Independent Successes: Implementing Direct Payments

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.

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. In this Under the direct payments pilot project, report, the terms disabled people and disabled employees of disabled employers were called employers will be used generically. When personal assistants. referring to the different SSD provisions, the following terms will be adopted: adult team Services provided (physical disability); adult team (mental health); adult team (sensory impairment); adult team As above, the SSD refers to domiciliary and (learning disability). Where necessary, personal care whereas disabled people prefer distinctions will be made between disabled the concept of domiciliary and personal people by use of the following terms: people support.

viii Glossary of abbreviations used in the report

DSS Department of Social Security HAND a charity offering Help, Advice and Advocacy for Norfolk Disabled People ILF Independent Living Fund ILP Independent Living Project (part of HAND offering support to people who employed their own personal assistants) JRF Joseph Rowntree Foundation NANSA Norfolk and Norwich Spastic Association (now renamed SCOPE) NCODP Norfolk Coalition of Disabled People (a registered charity which is a federation of organisations of disabled people throughout Norfolk) SSD Social Services Department

1 The situation in Norfolk prior to direct payments

The Independent Living Fund (ILF) was personal assistants through the support of such established in 1988 to provide income for a scheme. In 1992, there were 101,000 disabled disabled people to live independently in the people in Norfolk. It was estimated that in community. Between March and September Norwich there were 12,600 disabled people 1991, Ann Kestenbaum interviewed 123 clients living in the community of whom 1,500 were of the ILF and found that a quarter of those under 65 and used some form of domiciliary interviewed had experienced difficulty in support service. arranging support (Kestenbaum, 1992). Disabled people who were not eligible for In Norfolk, 103 people were in receipt of ILF funding from the ILF but received financial funds. Social workers were increasingly asked assistance from Social Security or services from for advice on matters relating to employment, the local authority also sought to control their income tax, insurance, legislation, contracts and own living arrangements and to choose their bookkeeping, which they felt ill equipped to supporters. Since the division in 1948 between provide. There were also requests for support in the Department of (Health and) Social Security, recruiting and interviewing personal assistants. dealing with financial benefits, and the Social People were in receipt of large sums of money – Service Departments, providing services, the up to £700 a week to pay for 24-hour support latter had been constrained from giving money (SSD funding via a third party, ILF monies and directly to service users to pay for their support. DSS benefits). Some were confused about their However, a survey by RADAR showed that, of financial positions. Personal assistants were 65 local authorities which responded, two-thirds facilitating the financial affairs of their were then making payments directly or employers and there was evidence that indirectly to disabled people. The device of a vulnerable people could be the victims of fraud. holding trust was often employed (RADAR, There was a growing recognition that the 1990). employment of personal assistants required In Norfolk, disabled people, with specialist information and skills that must be professionals, sought the development of an easily accessible to all potential employers. independent service that could enable any A pilot scheme, which offered support to six disabled person to employ their own personal employers, was initiated by social workers from assistants. Under the provisions of the National the Norwich team, which supports people with Health Service and Community Care Act 1990, a physical disability, and the Hamlet Centre; a the local authority could purchase a service that local charity controlled by disabled people. The facilitated the employment of personal scheme ran for a year and proved very assistants by disabled people. The service successful. Employers felt more secure and would enable the Social Services Department to social workers found that calls on their time by meet its obligation of spending funds for employers were reduced. It became apparent community care in the independent sector, and that many more people could employ their own would fill a gap in service provision between

1 Independent successes

private care agencies and the local authority • the regulations governing the domiciliary service. NANSA (now SCOPE) administration of the Independent Living initially acted as a third party receiving SSD Fund. money on behalf of a disabled person. During The expressed aim of the ILP was: to offer a 1992, HAND, a voluntary organisation that service to disabled people who are under the aimed to provide help and advocacy for Norfolk age of 65 and who live independently or who disabled people, undertook to develop a pilot express a wish to do so. project. The SSD provided £4,000 to employ a The objectives were to: development worker. The pilot received practical support from the Hamlet Centre • enable disabled people to live (another organisation controlled by disabled independently in the community people) in operating the payroll. • provide advice, assistance, advocacy and During 1993–94, Norfolk Social Services support to enable people to employ their Department made a grant of £11,250 and Joseph own personal assistants Rowntree Foundation a grant of £12,003 to fund a project development worker who was • make these services self-financing by supported by a liaison officer from the Norwich charging commission for services offered. team for people with a physical disability. The Two major issues determined the role of the service, which became known as the project and set the parameters for the Independent Living Project (ILP), was formally collaboration with the SSD: the assessment of launched on 4 October 1993. The inception of need and the payment for services. The funding the project was recorded through funding from for disabled people to employ their own the Joseph Rowntree Foundation (Findings assistants was obtained through a number of Social Care Research No. 61 and Dawson, 1995). routes: The ILP had thus arisen through a combination of factors: • the Independent Living (Extension) Fund

• the need for disabled people to receive • the Independent Living (1993) Fund support and advice in employing • social security benefits personal assistants • independent means, e.g. private income, • the changes in the arrangements of social charitable grants. care brought about by the implementation of the National Health Whilst the local authority was not legally Service and Community Care Act 1990 empowered to give a disabled person money to pay for their own support, the SSD could pay • the requirement that Social Service money for the social care of disabled people to Departments must spend a proportion of the ILP. The project thus acted as a broker for the budget for community care in the services; it did not employ personal assistants. independent sector (this was In 1995, the ILP extended the service offered subsequently relaxed)

2 The situation in Norfolk prior to direct payments

within 25 miles of Norwich to encompass the appointed for skills in business management. whole of Norfolk. There were also additions to The co-ordinator of the ILP had become the Board of Trustees of HAND (the ILP parent involved with HAND as a volunteer; then organisation), some of whom were able-bodied became an employee, before applying for and and some of whom were disabled. The ILP had being offered the post. a turnover in excess of £250,000 per year and In 1996, a political force, the Norfolk there were debates about whether the ILP Coalition of Disabled People (NCODP), was should remain within the remit of HAND or established in response to the debates about the become a separate business with its own Disability Discrimination Act and changes to constitution. Conflicts about this and ideological social security benefits. The NCODP sought to issues arose between the trustees, between the bring together all organisations of disabled trustees and the staff, and within the staff people across Norfolk as a campaigning force group. In 1996, three trustees resigned, leaving and is described by the chairman as ‘a political four disabled people as trustees. The project organisation with a constituency of all disabled workers of the ILP did not have their contracts people in Norfolk’. The chairman had briefly renewed when they came to the end of their been a trustee of HAND during the period term and the manager of HAND resigned. A co- 1995–96 and HAND became a founding ordinator of the ILP was appointed and a few member of the Coalition. The NCODP gained months later a manager of HAND. Both were charitable status in 1997.

3 2 The project and project evaluation

The national context direct payments. A team manager for social The Community Care (Direct Payments) Act workers who serve people with physical 1996 gave local authorities the power to make disabilities in Norwich was charged with the direct payments to some individuals in lieu of responsibility of researching and developing community care services provided under the direct payments in the SSD and released from National Health Service and Community Care his other duties for six months. He was the sole Act 1990. Prior to this time, Social Service remaining person, from the SSD or the ILP, who Departments had been constrained from giving had been involved with the setting up of the ILP monies directly to service users to enable them in 1993. to purchase their own support. Many counties, At this time, the ILP was supporting over 40 as in the example of Norfolk above, had people in the role of a broker across Norfolk. developed a third-party scheme, which acted as The third-party role had to change because the a broker for services for disabled people who criteria for payments under the Direct Payments wished to employ their own staff. In July 1997, Act differed from those adopted by the third- just under 50 per cent of all local authorities party scheme. The team manager from the SSD, were operating some form of payment scheme, under the newly created title of Direct Payments most of which were third-party schemes (Zarb Project Officer (a temporary post), worked with et al., 1996). The Act gives local authorities the the new staff of HAND and the ILP. Together power to make direct payments. It does not give they devised a scheme in which the ILP would them a duty to do so. The research suggested undertake a key role with respect to direct that over 80 per cent of local authorities payments in Norfolk. In June 1997, they intended to carry through some form of circulated a paper about the proposed scheme to implementation of direct payments. Amongst stimulate discussion and consultation. A paper these was Norfolk. was disseminated to groups of disabled people and an invitation was extended to attend a public meeting to be held in a day centre for Direct payments in Norfolk people with a physical impairment in Norwich. The consultation process At the consultation meeting, the chairman of Local authorities are exhorted to consult the NCODP raised objections to the proposed representatives of disabled people and other means by which direct payments would be interested parties in considering whether or introduced. The main bones of contention were: how to use direct payments to help meet the (a) that disabled people were given insufficient need of its local population (LAC (97) 11). The time to work through and respond to the consultation that took place in Norfolk was not proposal; (b) that it was presented as a fait initially a smooth process. accompli; and (c) that it only extended to people The drive towards a direct payments scheme with physical impairments. An extended in Norfolk came from within the Social Services process of consultation was agreed. A group Department, as the newly formed NCODP was jointly chaired by the Direct Payments Project not proactive concerning the introduction of Officer and the chairman of the NCODP was

4 The project and project evaluation

convened. The ILP was represented and other operated the payroll system for disabled participants representing people with learning employers, and a part-time office administrator difficulties, physical impairments, physical who also worked for HAND. The ILP had illness, mental health problems, sensory become self-financing by charging commission impairments and HIV/Aids were drawn from for services offered to disabled employers. Since organisations throughout Norfolk. the ILP would lose some clients as disabled A working party consisting of a cross-section employers transferred from the third-party from these organisations proposed an scheme to direct payments, the SSD agreed to innovative approach to direct payments, which underwrite the ILP to the sum of £78,000 (the broke new ground in three main areas: amount it needed to remain viable). Under a separate contract from the SSD, the ILP was to • the application of the scheme to all monitor the financial returns of all people disabled adults receiving direct payments. • the implementation through a The NCODP partnership between an organisation of A joint-funding (Health and SSD) grant for three disabled people (NCODP), an years was obtained for the post of a Direct organisation for disabled people (ILP) Payments Co-ordinator employed by the and a local authority Social Services NCODP. The post was for 25 hours per week. Department The Co-ordinator was managed by a committee • the development of three options (with of representatives drawn from different groups differing degrees of support offered by of disabled people throughout the county. the ILP and/or the NCODP) available to The role of the co-ordinator was to establish people receiving direct payments. peer groups in different locations. It was envisaged that the peer groups would comprise The partners disabled people with experience of, and skills The introduction of direct payments is complex. in, managing independent living. The groups In Norfolk, there were three partners involved would support individual recipients and each in the direct payments scheme. All had their other on all aspects of independent living and own issues and agendas. This added to the be responsive to local circumstances. It was also complexity and brought both strengths and envisaged that the Co-ordinator would offer weaknesses to the pilot project. Every issue was advice during the assessment process, induct thoroughly debated which increased the people into the scheme, arrange training and complexity and time involved. provide back-up support to the peer groups and support for those on the scheme. The ILP The ILP, still a project within the organisation Norfolk SSD HAND and managed by the general manager of There was a commitment to direct payments HAND, consisted of a co-ordinator, two part- from senior staff, such as the Director and time project workers, one finance officer who Deputy Director (Adult Care) within Norfolk

5 Independent successes

SSD. The Deputy Director confirmed his view in mental health services and older people. There writing that a direct payment scheme must be was one team across the county working with ‘owned in principle and in practice by disabled people who have sensory impairments. Teams people’. This was highly significant in the way working with children and families were also in which resources and systems were made organised by district but these had a different available to the project within the department. management structure. Each team had a team Concurrent with the debates about direct manager. payments, a restructuring of services was taking Services for adults were restructured on 1 place within Norfolk SSD. In 1993, the SSD had April 1999. The changes in the district arranged services to reflect the purchaser– boundaries and in management had little effect provider split which was introduced in the on data concerning direct payments. However, National Health Service and Community Care the uncertainties within the Department during Act 1990. Social workers and occupational the period before the restructuring was therapists, employed as care managers, were completed had an impact on the way in which purchasers of services and were organised in staff were able to focus on an innovative five districts across the county. Adults in receipt scheme. The role of the Direct Payments Officer of services were allocated to teams working within the SSD was deemed by all three predominantly with one client group in a given partners to be crucial to the success of the pilot geographical area. There were teams working scheme. This temporary post, which was with people with physical impairments, people initially created in the SSD for six months, was with learning difficulties, people who use extended to the life of the project.

Figure 1 The partnership

Social Services Committee

Norfolk County Council

Social Services Department

Service Contract Service Contract

HAND NCODP

Direct Payments Project Officer

NCODP ILP Co-ordinator Direct Payments

6 The project and project evaluation

The operation of the pilot project other personnel as required. This was the final decision-making body with respect to the The Social Services Committee of Norfolk scheme, within the SSD. From here County Council accepted the proposal and recommendations were taken to the Social agreed that direct payments should be offered Services Committee of Norfolk County Council. across the county under an 18-month pilot scheme to commence on 1 April 1998. The Implementation Group Monitoring of the pilot, also for an 18-month The Implementation Group was responsible for period, which was funded by Joseph Rowntree the practical day-to-day operation of the pilot Foundation, began formally on 1 July 1998. scheme. It was alternately chaired by the SSD Direct Payments Project Officer and the NCODP The management of the project Chairman, and consisted of these two with the The introduction of direct payments was SSD Contracts Officer, the ILP Co-ordinator and overseen by a Project Board, an Implementation the NCODP Direct Payments Co-ordinator. If it Group and a Consultation Group, each of whom was decided that further discussions were met regularly. A Finance Panel was a later required, the matters could be taken to the addition born of necessity (see Figure 2). Consultation Group and finally to the Project Board for ratification. The Project Board The Project Board consisted of SSD personnel; The Consultation Group the Assistant Director (adult care), the Head of The Consultation Group was chaired alternately Finance and Administration, the Direct by the chair of the NCODP and the SSD Direct Payments Project Officer, a Contract Officer and Payments Project Officer. It consisted of

Figure 2 The project management

Social Services Department

Directorate

Project Board

Implementation Finance Panel Group

Consultation Group

7 Independent successes

members of the Implementation Group, individual employers’ funding, employment representatives from a range of groups of and monitoring issues. Written disabled people and some recipients of direct recommendations were made about any payments, since the function was to review how necessary action to be taken by either the ILP or the scheme was viewed by disabled people who the SSD. The issues were then followed up at could be, or who were, in receipt of services subsequent meetings of the Panel in liaison with including direct payments. social workers or team managers if necessary. If The Consultation Group seemed an effective any of the issues raised at the Finance Panel vehicle for debate in the early stages of the indicated the need for consultation on a wider project but attendance began to wane after the basis, they could be taken to the first few meetings. In order to consult with as Implementation Group to decide whether or not many employers as possible, the partnership recommendations should be made to the Project arranged an event at a local hotel to which all Board to modify policies or procedures of the employers were invited. The event lasted an project. afternoon and was chaired by the Chairman of Clearly, there was much commitment to the the NCODP. There was a presentation about the scheme from the SSD in terms of the personnel processes of decision making within the scheme hours given in these panels and in carrying out and then most of the time was given to open the work to support the pilot project. Indeed, discussion in which people could voice their there was a heavy commitment to the scheme concerns or suggestions about the scheme to the throughout, from the Director and Assistant members of the Implementation Group. The Director (Adult Care) of Norfolk Social Services. partnership subsequently produced minutes of the meeting with an addendum in which the Support for SSD staff questions raised by employers were addressed. From the outset, it was apparent that staff This was highly effective in enabling people to within the SSD would need support in gaining feel a part of the planning and organisation of information about direct payments and in the scheme rather than recipients of a service. implementing the systems within the pilot However, the event also served to highlight project. differences between the employers. For, as will Training of staff be discussed later in this report, they were a All community care assessors (social workers very disparate group of people. and occupational therapists) within the adult Finance Panel sector of Norfolk SSD (except those working The Finance Panel was born of necessity during specifically with older people aged 65 and the pilot scheme. It met monthly and consisted above) were offered training in direct payments of the SSD Direct Payments Project Officer, the provided jointly by the Department, the ILP and SSD Contracts Officer, the ILP Co-ordinator and the NCODP. Five separate day-long events were the ILP Project Administrator. The group was held and the majority of staff were trained later joined by the SSD Monitoring Officer. The including managers. The training consisted of purpose of this Panel was primarily to address two parts. The Chairman of the NCODP led the

8 The project and project evaluation

first session in which he stressed the social in adult teams responded to a questionnaire. model of disability and made the links between Five of these were unaware that a help line this model and direct payments both in Britain existed. Two respondents were in adult teams and Europe. The Project Officer from the SSD (mental health) and two in adult teams (learning then briefed staff on the options within the disability). This suggests that they did not recall scheme; the Finance Officer from the SSD also information coming to the teams about direct briefed staff on the necessary paperwork; and payments, possibly having dismissed it as the Co-ordinators of the ILP and the NCODP irrelevant or because the information was not made their roles known. The days were very forwarded to them by their managers for similar full. With hindsight, it might have been more reasons. Workers who used the help line effective had there been separate training about reported finding it extremely useful. Assessors issues of equality and disability before the organise direct payments relatively rarely briefing about direct payments. Staff who were compared with other services. They are not very challenged by the session on the social model familiar with the minutiae and detail of setting could have had longer to explore this issue and up payments day by day and access to more time could have been given to the immediate assistance or a response to a questions related to direct payments. question, however minor, facilitated the whole There was a clear divide, as shown by the process. The Direct Payments Project Officer: questions asked in the open sessions and in the …. would strongly recommend it as a way of comments made during informal breaks on the cutting through some of the complexities training days, between those staff working in adult teams (physical disability) and those .... and also as a way of the SSD lead person working in others. The former were clearly keeping an ear to the ground on issues. aware of many of the issues involved in direct payments and were able to draw on experiences The project of the third-party scheme. Staff from other Eligibility for the scheme teams had little sense of how things might work The legislation only allows payments to be in practice. It might have been helpful to have offered to someone who has been assessed as offered some separate sessions for different staff needing community care services, as delineated groups in which their specific concerns could under the National Health Service and have been addressed. Community Care Act 1990. The decision to offer payments therefore follows an assessment of an SSD help line individual’s needs. Initially, in order to be A help line for staff was established, advertised eligible for direct payments under the Norfolk and operated within the SSD by the Direct scheme a person had to be: Payments Project Officer. All teams working with adults were leafleted twice about the help • between 18 and 64 years old when line during the pilot project. By the end of June, payments commence three months into the scheme, there had been 15 • disabled enquiries. In September 1999, 23 staff working

9 Independent successes

• assessed as ‘willing’ to receive payments Options for receiving direct payments There were three options for direct payments. • assessed as ‘able’ to manage their payments and arrangements (with 1 Direct payments (self-management): suitable for support if necessary) people who wished to personally manage their payments and arrangements. • normally expected to need services for a • SSD payments made directly into the period of at least 12 months person’s bank account set up specifically • willing to sign a Direct Payment for that purpose. Agreement with the SSD which was • Disabled person directly responsible for binding on both parties ensuring all tasks relating to managing payments and arrangements are • willing to attend an orientation/ undertaken. information session before a final decision • Disabled person is the employer of any was made to make payments. personal assistants. The legislation allows direct payments to be used • Disabled person directly responsible for for the purchase of any service that is defined as a ensuring receipts and financial returns are community care service except permanent sent monthly to the ILP for charging and residential care. Following the local consultation financial monitoring purposes. process, Norfolk Social Services Committee decided • Disabled person may access NCODP that payments could be used for: training and peer support.

