Top tips from local authorities who have developed strategies to help older people to accessdirect payments
The following case studies are reports taken directly from local authorities. They are provided here to illustrate approaches taken to increasing the uptake of direct payments in groups that have traditionally found services difficult to access. They are presented here to help stimulate thought and ideas that others may wish toexplore.
Each case study provides a top tip, a detailed explanation of the approach taken and contact details for further information.
The research for this work was undertaken by Trevor Edwards, independent social care consultant and CSIP associate.
1.CORNWALL COUNTY COUNCIL – mainstreaming direct payments
2.SEFTON METROPOLITAN BOROUGH COUNCIL – direct payments for older people as the first option
1.CORNWALL COUNTY COUNCIL – mainstreaming direct payments
Top tip:
To focus upon direct payments as a mechanism for mainstream service delivery and a first choice option for service users.
All services delivered should be viewed from the standpoint of how to make them work for direct payments users.
Background
Cornwall has a resident population of just over 500,000. It stretches for over 100 miles with most of the population dispersed in small towns and rural communities. The principal towns of St. Austell, Truro, Camborne, Redruth, Fowey, Wadebridge, Bodmin, Padstow, St Ives-Hayle, Newquay and Penzance are swelled by several thousand over the summer months in keeping with the county’s reputation as a holiday destination.
Cornwall has been successful in helping older people and older carers to access Direct payments, with over 500 older people choosing to use Direct payments.
Actions undertaken to increase Direct payments to service user groups:
Mental health service users
Over the last 15 months, up to April 2007, Cornwall County Council has been developing services with Cornwall Partnership Trust that allow mental health service users easier access to direct payments. Through a series of workshops and team meetings, staff are becoming more aware of the benefits of direct payments for the service users that they work with. The message about direct payments is being successfully circulated amongst workers and service users alike. Numbers of mental health service users accessing direct payments are set to continue growing steadily.
Older People
However, Cornwall’s most clear success has been making direct payments easy for older people and older carers to access.
Cornwall has over 300 service users receiving direct payments on a long-term basis. There has been a steady growth in the ‘classic’ direct paymentsservice inCornwall over a number of years.
Two other schemes introduced by Cornwall have had considerable success in attracting interest from older people in using direct payments. These schemes allow older people who are service users or carers to access a grant of up to £500 to arrange their own services, most usually to facilitate respite. This use of direct payments for a respite grant gives a high degree of independence and flexibility in arranging care. This can be particularly attractive in more isolated areas of the county, where travelling is more difficult. Often, friends, family or neighbours living in the same locality can provide occasional support and this arrangement also has a financial benefit to the County Council as well as providing an effective means of giving choice and control to service users and carers.
Effective Action
All social care staff working with older people receive training and support on direct payments. They are aware of the advantages of the schemes and are able to explain the benefits to service users. Indeed the norm is to offer respite grants as a direct payment, as in most cases it is more effective for all stakeholders. The grants apply to older people who receive a care service, and to carers who have been assessed for their own needs.
Many people find this form of direct payments especially effective in the provision of occasional, short-term ‘sitting services’. Some users chose to use direct payments for part of their care package, and receive care arranged by the County Council for the remainder.
A direct paymentssteering group has overseen the development of direct payments in Cornwall. In particular this group has devised and implemented a training strategy for direct payments. Service user and carer representatives are part of the steering group and play an active role in the training programme. The most powerful training message comes from service users explaining how effective direct payments have been for them. The steering group is able to continually re-evaluate the direct payments strategy, and work pro-actively to introduce initiatives designed to increase uptake.
Direct paymentssupport
Support for service uses and staff on direct payments is provided in-house. This is in the form of both support and advice, and brokerage in meeting care needs. Work is ongoing with the voluntary sector to provide a ‘Personal Assistant Bank’, which will be especially useful to service users living in isolated rural communities. Some service users currently access commercial payroll services.
The direct paymentsteam consists of a manager/senior direct payments worker, three direct payments workers and two administrative support staff. The DP workers spend most of their time supporting service users within their own communities, advising colleagues and making joint visits to potential first time direct payments users. All service users who express an interest in direct payments are sent an information pack prior to a visit. The direct payments workers are able to talk through the way the scheme operates and explain how direct payments can be used to best effect.
Cornwall is also keen to develop electronic communication of information and service user consultation / discussion about its services. It is part of a policy of establishing an optimum effectiveness and these will offer considerable benefits for the direct paymentsteam in an area where transport and distance often make direct contact problematic, expensive and timeconsuming. The direct payments workers also run local surgeries for all staff involved in helping service users to access direct payments.
Support for direct paymentspolicy
A recent evaluation survey amongst direct payments users revealed a high degree of satisfaction about the service. Local authority members have also supported the increase in direct payments uptake, and along with NHS Trusts are collaborating in setting up ‘Individual User Trusts’ to allow individuals to have more independence and control around the delivery of both social care and health care services. This is part of the ongoing commitment toward self-directed care and individual budgets
Cornwall believe that their success in increasing direct payments uptake has revolved around a radical change in perception of direct payments, together with a dedicated in-house support team and a committed workforce.
