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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views


Question 45: The draft direct payment regulations decreases the time period to conduct a review of the direct payment from 12 months to 6 months – is this workable?

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14 comments

  1. Anonymous says:

    Generally, we consider the draft guidance as a formulation of what should be good practice. The draft guidance on assessing mental capacity issues reflects the status quo, and the review of direct payments after 6 months and every 12 months thereafter is something that most local authorities are already working towards.
    As mentioned in respect of personal budgets, it is difficult to see how basing personal budgets on an “amount that reflects the cost to the local authority of meeting the person’s needs” will ensure that direct payments are sufficient.
    Recipients of direct payments may choose to buy services in an unregulated market place. If the service provided takes place in the service user’s home, for example and the service is of a personal and intimate nature, there are safeguarding issues to be considered. The guidance could usefully provide a steer on this matter.

    We believe that the term ‘suitable accommodation’ needs to be contextualised and conditional within the local context. Within housing there has been a substantial number of judicial challenges around what constitutes ‘suitable accommodation’, with the guidance not taking any account of market pressures (i.e. the cost of suitable accommodation which might not or below local housing allowance cap) or overall housing supply pressures which might result in accommodation being deemed to be suitable when they are not immediately in the vicinity of an apparent first choice and possible support networks.

  2. Anonymous says:

    Of course it is both workable and appropriate.

  3. Anonymous says:

    There should be an early review of direct payments both in terms of the support plan and the financial audit as problems are most likely to occur in the first few months and are more easily resolved when not entrenched.
    A system whereby reviews are annual but with the facility to be brought forward at any time subject to a change in need or circumstance may build in some flexibility.
    To decrease timescales from 12 to 6 months across the board is likely to impact significanly on workloads.

  4. Anonymous says:

    I do not think that this is workable it is currently every 12 months and there seems to be just about enough staff in place to cope with this regime reducing it to every 6 months does not gain much benefit would require more people in post to cover the extra workload. obviously if a recipient of DP monies has a change in their needs then they are able at any time to request a review to change their DP support.

  5. Anonymous says:

    Impossible!

    We are not meeting the 12 month target – so how are we supposed to meet the 6 month target?

    Would it be telephone or face to face – it’s not appropriate to have light touch at 6 months

    The only way this could happen is by the people providing the care – e.g. the Domiciliary care provider – to ensure they are being paid [Dom Care Provider]

    as this would be a good indication of whether they are managing the DP.

    There is a wider issue about doing reviews in ASC

    It’s already a struggle to achieve the Support Plan reviews
    There is a 2nd question about if it’s not a 6 month review, is there a way of picking up the intelligence?

    it’s more about a follow up on people who are new to DPs
    is Review the wrong word? It’s more about a follow up
    Lots of consensus on this point

    i.e. a 6 month probation – and at the end of this period if the DP is found not to be working then review the decision to be on one
    it’s more continual monitoring

    It could be a phone call – might need to be a visit – but a phone call initially

    In order to meet this ‘must do’ we would need additional resource
    The system as it stands now would not be able to do this

    Summary
    Strong consensus among ASC practitioners that a formal review is not workable under current resources

    General opinion that if it was more about a follow up – and the the ‘Review’ – as long as it’s not prescriptive – and it could be a telephone call – and a visit if needed – is more workable

    No!

    In theory it is a good idea to see if there are any hiccups with the DP

    But if i was a user – if I had a problem I would ring my worker. On the other hand – if there was a problem and someone rang – the user could say there wasn’t a problem

    I do feel that someone should ask them before 12 months if they are OK

    Clarification – It’s SCC policy that we set out to check a support plan after 6 weeks – but it’s law to do it at 12 months

    The guidance gives us the ability to give light touch review
    The principle of holding the review is good – but a recent issue came about in trying to get the information from SILC – to see how the DP was actually being used. They didn’t provide this – which made doing the review difficult

    Confusion over a needs review at 6-8 weeks and a DP review at 6 weeks

    It’s adding to practitioner workloads

    The reviews need looking at because they flag it all the time and no-one does it – even when they could save £200 a month on DPs – and no one does the review

    Summary
    The principle of holding the review is a good one – but in reality, is this possible?

    Confusion over the different reviews

    General concerns it will add to practitioner workloads and be unreasonable

    The reviews need looking at

    6 months is too short! It can take someone 6 months to get used to receiving DPs – Sometimes the care can stop because the carer leaves or they go in hospital – so 6 months may be too quick – but do it from the point the DP has started (rather than initial discussions)

    BUT – It’s a good check & balance – it does need to be less than a year – if people are struggling with their DP – it would be good to do it less than a year

    It doesn’t say you need a whole new assessment – it’s just a review. Q – Could the review be commissioned out – e.g. to SILC?
    The guidance is misleading – as it states the LA has a duty to make sure the check is done (which suggests the LA could commission it out – and check with e.g. SILC that the check has been done)– but the regulations say that the LA needs to do it .