• personal domiciliary assistance where the 2 Direct payments (assisted management – other): person was assessed as needing five suitable for people who wished to choose hours’ assistance or more per week their own agent to assist them in managing their payments/arrangements. • respite care where the amount of respite • SSD payments made directly into could be assessed annually in advance disabled person’s/agent’s bank account • transport for respite where this was an set up specifically for that purpose. assessed need and where no other • Disabled person may delegate all or some alternative was available. of management tasks to agent. • Disabled person is the employer of any Direct payments could not be made for day personal assistant. services or equipment during the pilot project. • Disabled person responsible for ensuring A disabled person could have a mix of direct receipts and financial returns are sent payments and services, for example day service monthly to the ILP for charging and provided by SSD, some personal assistance from financial monitoring purposes but this a contracted domiciliary agency and a direct may be one of the tasks delegated to the payment to purchase an additional element of agent. the total service required.

10 The project and project evaluation

• Disabled person may access NCODP community care manager within SSD. If the training and peer support. person was entitled to a service under the Act they would then be offered a range of 3 Direct payments (assisted management – ILP): alternatives including the option of direct suitable for people who sought a greater level payments. If they considered direct payments as of assistance in managing their payments and an option, they were required to meet with the arrangements, and where they preferred the Direct Payments Co-ordinator of NCODP or the ILP to act as their agent. In practice, there Co-ordinator of the ILP to discuss the scheme. If were two forms of assisted management. In they were willing to manage direct payments, both forms, the following applied. and were also seen as able to manage them • Payments made to the ILP who acted as (with support if necessary), the social worker the disabled person’s agent for payroll would raise the required forms and the person purposes. would enter into a contract with the SSD. If they • Employer responsible for ensuring ILP were to take the ‘self-management’ option, they receives accurate information for payroll would be required to open a separate bank purposes. account, to complete timesheets for their • Disabled person is the employer of any employees and to return the monitoring forms staff, which includes managing staff and on a monthly basis. The person would recruit arranging cover for shifts. their own personal assistants. If they were to • Disabled person is responsible for take the ‘assisted management’ option, they providing ILP with receipts monthly would be supported in whatever way they showing expenditure. required, for example in selecting personal • Disabled person may access NCODP assistants and in operating their payroll. The training and peer support. employer would send timesheets for their staff In the first system, the ILP offered a full to ILP in order to raise the payment to the financial management package in which the personal assistant. The social worker would employer submitted timesheets for the work subsequently review the situation. undertaken by personal assistants and the ILP operated the payroll, paid income tax and ran The evaluation framework the account. In the second system, the ILP operated the payroll but the employer held the A researcher was funded by the Joseph money and paid the personal assistants directly. Rowntree Foundation to monitor the project. The researcher had carried out the original work Becoming an employer with the ILP project (Dawson, 1995). The A potential employer would first require an research commenced three months after the assessment of needs under the National Health inception of the direct payments scheme Service and Community Care Act 1990. This although the monitor attended one of the would be undertaken by a social worker or an training days for SSD staff in the spring of 1998. occupational therapist undertaking the role of The aim of the research was to:

11 Independent successes

• monitor and record the events of the pilot Questionnaires project One year after the commencement of the pilot project, questionnaires were sent to all • highlight issues for policy and practice employers, and subsequently sent to new • disseminate the findings both locally and employers as they joined the scheme (see nationally. Appendix 1). In total, 36 questionnaires were returned. A breakdown of the respondents by The main areas of interest were the: gender and by the numbers of those who were • working of the partnership and the new employers compared to those who operation of the scheme previously used the ILP suggests that they were quite representative of those using the scheme. • take-up of direct payments with respect There was no reference to ethnicity in the to age, gender, locality and disability questionnaire as all recipients were white • effectiveness of direct payments from the British. One woman, from Sri Lanka, became an perspectives of the players in the arena. employer towards the very end of the project. It would be difficult to maintain her anonymity if Interviews ethnicity was introduced as a criterion of Three months after the start of the project, comparison. In the data within the report, some letters were sent to all recipients of direct information is plus or minus 100 per cent since payments requesting interviews with the some questions were answered with two monitor. There were 17 replies. By the end of the responses and others left blank. research, 23 people had offered interviews. The researcher also sought permission to speak to Statistical data their personal assistants. People were Figures relating to the numbers eligible for interviewed, some on more than one occasion, services and those in receipt of services were at intervals throughout the pilot. Interviews gained from the information and research were conducted using a tape recorder or hand- department of Norfolk SSD. Data relating to written notes during sessions, which lasted monitoring and numbers on the scheme was between one and two hours, usually conducted originally supplied by the ILP and then by the in the employers’ homes. Some interviews were financial monitor within the SSD. conducted with employers alone, some were conducted with personal assistants on their own Demographic data and some were conducted jointly. Material was taken from the 1991 census, Interviews were also conducted with reports concerning sparsity and rurality from employees of the SSD (including those closely the Local Authority (Coldicott, 1998) and data involved with the pilot and those in other parts produced by the information and research of the Department) and with the partners. These section of the SSD. were repeated throughout the 18-month period.

12 The project and project evaluation

Key outcomes Awareness-raising campaign HAND and NCODP began an extensive Uptake of direct payments during the first year awareness-raising campaign. Members of both At the outset of the pilot project, it was agreed organisations gave interviews on the local radio that the scheme would be limited to 50 new and in the local press. HAND printed leaflets disabled employers in addition to those already which were circulated widely, including to all using the indirect payment scheme run by the GPs’ surgeries. The Direct Payment Co- ILP. However, fears that this figure would be ordinator of the NCODP visited many groups restrictive proved to be unfounded. Numbers of of, and for, disabled people, including many for people wishing to join the scheme were very people with learning difficulties. much lower than expected by some. As direct payments had been introduced as a pilot Transfer of people from the third-party scheme project, there was a perceived need by members During the first year, of the 48 disabled people of the Implementation Group to have numbers served by the ILP, 21 transferred to direct large enough to fully explore different issues payments; eight were self-managing. The related to direct payments. transfer of people from the third-party system was more complex than envisaged. A number of Numbers on the third-party scheme at 31 difficulties arose. Some people on the third- March 1998 party scheme were employing relatives, which At 31 March 1998, when the direct payments is prohibited (unless no alternative) under the pilot project commenced, there were 48 terms of the Act; some were paying personal recipients of the third-party service provided by assistants at rates above the allowance then the ILP: 16 men and 32 women all of whom made by the SSD under the direct payments were assessed for services through the adult project; and some were receiving funding from teams (physical disability) (see Figure 3 and the Independent Living Fund where the terms Appendix 3, Map 1). differed from those for direct payments. There

Figure 3 In receipt of services from ILP at 31 March 1998 60 Total Male 50 Female

0 18–25 26–35 36–45 46–55 56–64 Total Age groupings

13 Independent successes

was confusion about what personal assistance needed a new assessment under the National was being purchased through monies from Health Service and Community Care Act 1990. different sources. Some of the packages of It was believed that all would be transferred by support were very complex and others did not March 1999. This was not to be the case. The come within the scope of the Act. worker became unwell and had a period of Jane, who had employed her own personal extended sick leave. Indeed, some transfers assistants through the ILP almost since its were not completed until almost the end of the inception, describes why she was one of the last pilot project, 18 months from the inception, and to transfer to direct payments: two situations still remained unresolved at that point. I had some girls already … on the DSS before … but since all this come to … I ain’t got anyone on Numbers receiving direct payments at 31 the DSS now – so now everything’s above board December 1998 – they’re all legal now … before if they weren’t At 31 December 1998, nine months after the working to give them a helping hand, you know beginning of the pilot project, 29 people – 11 of but … so I had to say that that’s the situation whom were self-managing – were receiving now. direct payments. Eight people in receipt of direct payments were not previously involved Jane, like many others reported in in the third-party scheme provided by the ILP. Kestenbaum’s study (1992), had recruited friends and neighbours in the grey market Uptake of direct payments after a year economy. The monitoring and checks in the A full study was undertaken at 1 April 1999, a third-party scheme were not as tight as those in year after the commencement of the pilot the direct payments pilot project and these project, to ascertain who was eligible for, and situations took some time to resolve. who was taking up, direct payments using the Clearly, the regulations surrounding the data held within Norfolk SSD. Data concerning direct payments scheme were tighter in law and the uptake of direct payments had been in practice than had been the situation with the received to this point from the ILP. The study third-party scheme. Individual exceptions were involved a detailed examination of data collated taken to the Assistant Director within the SSD by the SSD information department at the end who had to rule on a case-by-case basis. There of the financial year. The data were not held in was a need for unambiguous statements to one system and had to be analysed manually, in support individual decisions so that the some cases from different sources. The major Department could demonstrate that their difficulty was that data are recorded by contract discretion was applied without prejudice. of service provision. If a disabled person receives A dedicated social worker was appointed on more than one service, they will be recorded on a full-time basis on 28 September 1998 by the multiple occasions in the system, thus giving an SSD for five months to help to speed up the inaccurate picture of the number of people who transfers, since all needed clarification about the might be eligible for a direct payment. new scheme before they joined and some

14 The project and project evaluation

Numbers of people eligible for direct payments Table 1 People who would have been eligible for direct payments if the age groups had been in Norfolk at 1 April 1999 extended The Act enabled local authorities to make cash Age groups Total Men Women payments to some individuals aged 18–64 in lieu of community care services. Permanent 65–74 829 252 577 residential care is excluded. In Norfolk, people 75–84 2,316 634 1,682 85 and over 2,584 1,992 592 who were assessed as needing domiciliary Totals 5,729 2,878 2,851 assistance, and those who received regular respite care or transport for respite care, were considered eligible. People using the scheme a year after its At 1 April 1999, there were 1,064 adults aged commencement (31 March 1999) 18–64 in receipt of domiciliary support in At 31 March 1999, there were 43 people in Norfolk. There were 334 men (31 per cent) and receipt of direct payments (see Figure 4); 27 of 730 women (69 per cent). The data are the 43 used the assisted management scheme incomplete concerning the ethnic origin of offered by the ILP and 16 managed their own people who use the services of Norfolk SSD. support. If people living in residential homes and There were 33 women of whom 12 self- those attending day services were included in managed and 21 had assisted management. these figures, then the numbers would have There were ten men of whom four self- doubled. It is arguable that people in these managed and six had assisted management. situations should have been included in the All were white British. pilot project as direct payments may have been an alternative service provision. At the time of Figures at the end of the pilot and beyond writing, Norfolk is assessing the implications of The numbers of people continued to rise making direct payments for the provision of day throughout the pilot project as more people services. transferred from the third-party scheme and The pilot project was initially available to others became new employers. people aged between 18 and 64 in receipt of Uptake at the end of the pilot project more than five hours per week domiciliary At 30 September 1999, at the end of the pilot support. Across the county, there were 474 project, there were 58 people in receipt of direct people; 130 men and 344 women (see Appendix payments (see Appendix 3, Map 7 and Figure 5); 3, Map 2). 34 of the 58 used the assisted management If the regulations had permitted direct scheme offered by the ILP, one was assisted by payments to be extended to older people, the another organisation and 23 managed their own figures for people who would have been eligible support. under the criteria adopted for the pilot project in One person received services from the adult Norfolk would be as shown in Table 1. team (mental health). Two people received services from the adult team (learning

15 Independent successes

Figure 4 In receipt of direct payments at 31 March 1999

60 Total Male 50 Female

0 18–25 26–35 36–45 46–55 56–64 65+ Total Age groupings disabilities). Fifty-five people received services another three joined in March. Therefore, two from the adult team (physical disabilities). years after the commencement of the scheme in One recipient was born in Sri Lanka. All Norfolk, there were 75 people who had chosen others were of white British origin. to receive their services through this means (see There were 39 women of whom 14 self- Table 2). There were no new additions from managed and nine had assisted management. adult teams (mental health) or adult teams There were 19 men of whom nine self-managed (learning disability). It is possible to identify and ten had assisted management. amongst the social workers in certain areas one or two champions who more frequently Beyond the period of the pilot nominate people for direct payments than their At the end of February 2000, there were 72 colleagues. In total, 36 people have become new people in receipt of direct payments and

Figure 5 In receipt of direct payments at 30 September 1999

60 Total Male 50 Female

0 18–25 26–35 36–45 46–55 56–64 65+ Total Age groupings

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Table 2 Summary of uptake of direct payments may be that these people were in touch with the Month Year Number other services offered by HAND. The publicity campaign launched by December 1998 29 NCODP in the media apparently yielded no March 1999 43 September 1999 58 new people directly. However, such a campaign March 2000 75 serves to raise the profile of independent living in general, and direct payments in particular, and the results of such a campaign may not be employers; the others have transferred from the easily measured or apparent, and might not third-party scheme. Two people are still show results until some period of time has awaiting transfer. elapsed.

Joining the Direct Payments Pilot project Choosing direct payments Awareness of direct payments People chose direct payments as their method of Respondents were asked how they became service provision for different reasons, although aware of direct payments in the questionnaire it was clear that all respondents saw direct (see Figure 6). payments as a means of gaining more control It is significant that the majority of people and choice in their daily living. Alison valued who were not on the third-party scheme prior to being ‘able to choose my own staff, stay in my the pilot project learnt of direct payments from own home, be in control of my family’. Others their social workers. valued being able to have ‘control of your own Many of those who used the third-party staff’. Meg sought a situation in which she scheme identified the source as the ILP. Several could ‘do what I like when I like’. who did not previously use the ILP also Some sought direct payments because they identified this as their source of awareness. It adopted an ideological perspective in which the

Figure 6 Source of awareness of direct payments 14 ILP prior to 1 April 1998 New employers 12

0 ILP Friend Media Social Coalition Other worker Agencies

17 Independent successes

central tenet held that disabled people should I can employ one person rather than having an control their own lives, and thus their own army of different people trooping in and out of my support, with as little intervention from the house. I can choose that person rather than just statutory services as possible. Alan was being told (or not being told!) who’s coming in. saddened that he could not entirely lose the SSD Uncertainty about who might be coming involvement in his life even when in receipt of was a common theme from those who had direct payments. A negative of receiving direct received support from SSD direct service payments was that ‘I have to deal with the SS provision: network’. He wished that ‘they would just pay me the money and let me get on with it’. … when I had a home help from SS, I never Other employers joined the pilot project to knew who was coming to my home, some maintain a way of life that they had chosen and weeks I could have a different lady every day. It they viewed direct payments as a means to was really worrying for us and our children. enable them to continue their existing support A similar theme was expressed by those who package. For example John says: had received agency support. A benefit of direct I was paying £60 a week for help for almost a payments was expressed by two recipients as: year because I could not face an army of SS … not having the worry of who’s coming in to carers invading my home. I preferred to struggle your home every day, wondering if you can trust on ... until I was completely on my knees and them. needed but simply couldn’t afford any more help that I finally agreed to see a social worker. … choice over who I have coming into my house, more control than agency care. He valued: For some, the changes in personnel meant ... being able to recruit staff that suit my having to repeatedly explain their circumstances personality, people I know I can trust and rely on and condition. absolutely. Setting my own routine and time schedule. The whole thing is, I was so ill I couldn’t tell them what to do … I was so ill and they were making Others, however, seemed to have neither an me worse. I didn’t know whether I was coming or ideological commitment nor an established going. support package they wished to maintain but were dissatisfied with their existing service Similarly Mary, from another part of the provision. For some, this was provided through county, says: agencies contracted by the SSD or through the I tire quickly so when one person coming in SSD in-house home care service. knows the routine of what needs to be done I A major source of contention was the don’t have to keep explaining everything to them. changing face of the personal assistants. Several Different people every day means I have to show recipients used the term ‘army’ to refer to the someone every day where everything lives (e.g. numbers of staff sent to their homes:

18 The project and project evaluation

hoover, airing cupboard) and how it works, how clothes on if she was to leave the home early in some things need to be washed up carefully (e.g. the morning. non-stick saucepans, etc.). There was also a sense that the employees from SSD and agencies had their own rules and Joyce sums up this notion when she says methods, which may not have been those of the that direct payments lead to support which is: disabled person: … better because it’s consistent. I feel more at ease asking an employee to do There was also a sense that the changes in things in a certain way … Some social services staff meant that there was little opportunity to home carers didn’t like being asked to do things form relationships and so the disabled person in a particular way ... I can ask an employee to do was viewed as a task to be done rather than a things other than the basic help, e.g. occasionally person to be visited. washing a window if there are a few minutes left at the end of a session. If I’d asked a SS home With SS home care I felt like they came in, ‘did carer to do that they would probably have told the me’ and then went off and ‘did’ someone else HC manager and I would be afraid of losing some and I was beholden to them. With Direct of my allocated hours of help. I would not have Payments I’m the boss and the employee has a asked an SS home carer to do anything like that different approach to me as I’m paying them even though it would have been helpful to me. rather than someone else sending them to help a hopeless person. The fear of withdrawal of hours for deviation from an agreed care plan as voiced Another employer suggested that: above was common. PAs [personal assistants paid through direct One employer summed up the benefits for payments] are more interested in my particular him of direct payments, which he felt were not needs. available through agencies contracted by SSD or through the direct service provision of the SSD: Many recipients of direct payments complained of the inflexibility of both agency … the flexibility … hiring who you want to care and SSD service provision: for you ... having a good working relationship together, trust and routine. I can choose when I have help in and on which days rather than a social service home care Disabled employers chose direct payments manager telling me when someone will be as a means of service provision for a variety of coming. We used to have the same time every reasons although all sought more control over day which bound me to being at home at that their own lives and lifestyles. Some chose it time every day. because of dissatisfaction with previous forms of service provision. It was outside the scope of Meg described having to ‘go to bed at 1800 this research to interview people who were not or earlier’ because of previous patterns of in receipt of direct payments to ask why they support and having to go to bed with her had not chosen that form of service provision.

