DIRECT PAYMENTS (MENTAL HEALTH)
ANNUAL REPORT 2005/06
Introduction
The number of referrals for, and overall take up of, Direct Payments this year by mental health service users is very encouraging. The creation of the role of Direct Payments Worker (post taken up in March 2005) working closely with the Direct Payments Support & Advice Service (DPSAS), and combined with proactive and supportive promotion of Direct Payments to service users by both Health and Social Care colleagues, have been instrumental in achieving this growth.
There is stronger growth in Adult service users compared to Older People and the reasons for this need to be identified and addressed. There is certainly scope for a greater take up by Older People and supporting Care Managers and other colleagues to identify appropriate uses of Direct Payments with service users and carers from this group is crucial.
Uses of Direct Payments to date
Mental health service users are applying for Direct Payments for a variety of uses, as detailed below.
*Leisure/sports activities include:
Swimming
Yoga
Fishing
Pilates
Reflexology
Aromatherapy
Exercise classes
Bowling
Tai Chi
Archery
Snooker
Reiki
Horseriding
Massages
One-off Direct Payments
11 service users received one-off Direct Payments as opposed to ongoing Direct Payments. In addition, 15 service users received one-off Direct Payments as well as ongoing Direct Payments. The uses of one-off Direct Payments comprise:
Adult education
Driving lessons
Leisure/Sports activities (eg joining fees, licences, equipment)
Respite
Set-up costs for pendant alarm
Travel costs
Gym membership
One-off Direct Payments are provided when the service is best purchased in one lump sum (eg to buy a piece of equipment or a short course) and it would not be practical or cost-effective to Buckinghamshire County Council or the service user to provide ongoing Direct Payments.
In one case (travel costs), a one-off Direct Payment was provided as a temporary measure to enable the service user to obtain the necessary identification documentation to open a separate dedicated bank account.
Issues raised
Experience of both setting up Direct Payments, and monitoring existing Direct Payments, has identified the following important issues:
- an individual’s ability to arrange services and manage their Direct Payments (eg keeping accurate records of expenditure and sending in financial returns) is crucial. It must be remembered that this may be with as much or as little support as is required. There are structures in place to provide support (eg Direct Payments Support & Advice Service; Direct Payments Worker) and availability of these structures must be stressed to service users who receive Direct Payments;
- in addition to the above issue, it is vital that Direct Payments are reviewed after 6 weeks and annually thereafter (more often if required) to ensure both that assessed eligible needs are being met and that the Direct Payments are being managed correctly;
- Direct Payments Agreements must be drawn up in such a way that the service user is aware of the boundaries of expenditure of the monies provided, but also so there is flexibility within those boundaries. This is a difficult issue. For example, currently if a service user wishes to change the activity they purchase with their Direct Payments, they must discuss this with their Care Manager. Focus in future may be more on “outcome based commissioning” i.e. ensuring that needs are met with less focus on precisely how those needs are met;
- service users who are using Direct Payments to employ privately Personal Assistants must fully understand their responsibilities as employers. For those service users whose condition may fluctuate and consequently affect their ability to manage their Direct Payments, setting up an Advance Statement may prove helpful.
Plans for the year ahead
The year ahead will involve continuing to accept and process referrals from CMHTs and to promote use of Direct Payments to colleagues, teams, service users and other interested parties. Particular emphasis will be placed on Older People Mental Health where there may be greater scope for use of Direct Payments than is currently realised (eg through use of User-controlled Trusts or Enduring Power of Attorney where ability to manage is an issue). Problem-solving individual issues to facilitate access to Direct Payments will continue to be important.
In addition, consolidation of the achievements to date will take place by setting up a system whereby the need for formal review of service user’s Direct Payments is flagged up to Care Managers. This will happen alongside a more informal system of “customer care” follow-ups by the Direct Payments Worker so that any potential problems are nipped in the bud.
There will be a need to analyse the numbers of Direct Payments which are cancelled and the reasons for that (e.g. alternative care provision such as permanent residential care; natural turnover whereby Direct Payments form part of the recovery process).
A number of discussion fora will be set up in conjunction with the Direct Payments Support & Advice Service to identify employer’s responsibilities with those service users for whom they may be applicable, to provide necessary support with those responsibilities and to introduce the concept of Advance Statements for Direct Payments.
Robert Arthurton
Direct Payments Worker
10.03.06