Independent successes Implementing direct payments Carol Dawson The Joseph Rowntree Foundation has supported this project as part of its programme of research and innovative development projects, which it hopes will be of value to policy makers and practitioners. The facts presented and views expressed in this report are, however, those of the author and not necessarily those of the Foundation. © Joseph Rowntree Foundation 2000 All rights reserved. Published for the Joseph Rowntree Foundation by YPS ISBN 1 84263 011 3 Prepared and printed by: York Publishing Services Ltd 64 Hallfield Road Layerthorpe York YO31 7ZQ Tel: 01904 430033; Fax: 01904 430868; E-mail:ders@yps,ymn.co.uk or Contents Page Acknowledgements iv Executive summary v Language used in the report viii Glossary of abbreviations used in the report ix 1 The situation in Norfolk prior to direct payments 1 2 The project and project evaluation 4 The national context 4 Direct payments in Norfolk 4 The operation of the pilot project 7 The evaluation framework 11 Key outcomes 13 Training of employers and personal assistants 36 Monies 37 The views of the players about the scheme 46 3 Overview and evaluation by the monitor 51 The working of the project 51 Summary of the strengths and weaknesses of the scheme 55 Future developments 55 Closing remarks 56 Bibliography 57 Appendix 1: Direct payments questionnaire 60 Appendix 2: Competence checklist 63 Appendix 3: Maps 66 Acknowledgements The author would like to thank the following. • Alex O’Neil • Laurie A’Court • Keith Roads • Bill Albert • Simon Palmer • Suzanne Dunwoody • Members of the advisory group. • Geoff Empson • All those who must remain anonymous but who gave so generously of their time, • Marilyn Martin thoughts and feelings as respondents to this • Alex McAnulty study. • Ann McDonald • The Joseph Rowntree Foundation for the grant to monitor the project and to produce • Nick Miller the report. iv Executive summary The Community Care (Direct Payments) Act implementation, and draws conclusions and 1996 gave local authorities the power to make recommendations for those wishing to direct payments to some individuals in lieu of implement similar schemes. community care services provided under the National Health Service and Community Care Summary of findings Act 1990. Prior to this time, Social Service Departments had been constrained from giving Below are the major findings from the project. monies directly to service users to enable them Some are peculiar to schemes relating to direct to purchase their own support. Many counties, payments whereas others are pertinent to all including Norfolk, had developed a third-party partnerships between disabled people and scheme, which acted as a broker for services for Social Service Departments. disabled people who wished to employ their 1 Disabled people need to be involved in the own staff. introduction of any scheme which impacts On 1 April 1998, a direct payments pilot on their lives including those related to project, which adopted an innovative approach, direct payments. Failure to consult widely was launched in Norfolk. It broke new ground and appropriately in the initial stages may in that the scheme applied to all adults aged prove time-consuming in the long term and 18–64 who were assessed as eligible for antagonise potential allies. specified community care services (domiciliary support of more than five hours per week, 2 Disabled people should be full participants respite care and associated transport). It in the initial discussions, and significant provided three options available to people players in the implementation and receiving direct payments, which offered operation of any such scheme. differing levels of support and involved the 3 The introduction of direct payments is partnership between an organisation of disabled complex. Within a Social Services people, an organisation for disabled people and Department, it requires practical operational a Social Services Department (SSD). changes, a shift in approach to the concepts The Joseph Rowntree Foundation supported of risk and control, and a challenge to the the pilot scheme by funding a researcher. The culture of direct service provision. research took the form of qualitative interviews with disabled people who received direct 4 A direct payments scheme requires the payments, personal assistants employed commitment of senior members of staff through the pilot project, operational and within the SSD in order to validate the support staff within the SSD, and players within scheme, and to make available the staff and the two support organisations. Questionnaires resources to effect the necessary changes in were sent to all disabled employees and the culture and in practice. documentation of the project was reviewed. The 5 The creation of a post, Direct Payments report, written to inform both disabled people Officer, at a managerial level within the SSD and service providers, follows the process of v Independent successes dedicated to direct payments to oversee the people with learning difficulties and users introduction of the scheme is helpful. Staff of mental health services. Only three people require training in the policies and who did not receive their support from procedures relating to direct payments prior teams working with people with physical to the start of the scheme. Separate impairments joined the scheme. workshops addressing issues of equality 12 Most people became aware of direct with disabled people may be useful. payments through their social worker. 6 A help line established within the SSD for Social workers need to begin from an staff, operated by the designated Direct assumption of competence rather than Payments Officer, provides an effective two- incompetence when assessing willing and way communication system between those able. implementing the scheme and those putting 13 Personal assistants were recruited through it into practice. advertisement, informal networks and from 7 Norfolk SSD entered into different service the agencies that provided a service to the contracts with two support agencies. One employer before they joined the pilot support agency, controlled and managed by project. Most disabled employers had little disabled people, would arguably be the difficulty in finding staff. The scheme most effective means of offering support. brought into the market some new personal assistants who might otherwise not have 8 The transfer from a third-party brokerage entered this form of employment. scheme is complex and can involve much change for disabled employers who may 14 Children featured strongly in the project. need to alter their support arrangements to Risk to children and vulnerable adults may conform to the policies and procedures be reduced if personal assistants are asked relating to direct payments. to provide a certificate from the Criminal Records Office (cost £10.00). 9 The numbers of people joining the scheme was initially slow as staff within the Social 15 Norfolk has both rural and urban areas. Services Department and disabled people There was little correlation between came to understand the processes. measures of rurality or population density and the uptake of direct payments. 10 After two years, approximately 15 per cent of those eligible for direct payments in 16 The financial monitoring of direct payments Norfolk had chosen this form of service is best separated from the support function provision. There were 75 people in receipt and undertaken by the Social Services of direct payments. Department. 11 The Norfolk scheme was open to all adults 17 Direct payments are a cost-effective means of aged 18–64, including people who received service delivery when compared with similar support from Social Service teams for support costs from in-house service provision vi Executive summary and agency support, although there are many • determining the hours of employment hidden costs within the SSD and other • determining the tasks they require the agencies at the beginning of a scheme. personal assistant to undertake • the flexibility of the employment 18 Only eight people left the direct payments relationship which allows them to vary scheme during the two years. Five had left their routines and activities with more because of changes in their personal ease circumstances and three had found it • decrease of involvement with unsuitable. One failed to complete the professional agencies. required financial monitoring forms and two were unable to manage their employees. Conclusion 19 People who receive direct payments found A direct payment scheme that involves disabled that they had sufficient support in people from its inception and throughout its managing their monies and staff. They operation can provide a very positive suggest that, although direct payments may alternative to direct service provision, and one create more work for them, the positives which empowers disabled people to live their outweigh the negatives, which include: lives as they choose with no additional cost to • employing whom they choose the Social Services Department. vii Language used in the report The use of language and terminology has who have physical impairments, mental health reflected ideological and practical differences service users and people with learning between the partners involved in the Norfolk difficulties. Direct Payment Project, which are familiar tensions at the interface between those who People in receipt of direct payments receive services from statutory bodies and those who receive direct payments. Within the report, people in receipt of direct payments are referred to as disabled employers since, unlike others in receipt of services, they People in receipt of services directly employ their own staff. The Norfolk Coalition of Disabled People uses the term disabled people to refer to all those Supporters/carers who are disabled by society. The Social Services Department (SSD) distinguishes between Disabled people refer to people who provide different groups of disabled people both within assistance as supporters, whereas the SSD their policies and procedures, and also in the adopts the terms carers or home care assistants. very structure of service provision.