19 Independent successes

However, some demographical patterns began payments lived in 24 sparsely populated wards to suggest that the choice about whether to (8.2 per cent of the total eligible). No people in receive direct payments might not always have sparsely populated wards used the ILP prior to been made by the person in receipt of services. 1 April 1998. Two people in receipt of direct payments at 31 March 1999 lived in sparsely The location of people choosing direct populated wards (4.6 per cent of the total who payments received direct payments at that time). Four in The population in Norfolk in 1991 was 745,613. receipt of direct payments at 30 September 1999 A population count by parish was undertaken lived in sparsely populated wards (6.9 per cent in 1996. Norfolk has three major centres: of the total who receive direct payments). This Norwich, King’s Lynn and Great Yarmouth. shows that there is a small tendency for the Each area has a distinct culture. Much of the uptake of direct payments to be lower in county is also rural by most measures. During sparsely populated areas. 1998, the research department of the SSD undertook an analysis of the implications of the Rurality and the uptake of direct payments rural dimension of service provision within the A mapping of the wards of Norfolk using a county. The location of disabled employers was measure of rurality devised by Haynes and Gale mapped against the previous measures of (1996) aimed to find indicators of social rurality and sparsity. The figures in the study deprivation appropriate to rural areas are very small (there were 58 people at the time (Coldicott, 1998) (see Appendix 3, Map 5). Large the study was conducted) and may therefore be urban wards are defined as those in continuous skewed for any number of reasons. As shown built-up areas with populations greater than below, there appears to be some small 50,000 people. Small urban wards are defined as correlation between the uptake of direct those in continuous built-up areas with payments and measures of rurality and sparsity, populations between 5,000 and 50,000 people. but this cannot fully account for the distribution Near rural wards are defined as those within of disabled employers throughout the county. 15km of a district general hospital. Far rural wards are defined as those more than 15km Sparsity and the uptake of direct payments away from a district general hospital. Map 4 in Appendix 3 shows a mapping of A mapping of the uptake of direct payments wards by sparsity undertaken in 1996 against the census data of 1991 suggests that (Coldicott, 1998). Wards with 0.5 persons per there is no apparent correlation between income hectare are considered sparsely populated when support levels and indicators of deprivation. funding for services is calculated under the However, the data relating to direct payments social services assessment exercise. There were against the Haynes and Gale (1996) measures of 230 wards, 50 of which were sparsely rurality are shown in Table 3. populated. A comparison of the sparsity mapping and those in receipt of direct payments demonstrates that 39 people who were eligible for direct

20 The project and project evaluation

Table 3 Data relating to direct payments against the Haynes and Gale (1996) measures of rurality Total no. of people Total no. of people % of those eligible eligible for direct taking up direct who take up direct Ward classification payments payments payments Large urban 172 35 20.35 Small urban 161 14 8.7 Near rural 59 3 5.08 Far rural 82 6 7.31

These figures suggest that issues of rurality great differences in the percentages of those and sparsity might have some significance in who were eligible compared with those who the uptake of direct payments. Over 60 per cent take up direct payments by SSD district (see of those in receipt of direct payments lived in Table 4). These may begin to suggest that there large urban wards. The large urban wards in are other factors that are more significant in the Norfolk include Norwich and its environs and uptake of direct payments than issues of Great Yarmouth. However, 31 of the 35 people sparsity and rurality. in receipt of direct payments who live in large Eastern district includes the large urban urban wards live within Norwich city. There wards of Great Yarmouth and yet has a small were only two people in receipt of direct percentage of people taking up direct payments payments in Great Yarmouth, the other large when compared with Norwich which has a urban area. Clearly, this could not be explained percentage take up which is six times greater. solely in terms of rurality. When the ILP was established in 1993, it offered a service within a 25-mile radius of Norfolk SSD district boundaries and uptake of Norwich. This was extended in 1995. Map 1 in direct payments Appendix 3 shows the distribution of people in The SSD district boundaries are shown as at 1 receipt of services from the ILP at the start of the April 1999 in Appendix 3, Map 6. There were pilot project. The Norwich district in SSD

Table 4 Uptake of direct payments by SSD district No. eligible No. in receipt No. in receipt % of take up % of take up for direct of direct of direct of those of those payments payments payments eligible at eligible at District 31.3.99 31.3.99 30.9.99 31.3.99 30.9.99 Western 1115847.2 Northern 124 4 7 3.2 5.6 Southern 89 7 9 7.8 10.1 Norwich 94 25 31 26.5 32.9 Eastern 56 2 3 3.5 3.5 Norfolk 474 43 58 9 12.23

21 Independent successes

therefore has a longer history of payments made all people (18–64) who use community care for independent living than in some of the services. Norfolk SSD divides adult services by others. However, Northern district also includes client group. A year after the commencement of large urban wards in the environs of Norwich, the scheme, one person with a worker in an adult which were covered by the early service of the team (learning disability) received direct ILP and yet have a low overall percentage take payments at the discretion of the assistant director up. Southern district has no large urban wards and one person with a worker in an adult team and yet has a percentage take-up which is twice (mental health) was considering direct payments. that of the Northern and Eastern districts. The As indicated above, Norfolk SSD divided teams ILP, the NCODP and the Project Officer Direct of assessors by the group of people to which they Payments SSD all have offices in Norwich. Some offered a service. The team to which a person of the social workers in the Southern district requiring an assessment of need was allocated team share a building with those in the Norwich could be somewhat arbitrary and could depend district. Although there is little direct contact on the most severe or presenting issue at the time between the teams, their information is readily of referral to the SSD. Where people had a accessible. number of differing needs, this could lead to These data begin to suggest that the most some confusion. For example, it was possible for crucial factor in determining whether or not a someone with a mental health problem to receive person takes up direct payments is the approach support from an adult team (physical disability) if of their care manager, most usually a social they also had a physical impairment or vice versa. worker. This is supported by the material The numbers of people in receipt of concerning how people became aware of direct domiciliary support by social service teams payments, which was discussed earlier. were as follows. One employer living in the Eastern district • People served by adult teams (physical joined the pilot project quite late. She says that: disability): 831 in total; 250 men (30 per cent) and 581 women (70 per cent). ... It took me a long time to get onto the scheme • People served by adult teams (mental and without the NCODP and [name of the Direct health): 146 in total; 41 men (28 per cent) Payments Project Officer SSD] support I would and 105 women (72 per cent). have given up. • People served by adult teams (learning As the Direct Payments Pilot project disability): 87 in total; 43 men (49 per progressed, it became increasingly apparent that cent) and 44 women (51 per cent). the single most significant factor in determining The criteria established by the pilot project who became an employer through direct meant that the following were actually eligible payments was the potential employer’s social for direct payments in Norfolk, i.e. people aged worker. This is explored further below. between 18 and 64 who were in receipt of more Open to all? than five hours per week domiciliary support. The NCODP, in particular, argued that direct For all adults, this figure was 474; 130 men and payments in Norfolk should be made available to 344 women.

22 The project and project evaluation

• People served by adult teams (physical Assistant Director (Adult Care) was disability): 389 in total; 106 men and 283 ambiguously worded when sent to District women. Managers (Adult Care); Team Managers (Disability); District Managers (Support • People served by adult teams (mental Services); Development Officers (Adult Care); health): 56 in total; ten men and 46 Project Officer Direct Payments; Contract women. Officer and Contracts Manager. Significantly, • People served by adult teams (learning Team Managers (Mental Health) and Team disability): 29 in total; 14 men and 15 Managers (Learning Disability) were not cited. women. The framing of the pilot project was described by one senior staff member in the Many people with learning difficulties and field of mental health thus: mental health service users receive services from SSD within day centres and residential It is written from a physical disability perspective placements. Day services within centres were … the way it’s written and designed is not included within the Norfolk Direct discriminatory in a way. Payments Pilot Project and permanent As described earlier, all social work staff residential care is excluded by the government within the adult sector of Norfolk SSD (except regulations concerning direct payments (LAC those working specifically with older people (97) 11). Direct payments were not offered as an aged 65 and above) were offered training in alternative to these forms of service provision. direct payments. Staff within adult teams Hence, the figures for these two groups are low. (physical disability) had knowledge of the ILP Although the figures involved are very small, as but individuals purchasing their own support a percentage of people eligible, the take-up of was a new concept for most staff working with direct payments amongst people who use people who use mental health services or mental health services and people with learning people with learning difficulties. Staff had little difficulties was lower than that of people with a experience locally or nationally to draw upon. physical impairment. Awareness of publications by such as Values Staff involved with the direct payments into Action concerning direct payments and scheme within the SSD worked within adult people with learning difficulties was beginning teams (physical disability). The Projects Officer to enter the arena towards the end of the pilot Direct Payments was originally a team manager project (Holman and Collins, 1997; Ryan and in the Norwich adult team (physical disability) Holman, 1998a, 1998b). and the worker seconded to the assessment role A senior member of the Training and Staff (to speed up the transfer of people from the Development Team perceived direct payments third-party scheme to the pilot project) was to be ‘a physical disability thing really’. sited within the same team. The policy and There was some debate within SSD in the procedures manual relating to the pilot project, early stages of the scheme, particularly within Operational Instruction No. 353 Direct adult teams (learning disabilities) and adult Payments 28 May 1998, circulated from the

23 Independent successes

teams (mental health), about the concepts of occasions where direct payments are ‘willing’ and ‘able’. There was an assumption by appropriate for their clients because they people within these teams that people served by are usually too unwell to control their these teams would be unable to manage. The arrangements. restructuring within the SSD, changes in the • Staff working with people with learning delivery of health services nationally and difficulties are beginning to think more locally, and the debates about the training, about the appropriateness of direct approval and reapproval of Approved Social payments. Workers in the mental health arena absorbed the energy of these teams and the topic of direct These findings are being used to inform the payments was marginalised. development of staff training within the SSD. At the end of the pilot project, the SSD The NCODP was heavily involved in the Project Officer sent a questionnaire to staff. In a arena of disability politics. Although review dated 31 October 1999, he reported that membership of the coalition was drawn from 30 staff had responded of whom six had set up organisations of different groups of people, direct payments. He concluded the following. including mental health service users and people with learning difficulties, the main thrust • Staff generally have a ‘broad brush stroke’ was from people with a physical impairment. awareness of the scheme with some staff They were quite a disparate group of people who have been involved in setting up with varied agendas. A development worker in payments having an in-depth the mental health field commented of people understanding. who use mental health services: • There are sometimes difficulties in I don’t think they see it as a natural coalition … assessing users’ willingness and ability to The coalition doesn’t figure in my day to day work manage payments. – doesn’t figure full stop. They are not involved in • Staff are normally required to give the mental health field. information to users about the range of Whilst there were mental health service services available. However, some staff users who attended the Consultation Group, are withholding information about direct and a person who represented mental health payments where they consider the person service users in the west of the county was on would not be able to manage. They make the management committee of the Direct the point that it is unreasonable to raise Payments Co-ordinator of the NCODP, there expectations only to dash them and was no lobby by people who used mental health resultant discussion can also take longer services concerning the introduction of direct potentially lengthening waiting lists payments. There were no major debates within unnecessarily. groups involved with the Norfolk Mental • Staff working with people with mental Health Care Trust, which was the largest illness felt that there are very few provider of mental health services in the county,

24 The project and project evaluation

nor in the major independent voluntary and service on the scheme. However, some people in advocacy organisations. receipt of direct payments who had social Members of the self-advocacy group for workers in adult teams (physical disability) also people with learning difficulties, Norfolk People had major cognitive and mental health First, sat on the Consultation Group and were problems. Two had enduring powers of more active in discussions about direct attorney. There were people with neurological payments throughout the county. Groups and degenerative conditions that lead to actively engaged in debates about direct significant physical and mental health payments, often with the involvement of, or at problems. Many complained of difficulties with the instigation of, the Direct Payments Co- memory, concentration, processing information ordinator of the NCODP. A slow but increasing and confusion; sometimes the result of pressure has grown for the provision of an prescribed medication. Some were as advocacy service to support people with cognitively challenged as those served by adult learning difficulties, with others, to engage with teams (mental health) and adult teams (learning direct payments. At the time of writing, funding disabilities). has been agreed for an advocacy worker. There seems evidence of an underlying At the start of the project, the Direct assumption that disabled people were ‘unable Payments Co-ordinator of NCODP worked to manage’ in the latter two and an assumption from his home. At one stage, there was a that they were ‘able to manage’ in the former. suggestion that he might spend some time at the Clearly, both assumptions carry risks. Some office of the ILP since the two Co-ordinators people who may have benefited from being in worked closely together. The politics of the receipt of direct payments were not offered that situation, as discussed later, led to a change of opportunity; ‘some staff are withholding heart by the NCODP. He subsequently moved information about direct payments where they into an office in an SSD day centre in Norwich consider the person would not be able to which has traditionally served people with manage’. Whilst recognising difficulties staff physical impairments. This was a pragmatic face in some situations, this raises wider issues solution in many ways since there was space in of equity of service provision for people within an office that was accessible to the Co-ordinator. the county. Some people were being However, this also inadvertently reinforced discriminated against when being offered notions that direct payments were essentially an service options. Other people were in danger of issue for people with physical impairments. exploitation and poor support as they were not As indicated by the above-mentioned properly able to manage the direct payments questionnaire to staff, people working within that they received. A review of one situation by mental health teams felt the people with whom the Direct Payments Project Officer resulted in they worked were too ill to manage direct direct payments being withdrawn from a payments. Workers within adult teams (learning severely physically disabled young woman disability), while apparently more open to the whose condition affected her cognitive idea, still had only two people within their processes and who, as a result, was not

25 Independent successes

sufficiently able to control her personal Formal sources of support assistants. Social workers appear to be operating The dichotomy between disabled people who as gatekeepers with respect to direct payments. self-manage and those who use an assisted Fay comments about this thus: management scheme, and the differences in the roles of the NCODP and the ILP, were not I don’t think they [social workers] are quite as distinct in practice. Fay, who self-manages, says: clued in as they could be about what it means to us … What is good for the spirit is good for the I go through the paperwork and highlight things body … I think sometimes that gets neglected … that seem relevant to me ... knowing your own sometimes they are so busy looking after our back-up system … You pick up on things that bodies – making sure we’re safe and secure and might be useful to me … the fact that there is that we’ve got food on our plates that they don’t someone on the end of the phone. realise that the spirit is being neglected … There was a continuum with some people achieving something ... that’s important. requiring more or less support. The amount of During the pilot project, Dawson and support required by one individual also varied McDonald (2000) drew up a checklist that might at different times. People who self-managed help social workers to ensure that they are from time to time required support and advice working from an assumption of competence and about financial issues and legal matters relating give more clarity to situations in which they judge to employment. Throughout the project, the that a person is not ‘able’ (see Appendix 2). expertise in these matters was perceived, by disabled employers and members of the Systems of support for disabled employers partnership, to be located within the ILP. For At the start of the pilot, support mechanisms example, when Fay had difficulties in were established for disabled employers. The establishing her payroll and in sorting the scheme was constructed so that the NCODP financial issues, she went to the ILP for support. would support those who self-managed She explains: through the Co-ordinator and the operation of Just because I use a remote control to turn my peer groups. The ILP was to manage the payroll telly over doesn’t mean I don’t turn it over myself. for those who wished it and offer practical Just because I don’t paint the walls but I’ve support to people on assisted management. It chosen the colour … It’s under my control ... it was apparent that some people gained most of sounds obsessive sometimes … I go on and on their support concerning direct payments from about having control ... I’ve made all the choices. informal networks: The ILP was thus offering support to people ... My family was the greatest support network – for whom it did not receive a management fee. plus friends and neighbours. Early in the pilot, it was believed that this was However, many did use formal sources of because people, particularly those who had support, although not quite as envisaged by the used the third-party scheme, were familiar with implementation group at the outset. the ILP as a support mechanism. This was not

26 The project and project evaluation

borne out by the questionnaires completed by the people wishing to receive direct payments to disabled employers a year into the project (see attend a formal briefing session. The Direct Figure 7). Payments Co-ordinator of NCODP and the Co- The questionnaires indicated a high level of ordinator of the ILP have made home visits. understanding by disabled employers about There have been practical difficulties about processes and structures relating to direct access to private homes for the former who uses payments. They were able to identify sources of a wheelchair. However, he suggested that the support or points of contact about a range of ILP Co-ordinator would accurately, and without issues; they were not constrained by a need to bias, reflect the different options of support to approach only one source for support. People anyone considering direct payments (see who were heavily involved in the NCODP, Figures 8 and 9). indeed who were personal friends of the The contract between ILP and SSD was re- NCODP Co-ordinator, and who also self- negotiated. SSD made a block grant to ILP to managed sought information and practical provide a support service rather than ILP advice from the ILP. They sought emotional and seeking commission from employers. This also ideological support from the NCODP. Fay served to minimise the potential for competition praises both the Co-ordinators of the NCODP between the two organisations offering support. and the staff of the ILP: Peer groups They are very generous with their time ... They do At the outset of the pilot project, peer groups a brilliant job. They all do. were envisaged as a form of support and expenses were available for those who wished The differences in the roles between the ILP to attend. However, these were largely and the NCODP also became more blurred for unsuccessful although some members did practical reasons. It was not possible for some of