    Need clarity on this

    it would be good to have the 6 month review with the person who set you up with the DP – so there is continuity
    Is it workable? Depends on what % of DPs that Surrey organise involve employing somebody – this dictates whether a full review needs to be done in terms of employment checks – or whether it can be a light touch review

    Operationally it’s a challenge for locality teams

    Summary

    6 month review would be good on behalf of service user

    Challenge for locality teams

    Clarity needed on 2 things

    Does the LA have a duty to make sure the check is done – or does the LA need to carry out the check

    Does the LA have to do a full review if someone on a DP is employing somebody – or can this be a light touch review

    Best practice in Surrey says we should be reviewing at the point of first DP to pick up on early signs – agreement amongst SCC rep
    linking this to financial monitoring in the first period makes for more robust reviewing

    trusted assessor role – will ASC relinquish this as a role with their providers? Are providers able to do reviews? At the moment with locality teams doing it – is not possible

    the proposals are not workable as they currently are. Reviewing DP every 6 months is good practice (ideally we should review at 3, 6 and then 12 months) but there was agreement amongst SCC that this is not workable – aspirational rather than achievable

    6 months is too long a gap – in terms of support probably not soon enough.

    will people doing the review be properly trained?

    if we subcontracted –how would we make sure subcontractors were reviewing correctly and what support would they be given to ensure they are doing it correctly?

    Reviewing every months is a good thing but LAs need to be properly resourced to do this

    6 month reviews are about looking at what support is available – work out what the problem is and work with that person to resolve the problem

    at the moment we do not do the evaluation, check how it is for people – becomes a bit of a tick-box exercise – need to check how people are getting on better

    The proposals are not a bad idea but we just do not have the resources available at the moment to do it and there is uncertainty that practioners would be the most appropriate agencies to carry out the reviews

    Problems with system – outcomes currently look at the money going into the bank account – not user experience

    Overall, good idea but realistically we are not resourced currently to do this

  6. Anonymous says:

    Undertaking a review at 6 months as a stand-alone piece of work would not be workable, the increased resource required to implement this at a time of change in assessment and implementation of training would make this unachievable. It is difficult to see which other processes could be aligned with a 6 month review which would enable this to be cost effective. Requiring that the review must be undertaken with 12 months, but giving the discretion to the Local Authority of timing would enable flexibility and support responding to difficulties.

  7. Anonymous says:

    There would be resourcing issues across direct payment administration and care management. Could not manage within current resources but would welcome this change

  8. Anonymous says:

    Might be more reasonable to ensure that a review can be triggered at any time after the first month by the client; at any time after the first 2 months by carers, professionals, client, family or if the assessor was not confident that direct payments could/would be managed effectively. Safeguards would be needed so that family or others could not trigger repeated/ vexatious reviews causing distress to clients & costing authorities time & money.
    Conversely, it may not be essential to have a review annually if the client & assessor are confident, though a minimum period will be required – perhaps 16 months to offset the short-period reviews where more help is needed.

  9. Anonymous says:

    Six-monthly reviews for all clients can only be workable if government are willing to attach dedicated funding for the required number of trained-assessor hours, which seems unlikely at present.
    More reasonable to give local authorities freedom to undertake first review at a period of no more than 16 months.
    That would allow reviews at much shorter periods (six months or even less)if the assessor is unsure that direct payments will be managed effectively – or if the client asks for a review/ change. Conversely, if an assessor is confident that a client understands the process well & can deal with any necessary admin work, there may be no need for a full review in a year.
    It’s important to leave a channel for the client, carer, family & professionals to raise any concerns & trigger an early review – especially so while local authorities have budget constraints that could tempt managers to leave almost all reviews as late as possible.

  10. Anonymous says:

    Rather than the 6 month / 12 month option, is it not preferable to consider a Red, Amber, Green approach to each individual. All new people using Direct Payments could automatically be subject to a 6 month review (Red), but once processes have been seen to be followed, the person could be placed in the Amber monitoring group (12 month), then if still appropriate, on a Green monitoring group (i.e. every three years). This would enable local authorities to target resources on people who require most support / monitoring.

  11. Anonymous says:

    Whilst prompt review can identify issues with the Direct Payment arrangements and often result in the return of unspent monies a statutory 6 month review is not workable. LA’s might consider that for a section of DP’s a 6 month review might be appropriate, perhaps because they have concerns about how the DP is being managed the resources needed to reveiw all DP’s at 6 months is cost prohibitive.

  12. Anonymous says:

    Six monthly reviews will be totally unworkable.

  13. Anonymous says:

    This is not workable for our local authority who have trouble finding the resources to review direct payments after 12 months. When questioned about delays in assessments and reviews the answer is always lack of capacity and no money.

  14. Anonymous says:

    I would hope that sufficient resources would be put in place (i.e. More trained social workers/needs assessors) so that the initial “needs assessment” is seen less as a one-off, and more as a process. This would require multiple ongoing interactions between the assessor and person + carer. This would overcome some of the issues about how long to assess needs for when a person has fluctuating needs, and would allow people who are not sufficiently articulate at the initial needs assessment to feed back on whether the support they are receiving is actually meeting their needs and promoting their well-being. It may also allow issues about abuse and inadequate services from new outside providers to come to light.