says Congdon.

Direct payments can only be used to buy services from providers
and not from the council. Individual budgets would allow people to
do this if they wish and the government hopes that it will provide
an incentive for councils to reach the same standards as the
private sector and vice versa.

Roy Webb, head of policy at the National Centre for Independent
Living, is not sure that increased choice alone will definitely
drive up standards “If you look at this you have got to go on
direct payments and how that’s worked. Already there has been
an increase in the number of providers but it’s not
necessarily that all those providers are providing good quality
services,” he says.

He says that there also needs to be consultation with services
users on any future service provision and policies to ensure that
this happens.

Widening the options available

Ladyman: Driving force behind         the plans

Alongside individual budgets, the green paper also proposes
extending direct payments to people who are currently excluded from
using them. This is because they either cannot consent to using the
scheme or cannot manage it even with assistance. Under the plans
this would be done by using an agent for these groups.

Rowland-Crosby says that he welcomes all policies that widens
the range of options open to disabled people. Congdon agrees.

“It’s silly to have a system where all you can do is
manage the money for yourself,” he says.

For Webb a key part of making the policies work will be ensuring
that service users are involved in providing people with support in
how to use the schemes. “Our preference is for that support
to be given by local organisations run by disabled people,”
he says.

He adds that where this has happened under the current direct
payment system the scheme has been more successful.

Money, money money

While many in the social care sector welcome the green
paper’s proposals eyebrows have been raised at the fact that
there will be no extra resources to deliver them until the end of
the current spending review period in 2008

The ex-community care minister Stephen Ladyman has said that
there could be extra funding after that. With an ageing population
and disabled people living longer, Congdon argues that this is
essential.