Figure 7 Sources of support for people who used ILP prior to 1 April 1998

Coalition Social worker Other 10 ILP County Hall Unspecified

0 Recruit Management Payroll Forms Hours Payment Charges Sources of support

27 Independent successes

Figure 8 Sources for support for self-managers

7 Coalition Social worker Other ILP County Hall Unspecified 6

0 Recruit Management Payroll Forms Hours Payment Charges Sources of support

Figure 9 Sources of support for assisted managers

20 Coalition Social worker Other 18 ILP County Hall Unspecified 16 14 12 10 8 6 4 2 0 Recruit Management Payroll Forms Hours Payment Charges Sources of support phone each other occasionally for support (see … users to work together not just for Figure 10). themselves. Although 11 respondents of the Some found that they had only energy for questionnaires suggested that they belonged to their own situations: a peer group, attendance at the meetings was minimal. Disabled employers in receipt of direct I do not feel the need. I’m bedridden, payments were very widespread geographically housebound and too ill to bother with it. and in a rural county such as Norfolk it is often Others may have wished to share their difficult for people to meet. The groups ceased. experiences and learn from others but practical This saddened the Direct Payments Co- or emotional considerations inhibited their ordinator of the NCODP who wanted:

28 The project and project evaluation

Figure 10 Sources of support for people who belong to peer groups

9 Coalition Social worker Other 8 ILP County Hall Unspecified 7 6 5 4 3 2 1 0 Recruit Management Payroll Forms Hours Payment Charges Sources of support attendance. Physical resources were low for for not wishing to become involved were some and many people expressed a sense of fundamentally different. For example, Joy saw tiredness: direct payments as a means of her maintaining a lifestyle which she had enjoyed before He [Co-ordinator for NCODP] keeps sending me becoming very disabled by a degenerative things for these functions and I have to keep condition. She did not want to spend her time turning them down. I just feel whacked out. So with disabled people but, when her health he rang me up. He thinks I’m being nasty but I’m permitted, she wished to go to the pub with her not … I asked him if he knew what was going on non-disabled friends. Lesley voiced a similar here so he said he didn’t have a clue ... so I told view somewhat forcefully: him … I just feel whacked out to come to do things in the evening. I’m not a male middle-class paraplegic. It has little to do with chronic sick like myself. Some were concerned that too many demands might be made of them and were ‘not These views highlight a very important sure how much time and energy I would have issue. The people who chose direct payments as available to give’. a method of service provision differed greatly Whilst some of the above indicated that they from one another. Indeed, the only common did not want to spend their financial resources factor was that they received domiciliary or use their personal assistant hours to support, services from Norfolk SSD. Some had congenital or receive support from, the peer groups, there conditions, others acquired impairments. Some was a suggestion that, had personal and had illnesses or conditions that were material resources been in abundance, they degenerative; some did not. Their life would have been willing participants. Travel experiences differed enormously. There were expenses were available to ease the latter. different sexual orientations. Some had been, or Others, however, were clear that their reasons were still, married. Some had children,

29 Independent successes

grandchildren and extended families. Some Some older recipients of the service viewed were young and single. Some were employed, family as a significant support mechanism and some had been employed and others had never actively welcomed their involvement. One says been in paid employment. Some had families that their: who were wealthy whereas others were raised … family was the greatest support network plus in poorer circumstances. Their ages were as friends and neighbours ... paid assistance is only a wide apart as the scheme allowed and both small part of my support – more often than not sexes were represented. One person was from a it’s so stressful that it’s as much hard work for me non-white ethnic group. Some lived in rural as not having any assistance. settings, others lived in towns. Only a few people on the direct payments scheme would Alice lived on an estate similar to that of have socialised with each other outside of this Dawn and had a large extended family in the context. vicinity. Her partner works away from home most of the time, but her mother, father, Extended networks daughter and niece all offer her support. She has Families were highly significant to many people visitors at least daily and also attends a day in receipt of direct payments and to personal service twice a week. assistants. However, the views about family Some older employers did not have parents involvement and support differed within and but had children who were adult, and their between the two groups. involvement and approval was important. Fay Families of employers had been in a difficult marriage and, following a Dawn, a young woman of 24, had recently left long period within the health services through the parental home but lived close to her parents the onset of a very disabling condition, had set who visited regularly. Dawn welcomed this. If up her own home and was now self-managing she had difficulty in paying her household bills her direct payments. She says: or in matters of running a home, she felt pleased ... one of my daughters has been gob smacked by to know that her parents would be able to what I have achieved over the last year ... she’s support her. This type of contact seems little been very proud of what I have achieved and that different from many of the parent–child has been very nice too. relationships within the local estate where Dawn lives. A number of employers had dependent By contrast, other young employers had children and this was significant when choosing limited contact with their parents. Some had personal assistants and determining their role parents who could be called on in an emergency. within the home. Employers were not In reality, this support was seldom sought. ‘dependent people’ but had other, often very Independence for many younger employers vulnerable, people such as children dependent meant moving away from their parents and upon them. Lesley says that in contrast to the being able to live alone without their parents’ situation with agency care she can: regular intervention in their lives.

30 The project and project evaluation

… decide on some of the things I need doing … extended family that lives outside of Norfolk. and don’t have someone bossing my family and I Her prime personal assistant has an extended around and telling us what to do. family that lives locally and also cares for her grandchildren. All visit Kate and this has An important issue is raised here with respect created a new social network and in her words a to the welfare of children and of vulnerable ‘second family’. adults. Employers are responsible not only for Wendy, an employer in a more rural part of themselves but also for others with whom they the county, has small children. She employed a live. Many were acutely aware of this. mother from the school attended by her own Employers in receipt of direct payments children as a personal assistant. This provided viewed dependency and independence very support for her and company for her children as differently from one another. Debates raised at both sets of children came to the home after the consultation conference also highlighted school and would spend time together during difference in this area. For some people, the school holidays. independence meant that the locus of decision The husbands of personal assistants also making should be within their own family; gave support to employers particularly with within a wider context of dependent and inter- respect to heavy work, building or decorating dependent relationships. For others tasks. There was a sense from some employers independence meant making decisions alone and from some personal assistants that there and apart from their families. was a mutual support, which could stretch Families of personal assistants beyond the immediate employer–personal Children also featured heavily in the lives of the assistant relationship. Employers felt they were personal assistants. Many personal assistants contributing to the welfare and income of their were women who had dependent children and personal assistants in exchange for their support who were balancing the needs of children with in domiciliary tasks. paid employment. Personal assistants And Lisa said well … I know someone who Experience gained from the third-party scheme wants work ‘cos she’s got children and so she’s of the ILP suggested that people may need now home when she leaves off – for her children support in finding personal assistants. However, ... I’m easy … well I don’t mind children and if it had also shown that many people recruited they’re stuck and they can bring the child ... I can assistants through informal social networks stick the video on. I’ve got all the Walt Disney or (Dawson, 1995). Those moving to direct they can go in the garden and play ball on a day payments from the third-party scheme, for the like this … so I go flexi with them as well. most part, transferred with the same assistants. Personal assistants bringing children and Recruitment of personal assistants grandchildren to the home were not only Recruitment of personal assistants was tolerated but also actively welcomed in some repeatedly voiced as an area of potential situations. Kate, a disabled employer, has an

31 Independent successes

concern by employers. Interestingly, those who Methods of recruitment varied (see Figures had had no difficulty in recruiting perceived 11 and 12). that there may be a future difficulty in this area There was little difference in the pattern of if their present personal assistants were to leave. staff recruitment between those who are assisted Some concerns were very clear. People who in their management and those who manage employ personal assistants do not have the their own arrangements. The former group power to seek police references about their employed 36 staff and the latter 31. Friends and employees. Disabled employers may be open to word of mouth were the second route compared abuse. As Emma who lives alone said: with placing advertisements. Many personal assistants who were recruited through I am not able to check on potential employees so advertisements or word of mouth would not I could be open to criminal abuse. have considered employment with the SSD or Others were concerned that vulnerable with an agency. The terms of contracts of service adults or children with whom they lived might were considered too restrictive in these formal also be victims of abuse. The latter raised settings. Also many viewed their ‘work’ as a questions about potential child protection issues relationship with the employer and would not for disabled parents, and the SSD children and wish to work for more than one disabled family teams. Disabled parents, like any others, person. have responsibility for the welfare of their Advertisement children but there can be no assumption that Some employers who recruited through advert they will not fulfil this role appropriately. Some found it quite difficult. One said: employers on the direct payments scheme in Norfolk asked their employee to provide their I’m still looking for an assistant … it takes ages ... own statement from the Criminal Records Office it’s so long winded. which cost approximately £10 to obtain.

Figure 11 Recruitment of staff by people with assisted management

0 No. of No. of Friend SSD Other Residential Advert Other employers employees agency carer

32 The project and project evaluation

Figure 12 Recruitment of staff by employers who self-manage

0 No. of No. of Friend SSD Other Residential Advert employers employees agency carer

Fay placed an advertisement and had three unfortunate experiences with unsuitable respondents. She describes the interviews: personal assistants that they had recruited through advert. One very physically disabled The other two people were really unsuitable, they employer laughs when telling the story of one weren’t flexible enough. One wasn’t flexible employee who had arrived drunk for a shift and enough timewise. She could only offer me he had arranged for a taxi to take them home. between 10.00 and 12.00 each day. The other He now has two live-in personal assistants. one thought I would be a severely disabled Another employer discovered he still had a person ... more personal care … Whereas Kelly high turnover of staff and found a negative of was actually more (a) flexible in her time and direct payments to be ‘having to recruit every more (b) flexible in what she was prepared to six/12 months’. learn for this ... what she was prepared to offer. This highlights an issue about the sort of Kelly had never undertaken any work in this person employed. This person employed young field before whereas the other two applicants people who had similar approaches to life as had, but Kelly was offered the job. ‘I know they himself. However, the people available for work offer training for people but I did a session in this category were often students who moved between my daughter, Kelly and I’. Her at the end of their course. daughter had worked in professional support Friends tasks previously and ‘showed her how to do it Some people, like Jane, employed friends or all without her getting hurt’. friends of friends in their local area. Alan found that some people did not come for the interview despite having made an And Lisa said well … I know someone who arrangement and another person actually did wants work ‘cos she’s got children and so she’s not turn up for their first shift. now home when she leaves off – for her children Exceptionally, employers had had very ... if one can’t make it they phone the other one

33 Independent successes

so we all work in … I interview them, I give them assistants employed on the scheme). On a month’s trial and see if they work in fine with occasion, the personal assistant was still me. employed by the agency with respect to other work. Conflicts of interest arose infrequently but Jane has four women who come in on a these were issues which needed to be regular pattern and two ‘floaters’. She affords addressed. There was discussion by some them different status. Her main supporters agencies of charging a fee if their staff were to receive holiday pay but her relief staff do not. support people privately when they had been As discussed below, many employers sought employed by an agency to perform the same staff who lived in close proximity. This was tasks. This did not happen during the pilot valued by both parties. The personal assistant project. SSD considered the in-house home care could go home quickly if needed by their own service employment contracts with their family, but was also on hand if there was an employees very carefully and drew their emergency at the home of the employer. For employees’ attention to the terms of their example, one employer had been able to call on contracts. In some areas, SSD home care service a personal assistant at short notice when she fell found it difficult to recruit staff and there was out of bed. no agreement of consistent hours to be worked Agencies each week. Some former SSD staff who became Both groups of people, those who received personal assistants suggested that they had assisted management and those who self- found this unsatisfactory. managed, employed five personal assistants Gender and age of personal assistants who had worked for agencies from whom the All age groups of employers chose most people employers had previously received services (13 within the age range 30–50 (see Figure 13). Both per cent and 15 per cent of the personal genders employ more women (see Figure 14).

Figure 14 Gender of employees by gender of Figure 13 Age of employees by age of employer employer

20 50 PA <30 Female PA 30–50 employer PA >50 40 Male 15 employer

30 10

5 10

0 0 18–25 26–35 36–45 46–55 56–64 Female Male Employer age groups employees employees

34 The project and project evaluation

This is consistent with the data from within people might find it difficult to recruit personal SSD, and national research, which also suggest assistants. This fear seemed to be unfounded. that the majority of staff in caring and support Most people recruited assistants who lived very roles are women. There is no difference between close to them. There is little difference between the employment patterns of those self-managing the groups of assisted and self-managed groups and those with assisted management. with respect to the mode and time of travel by their personal assistants (see Figures 15 and 16). Travel to work by personal assistants There is a small difference in that more personal In a rural county like Norfolk, which has a very assistants with employers on assisted poor public transport system, there was concern management take ten rather than five minutes at the outset of the pilot project that some to make their journey.

Figure 15 Mode and time of travel: assisted managers’ employees

40 No data 35 Lives in Bicycle 30 Public transport 25 Walk Car 20

0 Total 5 minutes 10 minutes 30 minutes 60 minutes Lives in Time

Figure 16 Mode and time of travel: self-managers’ employees

40 Lives in 35 Public transport Walk 30 Car 25

0 Total 5 minutes 10 minutes 30 minutes 60 minutes Lives in Time

35 Independent successes

Management of personal assistants tribunal. The employer received support from The management of staff was an issue for some the ILP in managing her affairs and the ILP was employers. The ILP offered financial assistance named as a co-respondent in the hearing, which and support in recruiting personal assistants but had major ramifications within the scheme. the daily management of staff was the Legal advice was sought and the ILP was responsibility of the disabled person. eventually deemed not to be an employer. This Relationships between the employer and contrasted with the findings of the tribunal in personal assistant could take many forms. In South Lanarkshire in which the Council was one situation, a romantic entanglement caused regarded as an employer in a situation where a some embarrassment. Close proximity of personal assistant sought damages when employers and personal assistants was employed through monies from the particularly pertinent when staff lived in or Independent Living Fund (Hun, 1999). In worked very many hours involving support Norfolk, a settlement was eventually agreed with intimate personal needs. Paul explains the between the employer and the personal difference thus: assistant. However, in one situation, in March 2000, a … if you upset someone in the morning well ... person had not transferred from the third-party they are still here … it’s different if you only have scheme to direct payments because of a debate someone coming in for a couple of hours. about the suitability of one of the personal Whilst most situations worked very well for assistants to be employed in that capacity. both the employer and the personal assistant, there were some circumstances in which Training of employers and personal employers needed to assert their control over assistants the situation. Many were uncomfortable with this aspect of the employer’s role but were able Training of employers and personal assistants to carry it out when required. As cited above, was seen to be an important issue at the one employer dismissed a personal assistant beginning of the pilot project and the NCODP who was drunk on arrival at his home. was contracted to provide training. Not all employers were able to assume control. In one instance when a young woman Training of employers was unable to assume the level of control The Co-ordinator of NCODP wrote a manual for deemed necessary after much support, she left employers explaining the operation of the the pilot project. scheme and outlining issues of employment In another scenario, the mother of an practice. There were no formal training events. employer intervened when she had to respond in an emergency as a personal assistant had Training of personal assistants again let the employer down. In this instance, At the outset of the scheme, the Implementation the mother dismissed the personal assistant Group also perceived a need for the training of who subsequently complained to an industrial personal assistants. The nature of the training

36 The project and project evaluation

and the topics to be covered were discussed by Personal finances the Implementation Group. The significant Whilst the direct payments scheme has factor was that disabled employers did not want safeguards concerning the spending of the their staff to be trained without their being payments for personal care, there is no such involved. Some employers, like Fay above, safeguard around other monies. There was wanted to train their staff themselves. Some confusion on the part of some recipients personal assistants did not want to be trained concerning charges for services. Norfolk SSD formally but to learn from their employer what has a charging policy, which means that all was needed. It was agreed that employers people in receipt of community care services are should decide for themselves how best to train assessed according to income for a charge their own personal assistants and money was towards their services. Recipients of direct made available for them to purchase training if payments are not exempt from this. The Income they so chose. Section of SSD was somewhat slow initially in issuing invoices for charges. Many employers found this distressing as they were confronted Monies with large bills which some had not been Financial issues impacted on the pilot project in expecting. One employer voiced this negative a number of ways. Disabled employers were aspect of the scheme thus: required to open separate bank accounts … not getting my bills regularly from County Hall through which to handle their direct payments. for weeks at a time. They write to me saying they This became complex for some people as they are at fault with the delay and then send me a also received funding from other sources, which threatening letter ... if I don’t pay immediately. they used to purchase support. There were also areas where it was difficult to ascertain which This situation was resolved to a large extent was an expense that should be met from the when the financial monitoring role was direct payments fund and which from the assumed by the SSD and the departmental disabled employer’s own money. For example, procedures were tightened between the system Joan talks of the issues when her personal concerning direct payments and the Income assistants take her out for the day. Section. Some disabled employers found themselves … personal care isn’t all in my home. I’m not in difficulties with respect to the payments of going to sit in all day if I can go out but that’s still household bills, and were dependent on my personal care isn’t it? informal carers and supports for this task. She pays the hours for her personal support Dawn’s mother paid her bills. She hopes that from her direct payments budget, her personal her household bills will soon be paid by her assistant’s mileage expenses from her mobility personal assistants. She also feels that a new allowance and lunch for her personal assistant electric wheelchair will aid her independent from her own money. mobility and she may be able to maintain more privacy concerning her monies.

