How to… support clients who direct their own care

How should social workers support clients who direct their own care, asks Gordon Carson

As responsibility for care commissioning is increasingly devolved to clients in receipt of personal budgets and direct payments, so the role of social workers in overseeing the quality and reliability of care has become less prescribed. But there are some core considerations for social workers involved in supporting these clients.

1 Trust the client and let them lead the process

Many people receiving direct payments will want to take charge of their own destiny and social workers must trust them to manage their own care, says Melanie Henwood, an independent social care consultant.

If required, social workers should be able to support service users by pointing them to further sources of information, such as local support groups able to provide advice on the ins and outs of employing carers, and services matching clients with personal assistants.

But Henwood says the tone used by social workers is crucial, and their role should not just be “checking up on people”.

“It’s partly about ensuring funds are being used appropriately,” she says, “but it’s also about ensuring people are able to put together the support they want to get the outcomes they want to achieve.”

2 Ensure social services and the service user are clear about each other’s responsibilities from the outset

If the service user plans to take full responsibility for arranging their own care through a direct payment, social workers should ensure that details are agreed in writing so there will be no divergence in expectations.

John Nawrockyi, secretary of the Association of Directors of Adult Social Services’ workforce development network, says: “The authority needs to do a personal support plan and a risk assessment, and get agreement with the service user that services put in place are mutually agreed and they will spend their personal budget in line with the local authority’s priorities.”

3 Be honest about your knowledge and expectations

Sue Bott, chief executive of the National Centre for Indepen­dent Living, which campaigns for disabled people’s rights, says social workers should admit the limitations of their expertise – for example, in employment law – when giving advice on directly employing a PA.

However, such honesty and acceptance of responsibilities is a two-way process, says Bott. “If you do employ your own PA it would not be right to expect that the local authority is going to step in immediately and sort out anything that goes wrong,” she says. “But it’s important that councils contract with good local support services, as people are not going to know automatically how to manage employees.”

4 Manage risk without being too controlling

Bott admits there is an element of risk in the direct employment of PAs, but adds that the local authority should raise the issue of risk rather than trying to solve everything. “Things can often be solved through local support systems,” she says.

Through regular, face-to-face reviews of personal support plans with service users, social workers can also ensure they are aware of any potential problems in employment relationships.

5 but be aware of your safeguarding responsibilities and be ready to provide support in emergencies

Oldham Council has 60% of adult care service users on individual budgets and, over five years of personalisation, Helen Sargeant Dar, assistant director for adult social care, says it has “become apparent that we need to safeguard service users”.

To help achieve this, the council has introduced a quality assessment framework for brokerage and payroll services for PAs. These services must show they have carried out Criminal Records Bureau checks on PAs, as well as meet accounting and governance standards.

Oldham also offers a more basic quality mark for smaller, community organisations, to prove they meet expected standards.

Nawrockyi says social workers and local authorities must retain their underlying duty of care and monitor services, and should highlight to service users the benefits of carrying out CRB checks on PAs they employ.

If something does go badly wrong for a service user directly arranging their own care, Nawrockyi says local authorities should be ready to provide immediate support if required.

6 Gather feedback from clients to ensure transparency and inform future service developments

Oldham is about to gauge the views of established recipients of individual budgets on personalisation. Sargeant Dar says: “It will give us a snapshot of how it has affected people’s lives.”

(Pic: Rex Featues; posed by models)

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