CONTACT
Graham Allen Senior Disability Manager
01872 324206
Information provided by Graham Allen.
2.SEFTON METROPOLITAN BOROUGH COUNCIL–direct payments for older people as the first option
Top tip:
In the first instance, always assume care is offered through direct payments unless there is good reason not to.
In Sefton, this is reinforced by staff training policies and is supported by senior managers, managers and members, by voluntary sector support organisations, and by carers and service users themselves.
Background
Sefton have achieved dramatic increases in direct payments uptake over the last 18 months, particularly amongst older people.
Sefton is a metropolitan borough in Merseyside with a population of 284,000. It stretches from Bootle in the south to Southport in the north. It is mainly suburban with no large rural areas. It is characterised by having a mix of poor socio economic and health communities in the south, adjacent to Liverpool, and more affluent communities predominately in the middle and the north of the borough.
Sefton first introduced the principle of direct payments in 1996, originally as a “voucher scheme” before the legislation came into effect on 1 April 1997. The initial focus was on younger physically disabled people, and for this reason the dedicated direct payments staff were based within the adults physical disability team.
Given the importance of direct payments the function was transferred to the department’s central services unit in 2002 with a senior manager made responsible for the service. This was necessary to extend direct payments to a far wider group of service users in the borough and gave a clear focus to the DP sections identity.
In 2004 it was decided to amalgamate the direct paymentsteam with those of the Sefton Carers Centre, an organisation under the umbrella of the Princess Royal Trust. The Carers Centre already ran a voucher scheme for respite care for the council, and the principal of relocating and seconding the direct payments staff fully with the Carers Centre was an extension of utilising existing good practice and gaining some economies of scale in staff terms.
Current position. (March 2007)
Sefton MBC have 5 DP staff seconded to the Sefton Carers Centre, and a further 4 staff, including a service manager, are directly employed by the Centre and the function is jointly managed with the borough council.
Sefton retains responsibility for the overall control and co-ordination of direct payments strategy and an increase in DP use is seen as a major part of the process of extending choice and independence to all social care users in the borough.
User groups who have found it difficult to access direct payments.
Sefton appointed a direct payments worker to increase uptake amongst Mental Health service users, 2 years ago in 2005. The post holder works very closely with the Mental Health Teams, and direct payments uptake amongst people with mental health problems has increased from 3 to 24 people over this period.
The borough has very low numbers of people from black and minority ethnic communities - less than 1% of the population. Efforts have been made to contact local minority ethnic organisations in order to increasedirect payments uptake, but with little success. Most people from BME communities in Sefton often look to organisations in Liverpool to give them support.
The biggest area of success in increasing direct payments uptake has been amongst older people in the borough. A specific instruction was issued to all staff working with older people in 2006) that direct payments should be the primary route for arranging and delivering care following an assessment or review. Social workers have to present a good and valid reason to an allocations panel as to why an older person should not be given direct payments to meet their care needs.
The Council arranging, providing and paying for services was to be a last resort not a first choice solution.
The Sefton Carers Centre arrange payment on behalf of Sefton MBC, but are able to use the Council’s payroll system to calculate costs, contributions etc. The Carers Centre pays the bills directly, releasing older people from the task of making payments themselves. As such the system may be termed ‘indirect payments’ rather than direct payments. However, the philosophy and principles of direct payments still hold up, although the administration of direct payments, especially for older users, is massively simplified.
Outcome of current policy
In October 2005, there were 91 direct payments recipients in Sefton, including 28 older people. By March 2007, the figures had grown to 287 direct payments users and 72 older people receiving direct payments.
Day care
The effective use of direct payments is nowhere more apparent than in the provision of day care for older people. Sefton externalised all its in-house day care in 2006, and the principle of allowing all day care users to purchase services to meet their own needs has been implemented. They negotiated a basic rate of £30 per day for all day care, allowing service users to choose any day centre, or meet day care needs in alternative ways.
Individuals can use their direct payments to access support in attending local leisure facilities, including swimming, keep fit and aerobics. Others can pool resources to arrange ‘day trips’ by coach to local areas of interest.
Support from partner organisations and local authority members
There has been little support in expanding the use of direct payments from NHS partners, and there is no integration of health and social care services for direct payments users. However, other borough departments, such as leisure and libraries have been very supportive in assisting direct payments users to access services and local voluntary organisations regularly liaise with the council on direct payments issues.
Members have also been very supportive of efforts to increase direct payments uptake, and ask constituents what services they look for from the council, in their local surgeries. Members are clear that council-provided social care services are not the answer for many people with social care needs.
Sefton MBC regularly seeks the views of residents upon a full range of council services. It targets older people in this policy, and asks their views about what services the council should be providing for people when they are 60, 65, 70, 75, and 80 years of age. Some questions concern how services should be ‘delivered’. From this data, Sefton is confident, that many older people would choose to provide services for themselves if at all possible.
CONTACT
Colin Speight, Principal Manager,
0151 934 3743
Information provided by Colin Speight.
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