37 Independent successes

Some people are finding themselves in debt which returns had to be made. On a four- or are turning to the ILP for support in weekly basis, the employer supplied the ILP managing general finances. Others manage all with paid invoices, and any other supporting their own finances by post, Internet or evidence, detailing the service provided and telephone. In exceptional situations, this monies spent each week during the previous function has been wholly delegated to a four-week period. The employer was further personal assistant. Even where an employer has required to send the ILP a copy of his or her a number of staff, only one usually performs direct payments bank account statement once a this task. Clearly, it is an issue which employers quarter (i.e. every 13 weeks). The ILP checked need to consider when recruiting staff. It is also the returns received from the employer (or an issue which social workers need to assess agent) against the details on the contract and the when drawing up the numbers of hours care plan previously supplied by the assessor. allocated to people for direct payments. SSD Once a quarter, they also checked payments criteria allow for administrative tasks to be against the bank statement. Details of the included in care plans. services purchased by each employer were then sent to the Contracts Section at County Hall by Financial monitoring of the use of direct the ILP within two weeks of the end of each payments four-week accounting period. The information Monitoring of the ILP records was undertaken was entered on to the Contracts Database, with by the SSD Contracts Section and the Direct a copy being passed to Payments Section, to Payments Project Officer. It was identified that make any relevant payments, and Income those who were using the ILP on the second Section, which issued invoices for the system (where the person makes their own employer’s assessed contribution (charges for payments although the ILP operates their service). payroll) were not subject to the same level of Early in the pilot project, it became apparent monitoring as those on the self-management that the monitoring of financial returns by the scheme, although they did pay their own staff ILP presented an additional complication in an directly. There were eight employers in this already complex scheme. The very tight controls group. They will be expected to follow the and the copious paperwork were not monitoring process for those on the self- satisfactory for any party. Without exception, management scheme in the future. the monitoring process was identified, through Monitoring the use of direct payments for the questionnaires and through the research people who chose either the ‘self-management’ interviews, by recipients of direct payments as or ‘assisted management – (other)’ was initially the least satisfactory part of the process. One undertaken by the ILP. On receipt of a copy of disabled employer who manages her own direct the contract from the assessor (the social worker payments felt very strongly that the or occasionally occupational therapist), the ILP involvement of a third party with respect to this contacted the employer to explain the process, role was an infringement of her privacy. and to give him or her a schedule of dates by Another suggested that it impinged on her

38 The project and project evaluation

relationship with her personal assistant. She After a year of the pilot scheme, these rates argued that there should be: were changed because of:

No requirement for timesheets – [it should] work • a change in the employment market on trust between both parties. which meant that recipients started to experience difficulties recruiting The monitoring role also compromised the supporters at that rate independent status of the ILP since they were perceived to be ‘policing’ direct payments on • recipients were starting to accumulate behalf of the SSD. The full monitoring role was significant reserves in respect of unspent subsequently returned to the remit of the SSD on-cost monies that were not required. and a post was established within the As from April 1999, it was decided to tie the department for that purpose. rates into the hourly rate paid to local authority home care assistants. It was also decided to Summary of financial arrangements within reduce the percentage paid in respect of on-costs the project from 25 to 15.5 per cent. As from April 1999, the Domiciliary assistance rates rates paid were £4.98 per hour for support plus At the start of the pilot project in Norfolk, it was on-costs of 77p giving a revised hourly rate of agreed that for simplicity a standard hourly care £5.75. Recipients were also allowed more rate would be paid to recipients for all hours of freedom over the way in which they used the support to be purchased no matter what time of on-cost part of their payments. This seems to be day or week they were to be used, i.e. no working better and financial monitoring differential rates for weekends, anti-social indicates that people have sufficient money to hours, etc. Instead, a slightly enhanced rate purchase support-necessary on-costs. would be paid which would allow direct The Norfolk scheme has to date had a payment recipients enough slack to be able to minimum requirement of five hours per week as pay differing rates if they so chose. being the assessed need before anybody could At 1 April 1998, based on the previous qualify for direct payments. This was originally experience of the ILP of running the third-party introduced because of the cost effectiveness of scheme, an hourly support rate of £4.50 per providing direct payments and all the support hour purely for the payment of supporters was services. As the scheme is becoming more agreed. To this figure, on-costs of 25 per cent established, this will be reviewed. were added in order to cover such as income tax, national insurance and holiday payments. Night sitting This brought the overall hourly rate paid to At the start of the project, a figure of £40 per recipients up to £5.63 per hour. At this stage, night was agreed for the support costs which recipients were only allowed to use up to £4.50 then had the 25 per cent on-costs added, giving per hour to pay supporters as the on-costs were an overall figure of £50 per night. As with the specifically for other costs and they were domiciliary assistance rates, this was changed in required to keep the two parts separate. April 1999 and is now £44.27 per night support

39 Independent successes

costs plus 15.5 per cent on-costs giving an Self-management overall figure of £51.13 per night. These revised In addition to the rates paid to purchase the figures were arrived at by adding the same support required (as detailed above), people percentage increase to the support element as who were self-managing were also paid a was added to the domiciliary support element. standard weekly amount (irrespective of the amount of support they were being paid for) of Night sleeping £7 per week in order to cover any costs incurred At the start of the project, a figure of £30 per in administering their own payroll. Although night was agreed for the support costs which this was paid as a standard amount each week, also then had the 25 per cent on-costs added, recipients were allowed to use it as necessary, giving an overall figure of £37.50 per night. As for example they may spend a block of £30 per with the domiciliary assistance rates, this was month. However, they could only use it for changed in April 1999 to £33.20 per night plus expenses incurred in managing their direct 15.5 per cent on-costs, giving an overall figure of payments and they had to account for its £38.35 per night. These revised figures were expenditure. arrived at by adding the same percentage Again after the first year, it was discovered increase to the support element as was added to that very few people were making much use of the domiciliary support element. this money and as such it was just accumulating Live-in support in their accounts. Therefore, as from April 1999, At the start of the project, a figure of £280 per it was agreed to stop paying this as a weekly week was agreed for the support costs which entitlement and instead to hold the money also then had the 25 per cent on-costs added, centrally and allow recipients to claim against giving an overall figure of £350 per week. As this central pot of money as and when they with the domiciliary assistance rates, this was required it (up to an average of £7 per week). changed in April 1999 and is now £309.88 per However, in practice, few people claim this week plus 15.5 per cent on-costs, giving an despite being entitled to do so. overall figure of £357.91 per week. These revised Assisted management – ILP figures were arrived at by adding the same The ILP provides support, including a payroll percentage increase to the support element as service to people who wish to receive direct was added to the domiciliary support element. payments but who want/require more support Management fees with managing their payments (i.e. the ILP acts Under the Norfolk scheme, there were three as their agents). At the start of the pilot project, options, namely ‘self-management’, ‘assisted it was felt that the central government guidance management – ILP’, or ‘assisted management – was indicating that each case had to be shown other’. The differences between these options to be ‘no more expensive’ ( LAC (97) 11) than are explained elsewhere in this report. The providing direct services so, with this in mind, it financial implications of each of these options was decided that the costs of the ILP needed to were as follows. be shown against individual users who chose the ‘assisted management – ILP’ route.

40 The project and project evaluation

Again based on past experience and the has had to invest a considerable amount of staff number of cases choosing this route, it was time in the development and maintenance of the decided to add a 17.5 per cent management fee scheme. Originally, the pilot was set up with to the payments made in respect of people on input from a team manager for people with a this option. For example, a person in receipt of physical disability and a Contracts Officer ten hours’ domiciliary support would have been working within their existing posts. However, it paid £56.30 in respect of the support plus on- soon became clear that this was not practical so costs plus 17.5 per cent management fee of £9.85 a full-time temporary post of Direct Payment per week, giving a total of £66.15.This money Project Officer was created to oversee the was then paid to the ILP who kept the 17.5 per development of the scheme. This was at team cent towards their running costs and paid the manager level. remainder into the client account to administer After the first 18 months of the project, the on behalf of the user. following became clear. Again after the first year, this was changed • There was a need for a permanent 0.5 full- as it was found to be administratively time time equivalent post of a Direct Payments consuming. As from April 1999, the ILP has Project Officer to maintain and continue been funded via a service agreement for a block to develop the project. of service. During 1999/2000, this cost £95,000 for providing the service to between 50 and 60 • There was a need to create a Monitoring users (including the fee for the monitoring task). Officer Post in order to return the This has proved to be much easier both for the function to SDD. It has now been agreed local authority and for the ILP. that these 1.5 full-time equivalent posts will be established and recruitment is Assisted management – other currently under way. It is estimated that This has been dealt with in the same way as these posts will cost approximately self-managers (see above). £30,000 per year. It is hoped that, once the Funding the support organisations incumbents of these posts are in place, Under the Norfolk scheme, there were two other staff who have been involved will support organisations: ILP and the NCODP. The be able to be less involved. funding of the ILP has been explained above. In addition to the staff costs, the local The NCODP is funded via a service agreement authority also spent approximately £1,000 a and currently costs approx £21,000 per year. At year, from a budget of £2,000, on miscellaneous the start of the pilot scheme, a joint funding bid costs such as venues for meetings and was approved which pays for this support for consultations, and travel expenses for the first three years of the scheme after which employers to attend consultation meetings. the local authority will assume responsibility. Contingency fund Local authority support costs It has been mentioned earlier that, right from In addition to the costs of the support the start of the pilot scheme, a contingency fund organisations detailed above, the local authority

41 Independent successes

of £10,000 was set up in order to cover any users could ask for any training they felt they unforeseen expenses that a recipient might incur needed. This training fund is held and and which they could not cover from their administered by the NCODP. direct payments. For example, if an employer This fund works the same as the contingency experienced a high turnover of supporters, they fund. At the start of the project, the NCODP was might be incurring high recruitment costs which given £10,000 to hold and administer. At the end they could not meet from their payments. In of each financial year (or earlier if necessary), such a case, they could make a claim against the the local authority tops the fund back up to the contingency fund. As from April 1999, this fund £10,000 ready for the new financial year. has also been used for people claiming their During the first year of the scheme, very payroll allowance. At present, the contingency little use was made of this fund. However, fund is held and administered by the ILP, during the second year, it appears that although this is currently being reviewed and approximately half of the amount available will subsequently be resumed by the SSD. could be used (although some of this will be on This fund works as follows. the production of training materials rather than on direct provision of training courses). Again, • At the start of the project, the ILP was despite the relatively small use of this fund, it given £10,000 to hold and administer. provides employers with reassurance that they • At the end of each financial year (or can access training if they wish. earlier if needs be), the local authority Summary of figures tops the fund back up to the £10,000 As part of the ongoing monitoring of the cost ready for the new financial year. effectiveness of the scheme, the figures shown During the first year of the scheme, there in Table 5 were produced in respect of 1999/ was very little use made of the contingency 2000. fund (probably less than £1,000). As a result of some of the other changes introduced as from Cost effectiveness April 1999 (detailed above), more use has been Direct payments were introduced by central made of this during the second year. However, government with an expectation that local it is still likely to spend only half of the available authorities would be able to introduce this £10,000. Despite the relatively small use of this alternative to direct service provision with no fund, it provides a very valuable safety net to extra funding requirements (LAC (97) 11). employers. Within the pilot project, the estimated costs of direct service provision for the same services are Training fund higher than those for direct payments. If cost At the start of the project, it was anticipated that effectiveness is measured in these terms then users of the scheme might require training in a direct payments are a cost-effective means of number of aspects of direct payments, e.g. delivering a service. However, such figures do employment issues, etc. Therefore a training not take into account hidden costs, such as time fund of £10,000 per year was established so that

42 The project and project evaluation

Table 5 Cost of direct payments, 1999/2000 £

Costs of personal support/service delivery 574,867 Support organisation – ILP 95,000 Support organisation – NCODP 21,000 Contingency fund 10,000 Training fund 10,000 SSD development/monitoring 30,000 Project support costs 2,000 Less underspend on contingency/training –7,000 Total 735,867 Estimated costs of direct service provision (50% agency, 50% SSD in-house provision) for the same level of support Total 764,560 and resources spent within both the SSD and meetings of operational staff, within teams of support agencies in establishing the different home care managers, within senior systems, nor do they offer a measure of the management teams (including directorate), quality of service delivered and whether the within the research department, policy and service may be delivered more cheaply or planning department, and finance department. efficiently via other means. All of the meetings would have involved the preparation of papers and discussion Time and resources documents. The resources that supported these As outlined above, the pilot was originally set meetings and the time of the staff involved were up with input from a team manager (adult care) hidden costs within the SSD. physical disability and a contracts officer There was also time spent within the working within their existing posts. However, it support agencies of a similar nature. The fact soon became clear that this was not sufficient so that there were two support agencies increased a full-time temporary post of Direct Payment the time involved in meetings and negotiation. Project Officer was created to oversee the All was in duplicate; two service contracts with development of the scheme. This was at team the SSD, two venues, two sets of administration manager level. A social worker was also and equipment costs. seconded to the project to conduct the The scheme devised by the partners was reassessments necessary for the transfer from extremely complex. The three options the third-party scheme. This was not reflected in necessitated different systems within SSD and the costings. the support agencies. Initially, they also Prior to the commencement, and during the required different systems of financial early stages, of the project, time was spent monitoring. This was subsequently changed consulting with all the managers in adult and all was monitored directly by SSD. The services and there were discussions within team

43 Independent successes

complex nature of the scheme led to some is clear that the majority of the hidden costs in confusion at the beginning of the project within the Norfolk scheme were incurred in the staff of SSD and with potential recipients of establishing the scheme and in the early stages direct payments. A less complex scheme may of its operation. The hidden costs will decrease have led to less discussion time and paperwork. as the scheme continues and the hidden savings Another hidden cost involved social work will increase. time. To establish a direct payment for an Quality of service individual employer required the systems to be There are many points at which quality might set up and the processes to be engaged. The be measured in this project. All may be judged systems for payment and monitoring had to be by standards set by SSD, by criteria determined established. This was another hidden cost. by the agencies involved in the scheme, by However, once direct payments were criteria established by external bodies, or by established and personal assistants recruited, measures adopted by disabled employers. There the involvement of social workers, and their was no agreement at the outset of the project time, was deemed to be less than might have about the means by which the quality of the been the case were the person in receipt of direct service would be measured and there was an services or agency support. ongoing debate about what constituted a good When people are in receipt of a direct quality service. General notions, such that the service, the costs of employing the home care money would be spent on support, that people assistants and their management are incurred would receive the support which they were by the SSD. Employees of the SSD invoke the assessed as needing, and that people would involvement of the personnel department, the receive the support they needed in their role as finance section, policy staff and operational and employer in a manner which was acceptable administrative managers. All employment and accessible, and that the whole would be issues were dealt with by the disabled decided by the members of the partnership employers themselves on the direct payments working in harmony, guided the discussions but scheme, which has resulted in a saving in this were not defined in measurable outcomes. respect within the SSD. These may be seen as The criteria used by different parts of the hidden savings. service system to judge quality are not always A survey by Zarb and Nadash (1994) of four the same and can be, in some circumstances, in local authorities and 70 disabled people, which direct conflict with one another. For example, if considered detailed budget data including all the conduct of personal assistants was identifiable administration costs and overheads measured by the criteria within the SSD set for involved, concluded that arrangements financed home care assistants, the quality would have by direct or indirect payments (through a third fallen very short of the stated standards in party) were on average 30 per cent cheaper than certain respects. As discussed above, some direct service provision. The Norfolk pilot disabled employers actively encouraged their project does not have detailed figures for the personal assistants to bring children, and in one administration and overhead costs. However, it

44 The project and project evaluation

case grandchildren, to their home. Yet, this is recommended to employers. On the whole, this forbidden within direct service provision. The was in evidence during the pilot scheme and few Employee Handbook (Home Care Assistants) states personal assistants left their employment. that ‘under no circumstances must you take The primary judges of the quality of the your children to your place of work with you’ service were the disabled employers. Employers (Norfolk Social Services Department, 1996, p. 6). were actively involved in steering the direction The decision about whether the service was of the pilot project in many ways. The NCODP ‘good enough’ rested in five places during the Direct Payment Co-ordinator was himself a pilot scheme: senior management within the disabled employer in receipt of direct payments. SSD (and subsequently the social services The peer groups that he supported, the committee of the County Council); the review consultation group and the conference for system for receipt of community care services; recipients of direct payments were all means of the personal assistants; an employment tribunal; eliciting their views. Feedback from the work and disabled employers. The role of the first supporting individuals undertaken by the was primarily to ensure that the scheme met the NCODP Co-ordinator and the staff of the ILP, criteria laid down by central government and and the research from the JRF monitor, also that the budgetary implications were sound. informed the Implementation Group of the The financial monitoring system highlighted views of disabled employers. whether the appropriate number of support As indicated above, employers chose their hours were being claimed and any discrepancies own personal assistants and, within were picked up. There was also a review of employment legislation, were able to determine service every six months. The last two functions the conditions of service and role of the personal were social work tasks but during the pilot assistants. In some situations, the personal project these were often undertaken by the assistants were not able to perform as well as Direct Payments Officer to maintain a the employer had wished but employers consistency of service and because of the maintained that, overall, when judged by their pressures on social workers. The review system own criteria, the support received through was to be strengthened after the pilot project direct payments was better than that provided when it would be continued by social workers through direct service provision or through who may not be as familiar with direct contracted agencies. Some employers had payments as the officer. actively chosen direct payments because the During the scheme, there was concern that quality of service they had received previously, personal assistants should receive a wage which in terms of flexibility and responsiveness to was at least equal to that of staff employed in their need, was considered to be poor (see similar roles within the SSD and that there should comments earlier in this report). For some be sufficient funding within the monies paid to employers, there were negatives in managing disabled employers to take into account matters their budgets and staff but in a cost/benefit such as sickness and holiday pay. Equitable analysis the benefits greatly outweighed the conditions of service were also sought and costs. This is discussed in more detail below.

45 Independent successes

A cheaper alternative? themselves. One man went to bed in his clothes Direct payments are a cheaper alternative than one night so that he did not have to call a direct service provision or contracted agency personal assistant out at 4.00 a.m. one morning service and become cheaper still comparatively when he was going to London. This was his over time. The present scheme could become choice and he was pleased to have had the more cost effective by using one support agency option of making that choice. The sense of being rather than two. Savings would also be made if in control, making decisions and taking less support were offered than at present but responsibility for their own decisions was this would mean that some people who have highly significant for some. One described the chosen the ‘assisted management’ option may sense thus ‘I’m in control’. Another suggested no longer feel able to manage. Others may that she had ‘total freedom in my day-to-day continue but the risks of financial, physical and life’. emotional harm would increase. A reduction in Some disabled employers spoke directly of the the wages of personal assistants or their pilot project. One maintained that ‘this scheme conditions of service would be another, although really works’. Another felt ‘really privileged to be equally undesirable, means of cutting costs. a part of this scheme’. One employer was very It is difficult to envisage an alternative clear about what the scheme had meant to her means of delivering a community care service, and wrote on the bottom of her questionnaire: where there remains the requirement for an It’s given me my life back, energy for my family, assessment of need by the SSD, which would be peace in the thought that there is some normality cheaper than a direct payments scheme. once again. I urge the SS committee to make this scheme stay. If it wasn’t kept I wouldn’t just lose The views of the players about the scheme my carer, I’d lose a better way of life for our family. Views of disabled employers Disabled employers had positively chosen For most people who joined the pilot project, direct payments and, with very few exceptions, it was a positive experience as illustrated by the were pleased to have made that choice. Some above comments. Only eight people left the suggested that the time and pressures involved scheme, all for very different reasons. Five had in employing their own staff were weighty but chosen the self-management option and three worth the effort. were assisted.

It’s more pressure – but then that’s life! • One man on the self-management option died. As highlighted above, some employers experienced challenges with their personal • One man on the self-management option assistants, particularly where there were was admitted to a psychiatric hospital. management issues. However, the ‘mistakes’ • One person who was managing their own that were made in some poor appointments support was also paying full charges to were seen as mistakes that they had made for

46 The project and project evaluation

the department and so it became more Payments Project Officer, it was decided cost effective to buy her support privately that she would find it more appropriate to rather than through the SSD. return to direct service provision.

• The personal assistant of one employer Few people, therefore, left the scheme who self-managed left and she chose to because of difficulties in managing direct withdraw from SSD services completely. payments or because they did not like the scheme. In most of the situations, withdrawal • One man who managed his own support was due to a change in life circumstances. refused to submit monitoring forms and For most people, the direct payments were a after six months his direct payments were positive alternative to direct service provision or suspended. that provided by agencies contracted by the • One woman on the assisted management SSD. The positives voiced include: option experienced a marital break-up • employing whom they choose and moved into residential accommodation. • determining the hours of employment

• One woman, in receipt of mental health • determining the tasks they require the services, experienced difficulty in personal assistant to undertake fulfilling her role as an employer and • the flexibility of the employment there were concerns that her behaviour relationship which allows them to vary towards her personal assistants, who she their routines and activities with more threatened frequently with dismissal, ease would cause future difficulties for both parties. The SSD now employs the • the level of support offered in their role as assistants who continue to offer the same employers support to the woman as previously. • decrease of involvement with • One woman, with multiple sclerosis, was professional agencies. unable to manage her staff even with Areas of improvement which they identified support from the assisted management within the scheme include: option since her mental capacity was greatly affected by her illness. Whilst the • more training and awareness raising for ILP operated her payroll, it remained her some social work staff responsibility to manage her staff. On one • the ability to use more flexibly the monies occasion, she had arranged for two in ‘care account’ (the account opened different agencies to provide support and specifically by the individual for the one personal assistant who she employed purposes of direct payments) separately to provide cover at the same time. After discussions with the Direct

47 Independent successes

• the cumbersome paperwork related to the individual employer. Direct payments were seen financial monitoring and the frequency of as a positive factor in their lives as well as the the forms lives of their employers.

• the financial systems (particularly those The partnership relating to charges for services) at County There were three partners in the Norfolk Hall. scheme: Norfolk SSD, NCODP and the ILP The last three were addressed during the (whose parent organisation was HAND). At the pilot project and improved in some part. These start of the pilot project, both HAND and issues are still under review. This was valued by NCODP were controlled by disabled people. All some recipients, who felt that their voices were three partners held different ideologies and had being heard and their concerns acted upon. One different aims. Whilst all the members of the claimed that ‘it’s brill to have input’. The partnership had a shared commitment to training and awareness raising of social work disabled people receiving payments, all also had staff was ongoing but needs further their own agendas, expectations and consideration. constraints. Within the SSD, the additional drivers were the need to transfer service users The personal assistants from a third-party scheme to one which Interviews with personal assistants were only conformed with the requirements of the new conducted at the introduction of the employer. legislation governing direct payments, to Therefore, a full range of views may not have provide a service which was in keeping with been accessed during this research. However, professional standards, and to do this with no those interviewed suggested that they preferred additional funds. The ILP also shared the need to work directly for a disabled employer rather to transfer people to direct payments but, since than for an agency or SSD. Many did not it derived its income by the commission it perceive themselves to be ‘professional carers’ charged on services offered under the third- but viewed their work as a relationship of party scheme, there was a need to secure support between themselves and their funding. The parent organisation continued to employer. Often the support was mutual. focus upon the need for advocacy for disabled Many would not have been able to adhere to people. The NCODP sought more control for the conditions of service within the SSD. Also, disabled people in whatever arena. Where aims since the SSD could not guarantee regular hours were shared, there were differences about how of work each week during the period of the they might be realised. This was to become pilot project, some personal assistants preferred highly problematic. The final proposal was born to work in an arena where this could be more of compromise and represented an attempt to easily negotiated. Others preferred to keep their bring together, and placate, different working hours under the requirements for perspectives. As a result, the pilot project was Income Tax and National Insurance, which very complex and demanded constant again could be more easily negotiated with an discussion and clarification. These discussions

48 The project and project evaluation

pulled the members of the partnership together. legal advice. Differences in perspectives and The work surrounding direct payments was approach became magnified by clashes of seen as a vehicle through which working personality. The Chairman of HAND, also an relationships were being established between employee of the SSD, was coincidentally at the the members, and one that was highly valued, same time deemed in breach of SSD policy for all involved. about employees operating as Trustees in The ILP had been given almost total organisations with which the SSD has autonomy by the manager and trustees of contractual arrangements. He was required to HAND and only the Co-ordinator of the ILP resign. Another Trustee, who was also a was present in the Implementation Group member of NCODP and a recipient of direct which was attended by at least two members of payments resigned. Two more Trustees were co- the SSD, the Chairman of NCODP and the opted onto the board and the organisation Direct Payments Co-ordinator employed by continued to function. NCODP. Similarly, the Consultation Group was The four staff of the ILP felt increasingly chaired alternately by the Chair of NCODP and estranged from their parent organisation and the Direct Payments Project Officer from SSD. sought management from disabled people who The Co-ordinator of the ILP was a participant in had an understanding of the issues of direct the group. payments. They approached the NCODP with a Six months after the inception of the pilot request that they might be managed by the project, when it became apparent that committee that managed the Co-ordinator of employers were not discriminating between Direct Payments for the NCODP. NCODP their use of the ILP and NCODP, concern on the agreed. However, the manager of HAND, with part of the latter led to the co-ordinator of direct the Trustees, refused the requested transfer. The payments for NCODP having an office within SSD contract for the ILP was due for renewal at the SSD day service rather than with the ILP the end of the financial year. After taking legal which had been previously discussed. Despite advice, the SSD renewed the ILP contract for six this, both co-ordinators worked very closely months whilst a resolution to the problem was together. As the partnership debated and determined by going out to tender. became more aligned in their thinking, the ILP All members of the partnership agree that, became increasingly estranged from its parent although the differences between the three organisation, HAND. partners produced a creative tension during the Tensions within HAND, which had existed early stages of the scheme, more progress might since 1996, grew. Disputes emerged about the have been made if there had been only one allocation of resources within the organisation. support/voluntary agency involved. Both A crisis was provoked when the ILP was cited in support organisations had agendas which, the case of the disabled employer being brought whilst related to direct payments, were not before an Industrial Tribunal accused of unfair specifically about independent living. HAND, dismissal. The Co-ordinator sought guidance the parent organisation of the ILP, was from his manager and Trustees and requested concerned primarily with advocacy for disabled

49 Independent successes

people and had great expertise in the welfare The County Council rights arena. The NCODP, whilst having a sub- Within the SSD, the pilot scheme was also committee specifically to manage the Direct deemed to be a success by the Project Board. It Payments Co-ordinator, was primarily an was brought into the mainstream of social organisation established to campaign for change service provision after a decision by Norfolk in the opportunities and access to rights for County Council on 5 December 1999. This was disabled people. Although both had employees three months later than originally expected working exclusively in the field of direct because of restructuring within the local payments, and had interests in the issues of authority. The request raised by the independent living and the empowerment of Implementation Group, and approved by the disabled people, this was not the prime focus of Project Board, for two permanent posts to be either organisation. created within the SSD, a Monitoring Officer The pilot project had served to meet the aims and a part-time Project Officer, was granted. of all of the parties at the outset and had The NCODP and the ILP were involved in delivered a service that had enabled disabled the recruitment for these posts and were people to employ their own personal assistants involved in the interview process. The posts will with the level of support they required. By their be taken up as soon as is practicable in the new criteria, the scheme had been successful. financial year.

50 3 Overview and evaluation by the monitor

The working of the project compromise. Unfortunately, only the Direct The Community Care (Direct Payments) Act Payments Officer from the SSD had been 1996 empowered local authorities to give involved in the establishment of the third-party monies directly to service users for the first scheme in 1993. Some of the issues that were time. Previously, Norfolk like many counties considered during that period were debated and had established a third-party scheme that acted rehearsed again. Whilst this was necessary for as a broker for services. The drive for the the establishment of the partnership and the implementation of the direct payments pilot pilot project, there was less time to address even project came initially from within the SSD more innovative ideas. because of the need to transfer 48 service users Unfortunately, the introduction of direct from the third-party scheme to conform to the payments coincided with major changes within provisions of the Act. Disabled people were not service provision in Norfolk. A reorganisation actively engaged in the initial debates about the within the adult services in the SSD absorbed establishment of a direct payment scheme, much attention and energy of staff in this arena. which necessitated a further period of Services for people with learning disabilities consultation. The consultation was very and mental health problems were undergoing successful and disabled people became involved rapid change. The relocation of people from a in each stage of the process of planning and in local learning disability hospital occupied much the operation of the scheme. There was a spirit debate in this field. Nationally driven changes of co-operation and of active participation. in mental health services, outlined in the Disabled people were not passive recipients of a National Service Framework, created a climate scheme devised and managed by service of uncertainty and fundamental restructuring of providers. They came to understand the services on an inter-agency basis across the constraints imposed upon and within the SSD county. A decision had also been reached that and sought to work within these, and staff the department required more social workers to within the SSD came to a greater understanding be approved to operate under the Mental Health of issues pertinent to disabled people. The Act 1983. Twelve social workers were working in partnership, of itself, was a learning undertaking the training and a further 12 were experience for all; one which may be built upon operating as mentors. It had further been agreed in the future both within the arena of direct that workers already approved would be payments and beyond. required to maintain evidence files, which was The introduction of direct payments is perceived as an additional, and stressful, task. undoubtedly complex. In Norfolk, there were Workers in the teams serving people with three partners involved in the pilot project mental health problems were extremely which added to the complexity. Every issue was stretched. The introduction of Primary Care thoroughly debated, which increased the time Groups also involved much debate and energy involved, and many decisions were the result of within the department. Undoubtedly, these

51 Independent successes

factors conspired against the development of involvement of a third party and also because of the direct payments scheme. issues of confidentiality. It quickly became Against such a backdrop, the commitment of untenable and this function was resumed by the senior members of staff and the creation of a SSD. The statutory monitoring and the support post within the SSD dedicated to direct activities are quite distinct and are best located payments to oversee the introduction of the in different agencies. scheme was highly significant. Time and The NCODP was also under some pressure resources were given to the scheme by people to demonstrate that its services were required as within the finance section, contracts department the funding for the post of the Direct Payments and research department of the SSD. Staff Co-ordinator rested upon its success. This within these units had little experience of concern of the NCODP led to the maintenance working with disabled people at the outset but of the three distinct options for recipients of the changes in approach have been manifest. A direct payments. The NCODP wished to be champion of direct payments, who was identified with the self-management option. The committed to the empowerment of disabled dichotomy between the two agencies and the people and who had skills in establishing new service offered was little in evidence in practice projects, was a huge asset. and employers sought the support they needed The partnership in the Norfolk scheme from whoever and wherever they felt was most involved two agencies which had differing appropriate to a particular need at a given time. agendas and which, to some extent, were The partners moved closer, in both method of potential competitors. Initially, the ILP continued working and in philosophy, during the pilot to be funded by receiving commission for those to project and a mutual trust was established whom a support service was offered. If employers between the workers in the field. There was moved from the third-party scheme to manage collaboration rather than competition but the their own direct payments, the ILP would lose existence of two organisations meant that money, although the SSD had underwritten the negotiations and co-ordination were more time ILP so that the income would not fall below the consuming than might otherwise have been the amount it needed to remain viable. There was a case. One organisation with the sole interest of tension in the scheme since the ILP would supporting people in receipt of direct payments, benefit from creating dependency which was controlled and managed by disabled people, contrary to the spirit of direct payments and the would produce the most desirable and most pilot project, although there was no evidence of cost-effective outcome for all. Employers would the workers of the ILP engaging in practices of have one point of contact where they could this kind. The role of the ILP was further access a range of support depending on their compromised by the contract for the monitoring situation at any given time; the SSD would have of the financial returns. The ILP in effect became one organisation with which to negotiate a policing arm of the SSD. This was not contracts and service agreements, and there welcomed by disabled employers because of the would be no duplication of such as venue and added paperwork necessary for the equipment costs.

52 Overview and evaluation by the monitor

The take-up of direct payments was initially inspections of contracted agencies. Direct slower than anticipated as staff within the SSD payments were welcomed by some staff, and disabled people came to understand the particularly those who had experience of processes. The delay in transfer and the lack of working with the third-party scheme, but for new employers joining the scheme caused some others within the SSD it represented a shift in early concern, as the partners were keen to which they, as individual workers, or the demonstrate the viability of the scheme. There department as a whole, would be enabling was also a desire that sufficient people would disabled people to take greater risks. As come forward so that any flaws in the processes discussed above, those heavily involved in the could be identified and rectified during the pilot pilot scheme, including a member of directorate period. It is a measure of the trust and strength who chaired the Project Board, moved towards which developed between the partners and the a position of accepting more risk as the project boards overseeing the project within the SSD progressed. The monitoring and management of that, when a personal assistant took her the monies were relaxed somewhat. Greater situation to an industrial tribunal, the event was flexibility about the spending of the money was regarded as one of the inevitable, although given and this enabled some employers to take unwelcome, consequences of people employing greater responsibility for their lives and also to their own staff and the risks inherent in that take greater risks, both emotionally and scenario. There was confidence that the scheme physically. was sound and that this situation presented a Social workers, as the assessors for services challenge to be addressed and not a threat. The under the National Health Service and divorcing of the ILP from its parent organisation Community Care Act 1990, remained the HAND became apparent at this point as the gatekeepers to direct payments. It is concerning manager of HAND, who had not engaged in the that some chose not to discuss this option with process of the partnership and had not taken clients, particularly as the majority of disabled part in the debates, did not share the view of the employers became aware of direct payments partners. through their social workers. Throughout the pilot project, it was apparent The ILP was established within Norwich, the that the introduction of direct payments largest urban area within the county, and involved a change of culture within the SSD. subsequently offered a service across the whole Prior to the implementation of the National county. The direct payments scheme had Health Service and Community Care Act 1990, recipients living all over Norfolk although the both assessment and provider functions were majority lived in Norwich and its environs. within the SSD. From 1993, the functions had Proportionally far more of those eligible for been separated. Norfolk had embraced the direct payments who lived in Norwich actually purchaser–provider split powerfully. There was received direct payments. This had little to do still some culture of direct service provision but with notions of rurality and sparsity of now manifested in the control of service population and much to do with the culture of provided through service contracts and the staff within the SSD in other areas. The

53 Independent successes

above raise issues of equity of service provision, engaging in debates about the implementation which the SSD will need to address within its of direct payments within the mental health or training plan and operational policies. learning difficulty arenas either within or The Norfolk Direct Payments Pilot Project without the SSD. was open to all adults aged 16–64 who received Seventy-five disabled people used the domiciliary support for more than five hours a scheme. Most were highly pleased with the week, a regular respite service and who opportunity it afforded, few had criticisms and incurred transport costs related to their respite. even fewer left. By this measure alone it may be It did not include attendance at a day centre. deemed successful. However, the interviews Whilst some people served by adult teams with employers during the pilot project (physical disability) receive a day service, many indicated a much higher level of dissatisfaction people with mental health or learning with services directly provided by SSD home disabilities receive their support through day care service or agencies contracted by the SSD services. Over 800 people throughout the county than had been the case in the research which each day attend day centres for people with a monitored the establishment of the ILP during learning disability. Direct payments were not the period 1993–94 (Dawson, 1995). This is offered as an alternative means of service concerning. The research did not set out to provision for people who were living in assess whether the expectations of service users residential accommodation, and some people had increased during this period or whether the with mental health problems and more with quality of the service being provided had learning difficulties live in residential settings in decreased. However, anecdotal stories from the the county. Only two people who did not respondents suggest the latter. Perhaps the take- receive their support from adult teams (physical up of direct payments would not have been so disability) joined the scheme. As highlighted high if people had received a direct service above, teams in the other arenas were largely which was more flexible and responsive to their preoccupied with other significant changes in individual requirements. their services and some workers dismissed the There was no typical direct payments concept of direct payments on the basis that recipient. The ages, the gender, the sexual their clients were not ‘willing’ and ‘able’. The orientation, the family structure, their income Direct Payments Project Officer in SSD had and employment, and their family background discussed direct payments with social workers differed enormously. In some scenarios, from these other teams and they had also disabled employers sought to gain attended the training sessions. The NCODP independence from statutory services and Direct Payments Co-ordinator had spoken to contracted agencies. Some sought independence many groups representing people with learning from their families (in particular from their difficulties and the NCODP had sought parents) whilst others wanted to maintain the representation from mental health service users mutual dependence of family members upon on the Consultation Group. Yet, despite this, the one another. There was a sense from some pilot project was largely unsuccessful in employers and from some personal assistants

54 Overview and evaluation by the monitor

that there was a mutual support, which could • the commitment of senior staff, the stretch beyond the immediate employer– creation of a post specific to direct personal assistant relationship. Employers felt payments and the operation of the they were contributing to the welfare and telephone help line for staff income of their personal assistants in exchange • a relaxation of formal checks and balances for their support in domiciliary tasks. One was as trust grew between disabled employers not dependent on the other but rather there was and the SSD and the willingness within an interdependence. the SSD to take more risks.

The scheme was not so effective in: Summary of the strengths and weaknesses in the scheme • reaching out equitably to all who were eligible across the county The strengths in the scheme have included: • engaging with the debates within mental • the working together of disabled people health and learning difficulty arenas and and professionals in partnership accessing direct payments for people with • the willingness of each player to take on mental health problems and learning new ideas, to compromise and to move difficulties towards a common goal • resolving the tensions within one of the • the learning to resolve differences and to support agencies acknowledge strengths • changing the culture of service provision • the responsiveness to the voices of people by offering an alternative provision for using the scheme those in day or residential services.

• effectiveness in conforming to the requirements and guidelines of central Future developments government The partners involved in the pilot project have • effectiveness in enabling 75 disabled not ceased the development of the scheme and people to employ their own personal many of the issues that arose are now being assistants pursued. The post of an advocacy worker is being created to empower people with learning • the range of support options and the difficulties and mental health service users to perceived quality of the support offered access direct payments. to disabled employers Other means could be explored of opening • the perceived benefits from the up choice to people with more profound perspectives of disabled employers learning difficulties or mental incapacities. During the pilot project, two people were not • the mutual reciprocity between service able to manage their payments and the SSD users and personal assistants

55 Independent successes

subsequently employed their personal assistants The specification for a tender for the support to continue to provide the support sought by offered to those in receipt of direct payments is the disabled person. In a similar vein, the SSD being drawn up. It is hoped that this will might explore entering into service agreements resolve the tensions within HAND and ILP, and with a support agency or trust which could also reduce the complexity in the arrangements become the employer of personal assistants who for support. were chosen or preferred by a disabled person Direct payments are soon to be offered to and thus offer those who are not ‘willing’ and older people in the county and, drawing on the ‘able’ to receive direct payments a greater experience of the pilot project, the consultation degree of choice about the person who provides process between the SSD and all the interested their support. parties has begun. A working party is researching the implications of introducing direct payments in Closing remarks lieu of some day service provision. The next stage would be to consider the implications of The whole story of the Norfolk Direct Payments offering direct payments in lieu of residential Pilot Project is one of a moving kaleidoscope services. between dependence, independence and inter- The NCODP is establishing stronger links dependence; within and between the across the county with the aim of raising organisations involved in the partnership; awareness of direct payments. There will also between the scheme and disabled employers; need to be more awareness raising and training and the disabled employers and their personal for some staff within the SSD. assistants. The project is continuing to move and Work, which has already begun, also needs to change, and there is a sense of optimism and to be undertaken within the SSD with respect to challenge. It is a scheme that has brought issues of ethnicity and recording of ethnic fundamental questions of equity into the origin. debating arena and has raised the quality of life for many disabled people and their families.

56 Bibliography

Ahmed, W.I.U. and Atkin, K. (1996) Race and Dawson, C. and McDonald, A. (2000) ‘Assessing Community Care. Buckingham: Open University mental capacity; a checklist for social workers’, Press Practice, Vol. 12, No. 2, pp. 5–20

Appelbaum, P. and Roth, L. (1982) ‘Competence Finch, J. (1993) “‘It’s great to have someone to to consent to research: A psychiatric overview’, talk to’: ethics and politics of interviewing Archives of General Psychiatry, Vol. 39, pp. 951–8 women”, in J. Bornat, C. Pereira, D. Pilgrim and F. Williams (eds) Community Care: a Reader. Aronson, E., Wilson, T. and Akert, R. (1997) Milton Keynes: Macmillan/Open University Social Psychology. London: Longman Press Atkinson, D. (1988) ‘Research interviews with Goldsmith, M. (1996) Hearing the Voice of People people with mental handicaps’, Mental Handicap with Dementia. London: Jessica Kingsley Research, Vol. 1, pp. 75–90 Grisso, T. and Applebaum, P. (1993) Manual for Bewley, C. (1998) Choice and Control; Decision- Thinking Rationally about Treatment. Boston, MA: making and People with Learning Difficulties. University of Massachusetts Medical School London: Values into Action Haynes, R. and Gale, S. (1996) A Method to Coldicott, I. (1998) Mapping Need in Norfolk. Estimate the Health Needs of Rural Populations in Report of the Rural/Urban Sub-Group. Norwich: East Anglia. University of East Anglia Norwich, Norfolk County Council School of Health Policy and Practice, Research Conroy, J.W. and Bradley, V.J. (1985) The Report No. 5 Penhurst Longitundinal Study: a Report of Five Holman, A. and Collins, J. (1997) Funding Years’ Study and Analysis. Boston, MA: Human Freedom – a Guide to Direct Payments for People Services Research Institute with Learning Difficulties. London: Values into Davis, A. (1991) ‘A structural approach to social Action work’, in J. Lishman (ed.) A Handbook of Theory Hun, M. (1999) ‘Local Authorities are liable for for Practice Teachers in Social Work. London: personal assistants’, Community Care, 12–18 Jessica Kingsley Publications August Dawson, C. (1995) Report of the Independent Kestenbaum, A. (1992) Cash for Care: a Report on Living Project (Norfolk). Cambridge: Daniels the Experience of Independent Living Clients. Pubs/JRF Nottingham: ILF Dawson, C. (1996) ‘The practice of integration in Law Commission (1997) Decision Making and day services for adults with a learning Mentally Incapacitated Adults. London: HMSO disability; the experiences of service users and service providers’, PhD thesis, University of Letts, P. (1998) Managing Other People’s Money. East Anglia London: Age Concern

57 Independent successes

Lord Chancellor (1998) Who Decides? Making Richards, S. (1985) ‘A right to be heard’, Social Decisions on Behalf of Mentally Incapacitated Services Research, Vol. 14, No. 4, pp. 49–56 Adults. London: HMSO Ryan, T. and Holman, A. (1998a) Able and Lubinski, K. (1991) Dementia and Communication. Willing? Supporting People with Learning London: Decker Difficulties to Use Direct Payments. London: Values into Action McDonald, A. and Taylor, M. (1997) The Law and the Elderly. London: Sweet and Macmillan Ryan, T. and Holman, A. (1998b) Pointers to Control. People with Learning Difficulties Using McKenna, E. (1987) Psychology in Business. Direct Payments. London: Values into Action London: Lawrence Erlbaum Associates Sigelman, C.K. and Budd, E.C. (1986) ‘Pictures Morris, J. (1992) ‘Personal and political: a as an aid in questioning mentally retarded feminist perspective on researching physical persons’, Rehabilitation Counselling Bulletin, Vol. disability’, Disability, Handicap and Society, Vol. 7, 29, No. 3, pp. 173–81 No. 2, pp. 157–66 Sigelman, C.K., Budd, E.C., Spanhel, C. and Morris, J. (1993) Community Care or Independent Schoenrock, C.J. (1981) ‘When in doubt, say yes: Living. York: Joseph Rowntree Foundation acquiescence in interviews with mentally Norfolk County Council (1991) A Norfolk Census retarded persons’, Mental Retardation, April, Atlas. Norwich: Norfolk County Council pp.53–8

Norfolk Social Services Department (1996) Simons, K., Booth, T. and Booth, W. (1989) Employee Handbook (Home Care Assistants). ‘Speaking out: user studies and people with Norwich: Norfolk County Council learning difficulties’, Research Policy and Planning, Vol. 7, No. 1, pp. 9–17 Oliver, M. (1991) Social Work: Disabled People and Disabling Environments. London: Jessica Swain, J. (1989) ‘Learned helplessness theory Kingsley and people with learning difficulties: the psychological price of powerlessness’, in A. Pease, L. (1988) ‘Objects of reference’, Talking Bechin and J. Walmsley (eds) Making Sense, Vol. 34, No. 1 Connections. London: Hodder and Stoughton RADAR (1990) A Survey Undertaken on Behalf of Thompson, N. (1996) Anti-discriminatory the ACT NOW Campaign for the Full Practice. London: Macmillan Implementation of the Disabled Persons (Consultation Services and Representation) Act Walmsley, J. (1994) ‘Gender, caring and learning 1986. London: RADAR disability’, PhD thesis, Open University, Milton Keynes Rau, M. (1993) Coping with Communication Challenges in Alzheimer’s Disease. Singular Pubs

58 Bibliography

Zarb, G. and Nadash, P. (1994) Cashing in on Acts of Parliament, circulars and guidance Independence: Comparing the Costs and Benefits of National Health Service and Community Care Cash and Services. London: Policy Studies Act 1990 Institute Community Care (Direct Payments) Act 1996 Zarb, G, Hasler, F., Campbell, J. and Arthur, S. (1996) Local Authority Implementation of the Department of Health (1999) Code of Practice Community Care (Direct Payments Act): First Mental Health Act 1983 Findings. London: Policy Studies Institute Department of Health LAC (97)11 Community Care (Direct Payments) Act

59 Appendix 1: Direct payments questionnaire

Please tick or circle one answer per question:

1 Are you male/female?

2 Are you aged 18–25; 26–35; 36–45; 46–55; 56–64?

3 Approximately how long have you been receiving direct payments? one year; six months; three months; less than three months

4 When did you first hear about direct payments? two years ago; eighteen months ago; a year ago; six months ago

5 How did you learn of direct payments? Through: a friend; media; the ILP; a social worker; the Coalition of Disabled People; other (please specify)

6 Did you employ personal assistants through the ILP prior to April 1998? Yes/No

7 How do you manage your direct payments? self-manage (i.e. do it yourself or with your personal assistant); through the ILP; with the support of another agency (please specify)

8 If you self-manage did you use another agency previously? If yes was this the ILP; another agency (please specify)

9 How many personal assistants do you employ? Please circle: 1; 2; 3; 4; 5; More

60 Appendix 1

Please tick one option on questions 10–16 for each personal assistant

10 Is your personal assistant? Male Female

11 How old is your personal assistant? under 30; 30–50; over 50

12 How did you recruit your personal assistant? They were a personal friend previously They provided your support previously as a home carer from the Social Services Department They provided your support previously as a home carer from another agency They were your supporter in residential care You advertised and recruited through interview

13 How does your personal assistant travel to you? On foot In a car On a bicycle Public transport

14 How long does it take them? Five mins; Ten mins; Half an hour; More than half an hour

15 What tasks do you employ your personal assistants to undertake? Shopping Paying the household bills Housework Personal care Preparation of meals

16 On average how many hours a week does the personal assistant work? 3 hours or less 7 hours (i.e. about a day or a night) 2 days 3 days or more

61 Independent successes

17 If you needed support about any of the following please indicate who you would contact by using this number scheme: (1. Coalition, e.g. Keith Roads or peer group; 2. ILP; 3. Social worker; 4. Social Services Staff at County Hall; 5. Other – please specify)

Recruiting staff Managing staff Paying staff and running the payroll Monitoring forms for direct payments Needing more hours of personal assistance Paying your household bills Charges made for your services by Social Services Department

18 Are you a member of a direct payments peer group? Yes/No

If yes: Why? If no: Why not?

19 What are the positives for you in receiving direct payments?

20 What are the negatives for you in receiving direct payments?

21 Are there any changes you can identify that would make the scheme better?

22 Is there anything else I should know?

Many, many thanks for your time.

I would be willing to speak with you further in an interview:

Name

Address

Phone number

Most convenient time for me is:

62 Appendix 2: Competence checklist

Devised by Carol Dawson and Ann McDonald sentence content: (first appeared in Practice, Vol. 12, No. 2, 2000, – statements in the active voice are pp. 5–20). easier understood than the passive appropriate vocabulary: – possibly simplified Before you say that someone is unable to – use of circumlocation to talk round a make this decision ask yourself the word that is forgotten or not known following questions volume pitch 1 What is the significance of the life history • written word using: of the person on this decision? capital/lower case • life story/social history size of script • recent past type or handwritten script • present context Braille • future aspirations moon 2 What is known about the person’s ability • augmentative systems of to communicate? communication: • known issues arising from: communication boards cognitive difficulties: electronic systems – in receiving data • signed communication systems: – in processing data BSL – in responding Makaton – attention span Hand on hand hearing loss Cued speech sight loss Deaf-blind manual physical disabilities Block • pictorial representations: 3 Has the information been presented in photographs different formats? drawings • spoken work giving consideration to: symbols structure of the conversation: • objects of reference – introduce the topic at the beginning to • experiential/situational learning orient the person • video material – provide an overview of the topic or • audio material issue – finally fill in the detail 4 Is the person able to make a decision? sentence construction: • history of decision making – short and simple • make decisions about other issues of a – one topic similar level

63 Independent successes

• hold two ideas simultaneously • the information was given by different • effective memory people – immediate • free from distractions such as: – short term – other events happening – long term simultaneously – semantic – sounds – episodic – smells • concentration span – tastes • have a preference – colour • understand consequences – light • maintain internal consistency – comfort (continence/pain) • the emotional content of the decision • the time of day most helpful to the • techniques for facilitating decision- person taking into account such as: making have been tried – medication – decision trees – tiredness – small choices used to build skills – hunger – group discussions – stress levels – pain 5 What is the significance of this particular • the relation of the timing of the decision decision? to: • the legal status of the decision to be long-term factors: made – significant life events • the legal powers and responsibilities – major life crises with respect to the decision – transitions • the risk in the situation short-term factors: – the likelihood of a negative outcome – meal times for the person/worker – meetings with other people – the seriousness of a negative outcome – changes of venue for the person/worker – significant activities 6 What were the circumstances of the • the significance of the venue for the decision making? person: • not involved with another task – stressful • attention fully secured before the task – exciting was started – relaxing • the information was given on several 7 Who was involved in the decision-making occasions process? • the information was given in different • the worker was able to interview the settings person without support

64 Appendix 2

• the worker interviewed the person 8 How quickly was a decision required? alone • the person was given sufficient time to • the support with which the person is make a decision most comfortable • the decision was made over a period of • those who communicate most time effectively with the person • the opportunity was presented on more • someone who has no vested interest in than one occasion the outcome of the decision • the opportunity to try different • more than one other person has been alternatives over a period was given involved • the power issues in the relationships Only when the above questions can all be have been considered answered and it is established that a person is • issues relating to the age, gender, race unable to make this decision at a particular time and disability of all parties have been ask … considered Who is the most relevant person or persons to make a substitute decision?

65 Appendix 3: Maps

Map 1 People receiving a service from the ILP at 31 March 1998

uth

Caister North

Caister So Bradwell North

mouth

Nelson

outh

North

Gorleston

Sprowston S

Northgate

Yar

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston ingland ingland

ingland gent

Hemsby

Ormesby Crome Crome Crome and Cobham Loth Loth

Lakenham Loth

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh own Close Close Close own own own T T T Martham

St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

reethorpe

ollesby

Hickling

Coslany

Clavering

Mile

eedham

Cross

Acle

Eaton

Horsefen

Henderson

Catfield Heigham Heigham Heigham

University

aveney

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

Brundall xham xham xham heath

Beauchamp Brookwood Brookwood East Brookwood

o o o

lley Wr Wr Wr Dichingham

stonacres

Mundesley

Plumstead

lsham

Rack

osebery osebery North osebery R R Pa R

New Costessey

Hellesdon West

Overstrand

tow

Hellesdon North

West

Coltishall

Scot

Hellesdon Southeast ale Harleston

Suffield Park Suffield

Crown Point

Spixsworth

Tasv

ghton

Buxton St Faiths Faiths St St St Faiths St Hempnall

Hainford

Rou

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

R Chaucer Dickleburgh

Depwade

ylsham

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

ustens ustens ustens R R R

Berners

Cawston

Kidner

own

Corpusty

own

Diss

ng Row

Sheringham

Cringleford & Colney

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

house

eepham

Cley

sham

vers

Boyland

Wode

Foul

Abbey

ehow

Besthorpe

Glaven

Astley

st Guiltcross Guiltcross Guiltcross st st st We We We

Buckenham

For

Two Ri

Queen’s

Mattishall

Eynsford

East Guiltcross

Yore

Haverscroft

own

Upper

Hingham

anton

Blakeney

Morley

lmodeston

Neatherd

ur Stowes

All Saints

wood

Harling

Toft

lley

Upper Wensum

ensum

mplar

Shipworth

Beetley and

Gressenhall

ddars Way

rner

yland

St Withburge

Heathlands

Lancaster Lancaster Lancaster de Toni

lls

Haggard

alsingham

Tave

Watton

Launditch

Springvale

Necton

The

aynhams

Wissey

Thetford–Guildhall

Hermitage

ting

Creake

eting

Burnham

fham

WeWee

Swaf

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

est

Winch

The

ootons

5–10

atlington

Market

Downham

Denver

en Mile

iggenhall iggenhall

iggenhall T W W Gaywood North W

Gaywood South

warton

Clench-

Gaywood Central

Chase

North

3 4

KING’S LYNN

nn North

Lynn

LyLynn

uth West

outh West

St Lawrence

Kilometres

SSo

Spellowfields

and Delph

Upwell, Outwell

Mershe Lande Lande

The

1 2

alpoles

Emneth

est

allon

nn Central

01020

St Margarets

66 Appendix 3

Map 2 People eligible for direct payments at 31 March 1999

outh

Caister North

Caister S

Bradwell North

Nelson

outh

North

Gorleston

armouth

Sprowston S

Northgate

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston

Hemsby

thingland thingland

Ormesby thingland Crome Crome Crome and Cobham

egent Lo Lo

Lakenham Lo

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh own Close Close Close own own own T T T Martham

St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

reethorpe

ollesby

Hickling

Coslany

Clavering

Mile

eedham

Cross

Acle

Eaton

Horsefen

Henderson

Catfield Heigham Heigham Heigham

University

aveney

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

Brundall xham xham

xham Beauchamp Brookwood Brookwood East Brookwood

o o

o kheath

kheath

c Wr Wr Wr Dichingham

alley

Mundesley

Plumstead

astonacres

osebery osebery alsham osebery

North R R est R

New Costessey

Hellesdon West

Overstrand

Hellesdon North

cottow

Coltishall

S Hellesdon Southeast Harleston

Suffield Park Suffield

Crown Point

asvale

Spixsworth

aiths aiths

Buxton aiths St F F St St St F St Hempnall

oughton

Hainford

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

R Chaucer Dickleburgh

Depwade

ylsham

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

ustens ustens ustens R R R

Berners

Cawston

Kidner

own

Corpusty

own

Diss

Sheringham

Cringleford & Colney

ong Row

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

eepham

Cley

odehouse

Boyland

oulsham

Abbey

Besthorpe

Glaven

Astley

est Guiltcross Guiltcross Guiltcross est est est W W orehow W

wo Rivers

Buckenham

Queen’s

Mattishall

Eynsford

ore

East Guiltcross

Haverscroft

own

Upper

Hingham

anton

Blakeney

Morley

Neatherd

ulmodeston

All Saints

our Stowes

twood

Harling

Upper Wensum

alley

ensum

Shipworth

emplar

Beetley and

Gressenhall

eddars Way

ton

St Withburge

Heathlands

ayland Lancaster Lancaster Lancaster de Toni

averner

Haggard

alsingham

ells

Wat

Launditch

Springvale

Necton

The

aynhams

Wissey

Thetford–Guildhall

Hermitage

Creake

eeting

Burnham

affham

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

Docking

North Coast North

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

ard boundary

W District boundary

est

Winch

The

ootons

atlington

Market

Downham

Denver

ton

en Mile

T Wiggenhall Wiggenhall Gaywood North Wiggenhall

Gaywood South

war

Clench-

Gaywood Central

Chase

KING’S LYNN

ynn

ynn North

outh West

St Lawrence

Spellowfields

and Delph

1–20

Upwell, Outwell

5–10 1 21–30 31+

Mershe Lande

The

alpoles

Emneth

est

allon

ynn Central

St Margarets

Kilometres

1 2 3 4

enham 14

ymondham 13

Thetford 10 Norwich 94 Attleborough 9 Kings Lynn 60 W Gt Yarmouth 19 N Walsham 13 Gorleston 24 E Dereham 9 Fa

01020

67 Independent successes

Map 3 People in receipt of direct payments at 31 March 1999

outh

Caister North

Caister S

Bradwell North

Nelson

outh

North

Gorleston

armouth

Sprowston S

Northgate

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston ingland ingland

ingland gent

Hemsby

Ormesby Crome Crome Crome and Cobham Loth Loth

Lakenham Loth

ReRege

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh wn Close Close Close wn wn wn To To To Martham

St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

eethorpe

ham

ollesby

Hickling

Coslany

Clavering

Mile

Cross

Reed

Acle

Eaton

Horsefen

Henderson

ney

Catfield Heigham Heigham Heigham veney

University

WaveWa

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

ath

Brundall xham xham xham Beauchamp Brookwood Brookwood East Brookwood

o o o

Wr Wr Wr Dichingham

alley

Mundesley

Plumstead

astonacres

Rackhe

osebery osebery alsham osebery

North R R P R

New Costessey

Hellesdon West

Overstrand

tow

Hellesdon North

West

Coltishall

Scot

Hellesdon Southeast ale Harleston

Suffield Park Suffield

Crown Point

svale

Spixsworth

TaTasv

ghton

Buxton St Faiths Faiths St St St Faiths St Hempnall

Hainford

Rou

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

lsham Chaucer Dickleburgh

Depwade

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

stens stens stens Ru Ru Ru

Berners

Cawston

Kidner

own

Corpusty

own

Diss

ng Row

Sheringham

Cringleford & Colney

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

pham

Cley

Ree

dehouse

Boyland

oulsham

Abbey

Besthorpe

Glaven

Astley

rehow

st Guiltcross Guiltcross Guiltcross st st st We We wo Rivers We

Buckenham

Queen’s

Mattishall

Eynsford

East Guiltcross

Yore

Haverscroft

own

Upper

ton

Hingham

Blakeney

Morley

lmodeston

Swan

Neatherd

ur Stowes

All Saints

wood

Harling

lar

Upper Wensum

alley

Shipworth

Beetley and

Gressenhall

Wens

Temp

ddars Way

erner

St Withburge

Heathlands

ayland Lancaster Lancaster Lancaster de Toni

lsingham

Haggard

Tav

ells

Watton

Launditch

Springvale

hams

Necton

The

ynhams

Wissey

RaynRa

Thetford–Guildhall

Hermitage

Creake

eeting

Burnham

affham

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

est

Winch

The

ootons

atlington

Market

Downham

Denver

en Mile

iggenhall iggenhall

iggenhall T W W Gaywood North W

Gaywood South

warton

Clench-

Gaywood Central

Chase

North

3 4

KING’S LYNN

nn North

Lynn

LyLynn

uth West

outh West

St Lawrence

Kilometres

SSo

Spellowfields

and Delph

Upwell, Outwell

Mershe Lande Lande

The

alpoles

Emneth

est

allon

nn Central

01020

St Margarets

68 Appendix 3

Map 4 Sparsely populated wards

uth

Caister North

Caister So Bradwell North

Nelson

rmouth

outh

North

Gorleston

Sprowston S

Northgate

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston ingland ingland

ingland gent

Hemsby

Ormesby Crome Crome Crome and Cobham Loth Loth

Lakenham Loth

ReRege

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Close Fleggburgh wn Close wn Town Town To Town Town Martham

St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

eethorpe

ham

ollesby

Hickling

Coslany

Clavering

Mile

Cross

Reed

Acle

Eaton

Horsefen

Henderson

ney

Catfield Heigham Heigham Heigham veney

University

WaWave

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

ath

Brundall xham xham xham Beauchamp Brookwood Brookwood East Brookwood

o o o

Wr Wr Wr Dichingham

alley

Mundesley

Plumstead

astonacres

Rackhe

osebery osebery alsham osebery

North R R P R

New Costessey

Hellesdon West

Overstrand

tow

Hellesdon North

West

Coltishall

Scot

Hellesdon Southeast ale Harleston

Suffield Park Suffield

Crown Point

svale

Spixsworth

TaTasv

ghton

Buxton St Faiths Faiths St St St Faiths St Hempnall

Hainford

Rou

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

lsham Chaucer Dickleburgh

Depwade

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

ens ens ens Rust Rust Rust

Berners

Cawston

Kidner

own

Corpusty

own

Diss

ng Row

Sheringham

Cringleford & Colney

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

pham

Cley

Ree

dehouse

Boyland

oulsham

Abbey

Besthorpe

Glaven

Astley

rehow

est Guiltcross Guiltcross Guiltcross est est est W W wo Rivers W

Buckenham

Queen’s

Mattishall

Eynsford

East Guiltcross

Yore

Haverscroft

own

Upper

ton

Hingham

Blakeney

Morley

lmodeston

Swan

Neatherd

ur Stowes

All Saints

wood

Harling

lar

Upper Wensum

alley

Shipworth

Beetley and

Gressenhall

Wens

Temp

ddars Way

and

land

erner

St Withburge

Heathlands

Lancaster Lancaster Lancaster de Toni

lsingham

Haggard

WayWayl

Tav

ells

Watton

Launditch

Springvale

Necton

nhams

The

ynhams

Wissey

RaRay

Thetford–Guildhall

Hermitage

Creake

eeting

Burnham

affham

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

est

Winch

The

ootons

atlington

Market

Downham

Denver

ton

en Mile

iggenhall iggenhall

iggenhall T W W Gaywood North W

Gaywood South

war

Clench-

Gaywood Central

Chase

North

KING’S LYNN

nn North

Lynn

LyLynn

uth West

outh West

St Lawrence

Kilometres

SSo

Spellowfields

and Delph

Upwell, Outwell

Mershe Lande Lande

The

Sparsely populated wards

alpoles

Emneth

est

allon

nn Central

01020

St Margarets

69 Independent successes

Map 5 Wards classified by geographical type

outh

Caister North

Caister S Bradwell North

Nelson

outh

North

Gorleston

armouth

Sprowston S

Northgate

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston

Hemsby

Ormesby Crome Crome Crome and Cobham Lothingland Lothingland

Lakenham Lothingland

Regent

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh own Close Close Close own own own T T T Martham

St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

Hickling

Freethorpe

Rollesby

Coslany

Clavering

Mile

Cross

Reedham

Acle

Eaton

Horsefen

Henderson

Catfield Heigham Heigham Heigham

University

aveney

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

Nelson

Catton Grove Catton

South Walsham

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

Brundall xham xham xham Beauchamp Brookwood Brookwood East Brookwood

o o o

Wr Wr Wr Dichingham

alley

Mundesley

Plumstead

Rackheath

alsham

North Rosebery Rosebery est Rosebery

Pastonacres

New Costessey

Hellesdon West

Overstrand

Hellesdon North

Coltishall

Scottow Hellesdon Southeast Harleston

Suffield Park Suffield

Crown Point

asvale

Spixsworth

aiths aiths

Buxton aiths St F F St St St F St Hempnall

Hainford

Roughton

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

R Chaucer Dickleburgh

Depwade

ylsham

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

Rustens Rustens Rustens

Berners

Cawston

Kidner

own

Corpusty

own

Diss

Sheringham

Cringleford & Colney

Great

Long Row

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

Cley

Reepham

odehouse

Boyland

Foulsham

Abbey

Besthorpe

Glaven

Astley

est Guiltcross Guiltcross Guiltcross est est est W W wo Rivers W

Buckenham

Forehow

Queen’s

Mattishall

Eynsford

ore

East Guiltcross

Haverscroft

own

Upper

Hingham

Blakeney

Morley

Swanton

Neatherd

All Saints

Fulmodeston

twood

Four Stowes

Harling

Upper Wensum

alley

ensum

Shipworth

emplar

Beetley and

Gressenhall

ton

St Withburge

Peddars Way

Heathlands

ayland Lancaster Lancaster Lancaster de Toni

averner

Haggard

alsingham

ells

Wat

Launditch

Springvale

Necton

The

aynhams

Wissey

Thetford–Guildhall

Hermitage

Creake

eeting

Burnham

Swaffham

Thetford–Saxon

Rudham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

Priory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

ards Classified by Geographical Type ards Classified by Geographical

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

est

Winch

The

ootons

atlington

Market

Downham

Denver

ton

en Mile

T Wiggenhall Wiggenhall Gaywood North Wiggenhall

Gaywood South

war

Clench-

Gaywood Central

Chase

KING’S LYNN

ynn

ynn North

outh West

St Lawrence

Kilometres

Spellowfields

and Delph

ar rural

Upwell, Outwell

Mershe Lande

The

Large urban Small urban Near rural F

alpoles

Emneth

est

allon

ynn Central

01020

St Margarets

70 Appendix 3

Map 6 Norfolk SSD district boundaries at 1 April 1999

outh

Caister North

Caister S

Bradwell North

Nelson

outh

North

Gorleston

armouth

Sprowston S

Northgate

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston

Hemsby

othingland othingland Ormesby othingland Crome Crome Crome and Cobham

egent L L

Lakenham L

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh own Close Close Close own own own T T T Martham

St Andrews St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

reethorpe

EASTERN

ollesby

Hickling

Coslany

Clavering

Mile

eedham

Cross

Acle

Eaton

Horsefen

Henderson

Catfield Heigham Heigham Heigham

University

aveney

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

Brundall xham xham

xham Beauchamp Brookwood Brookwood East Brookwood

o o

o kheath

c Wr Wr Wr Dichingham

alley

Mundesley

Plumstead

astonacres

osebery osebery alsham osebery

North R R est R

New Costessey

Hellesdon West

Overstrand

Hellesdon North

cottow

Coltishall

S Hellesdon Southeast Harleston

Suffield Park Suffield

Crown Point

asvale

Spixsworth

Buxton St Faiths Faiths St St St Faiths St Hempnall

oughton

Hainford

NORWICH ton ton ton

Strat Strat

Cromer Strat

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

R Chaucer Dickleburgh

Depwade

ylsham

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

ustens ustens ustens R R R

Berners

Cawston

Kidner

own

Corpusty

own

Diss

Sheringham

Cringleford & Colney

ong Row

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

eepham

Cley

odehouse

Boyland

oulsham

SOUTHERN

Abbey

Besthorpe

Glaven

Astley

est Guiltcross Guiltcross Guiltcross est est est W W orehow W

wo Rivers

Buckenham

NORTHERN

Queen’s

Mattishall

Eynsford

ore

East Guiltcross

Haverscroft

own

Upper

Hingham

anton

Blakeney

Morley

Neatherd

ulmodeston

All Saints

our Stowes

twood

Harling

Upper Wensum

alley

ensum

Shipworth

emplar

Beetley and

Gressenhall

eddars Way

ton

St Withburge

Heathlands

ayland Lancaster Lancaster Lancaster de Toni

averner

Haggard

alsingham

ells

Wat

Launditch

Springvale

Necton

The

aynhams

Wissey

Thetford–Guildhall

Hermitage

Creake

eeting

Burnham

affham

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

WESTERN

est

Winch

The

ootons

atlington

Market

Downham

Denver

ton

en Mile

T Wiggenhall Wiggenhall Gaywood North Wiggenhall

Gaywood South

war

Clench-

Gaywood Central

Chase

KING’S LYNN

ynn

ynn North

outh West

St Lawrence

Kilometres

Spellowfields

and Delph

Upwell, Outwell

Mershe Lande

The

alpoles

Emneth

est

allon

ynn Central

01020

St Margarets

SDD DISTRICTS

71 Independent successes

Map 7 People in receipt of direct payments at 30 September 1999

uth

Caister North

Caister So Bradwell North

mouth

Nelson

outh

North

Gorleston

Sprowston S

Northgate

Yar

AREA

Bradwell South and Hopton

Thorpe

Northeast

East

Thorpe South

Claydon

Lichfield

Thorpe Northwest Mousehold

Thorpe Hamlet

NORWICH

Sprowston ingland ingland

ingland gent

Hemsby

Ormesby Crome Crome Crome and Cobham Loth Loth

Lakenham Loth

Winterton & Somerton

Sprowston Central Central Central Sprowston Sprowston Sprowston

Sprowston West

Catton Catton Catton

Fleggburgh own Close Close Close own own own T T T Martham

St Andrews St Andrews

Marshland

St Stephen

Mancroft

Magdalen East

Magdalen West

reethorpe

ollesby

Hickling

Coslany

Clavering

Mile

eedham

Cross

Acle

Eaton

Horsefen

Henderson

Catfield Heigham Heigham Heigham

University

aveney

Happisburgh

Stalham Burlingham Burlingham Burlingham

Horning

Abbeyfield

outh Walsham

Nelson

Catton Grove Catton

Chet

ARMOUTH

Bowthorpe

Blofield

Bacton

GREAT

Neatishead

stead stead stead r r r Wo Wo Wo Hoveton

Broads

Brundall xham xham xham heath

Beauchamp Brookwood Brookwood East Brookwood

o o o

lley Wr Wr Wr Dichingham

stonacres

Mundesley

Plumstead

lsham

Rack

osebery osebery North osebery R R Pa R

New Costessey

Hellesdon West

Overstrand

tow

Hellesdon North

West

Coltishall

Scot

Hellesdon Southeast ale Harleston

Suffield Park Suffield

Crown Point

Spixsworth

Tasv

ghton

Buxton St Faiths Faiths St St St Faiths St Hempnall

Hainford

Rou

Stratton Stratton

Cromer Stratton

Erpingham

Beck Vale Beck Horsford Horsford Horsford

Smockmill

Hevingham

The

untons Drayton

R Chaucer Dickleburgh

Depwade

ylsham

Humbleyard

Mergate Westwood

Old Costessey

averham averham averham

T T

T Beckhithe

ustens ustens ustens R R R

Berners

Cawston

Kidner

own

Corpusty

own

Diss

ng Row

Sheringham

Cringleford & Colney

Great

Bodham

Springfields

Witchingham

Fields

North-

Cromwells

house

eepham

Cley

sham

vers

Boyland

Wode

Foul

Abbey

ehow

Besthorpe

Glaven

Astley

st Guiltcross Guiltcross Guiltcross st st st We We We

Buckenham

For

Two Ri

Queen’s

Mattishall

Eynsford

East Guiltcross

Yore

Haverscroft

own

Upper

Hingham

anton

Blakeney

Morley

lmodeston

Neatherd

ur Stowes

All Saints

wood

Harling

Toft

lley

Upper Wensum

ensum

mplar

Shipworth

Beetley and

Gressenhall

ddars Way

rner

yland

St Withburge

Heathlands

Lancaster Lancaster Lancaster de Toni

lls

Haggard

alsingham

Tave

Watton

Launditch

Springvale

Necton

The

aynhams

Wissey

Thetford–Guildhall

Hermitage

ting

Creake

eting

Burnham

fham

WeWee

Swaf

Thetford–Saxon

udham

Nar Valley

Conifer

Mid-Forest

Thetford–Abbey

riory

Thetford–Barnham Cross

ard boundary

Docking

North Coast North

W District boundary

alley Hill

Gayton

Denton

Grimston

Dersingham

Airfield Heacham Heacham Heacham

Hunstanton Hunstanton Hunstanton

Middleton

Wissey

Snettisham

est

Winch

The

ootons

atlington

Market

Downham

Denver

5–10 31+

en Mile

iggenhall iggenhall

iggenhall T W W Gaywood North W

Gaywood South

warton

Clench-

Gaywood Central

Chase

North

KING’S LYNN

nn North

Lynn

LyLynn

uth West

outh West

Kilometres

St Lawrence

SSo

Spellowfields

and Delph

Upwell, Outwell

Mershe Lande Lande

The

1 2

alpoles

Emneth

est

allon

nn Central

01020

St Margarets