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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 46: The draft regulations seek to ensure choice is not stifled and the direct payment is not monitored excessively – is it strong enough to encourage greater direct payment use, but workable for local authorities to show effective use of public monies?

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14 comments

  1. Anonymous says:

    The question of effective use of public money is very important at a time of such severe financial restraint. It is essential that all parties are assured that the funds being made available are being spent on care.

  2. Anonymous says:

    We feel that the draft guidance has got the balance about right and agree that light touch is the right approach for the vast majority of service users, although we have some concerns about the lack of focus given to the ability to be able to undertake closer scrutiny of the very small minority of cases where misappropriation or abuse is suspected.

  3. Anonymous says:

    not really sure how much notice of any a local council will take of the fact that they should not stifle we have reports from an occupational therapist stating needs things that should be done/experienced only to be told that DP is not allowed to be spent in that way.

    what is the point in having expert assessments from various people only to be told that although there is an identified need the monies provided by DP cannot be spent that way and even more ridiculous you are told that you can do another activity that could be £30 for 1 hour instead of the one you prefer to do that costs £10 for 1 hour so where is the sense in that.

    perhaps the supporting guidelines for councils and the DP Payments should be the monies can be used by the recipient to pay for anything related to their assessed needs as detailed in their support plan that way we will not be wondering are we doing it right can we use it for this or I want to do this but they have said I am not able to use the money in that way.

    We had a DFG a few years ago to re-do the bathroom into a wetroom and part of the request was for underfloor heating because of the drop seizures we were told at the time sorry a DFG does not pay for underfloor heating so we substantiated the need and in our area were the 1st to get it done under the DFG.

    sometimes someone has to be the first to do or suggest or complain about something to bring about change.

    We would very much like to have some legislation to rely on as it is exhausting enough coping with the disability and providing the support without a multitude of battles with the council as they dodge and dive.

    We have recently found when writing and asking for answers to important questions like needs not being fully met that we have had to wait 20 working days to get a reply and that reply was not answers bit an offer of a meeting some 2 weeks later is there not any sensible time lines on councils when people requiring help/support are requesting it.

  4. Anonymous says:

    My concern lies in the main with autism and how the Autism Act 2009 and its resultant statutory guidelines seem to be persistently ignored. Autism is a lifelong complex disability and we keep coming up against barriers with the direct payment budget allocated and what we can and cannot use it for. There are plenty of assessed needs identified and clear limits on us due to the likes/dislikes/ability of our autistic and epileptic son so put that together with a long list from the council of what DP monies can and cannot be used for it makes for a very difficult job for us all. I strongly agree that choice should not be stifled but feel that this statement is too vague to be of any use to rely on. Would it not be more helpful to state that the DP monies can be used to achieve the assessed needs as detailed in the Care (Support) Plan that way we could all feel a bit more at ease about having and using DP budgets. We seem to have to constantly ask the care manager is it ok if we use DP money for X or for Y then he has to get clarification things need to be clear, and unrestrictive as long as the persons assessed needs are being met and all receipts are kept to prove how the DP money has been used to this effect then this would meet all that is needed surely. Annual audits take place at the moment not really sure what benefit if any a shorter 6 monthly audit would bring with it other than the need for a lot more staff to do the work. there also seems to be a lot of variations from one county to another in what people are or are not allowed to use the DP monies for again this should not happen what you are told and allowed to do should not be anything to do with your postcode. We need increased choice, personalisation and control. We also keep coming across issues of costs for the carer ie when someone is severely autistic with diminished capacity then they need a 1 to 1 carer maybe 2. So lets say they wish to go the cinema DP can pay for the disabled person to go to the cinema the cinema does allow 1 free carer so how do we pay for the 2nd carer. Whereas if DP rules/regulations were more user friendly then we look at the assessed needs yes visit to cinema complies needs to go with 2 support workers so DP monies pays for the whole thing. this is just a simple example but we all want to get on with our lives as fully as we are able and parents in a caring role want to make goods use of the respite time they have when their child is in the community with the carer/s and not be phoning/asking/checking if they are doing things correctly. The effective use of public money will be covered at the initial assessment of eligible needs and the annual care/support plan regime with the care manager, also by the annual audit of receipts for monies spent by the DP department. The current system is sort of there but the almost nit picky attitude of some council staff is very frustrating when they are not living and experiencing the disabilities day in day out and striving hard to achieve and better quality of life for their loved one.

  5. Anonymous says:

    Current monitoring arrangements are not onerous at all – in my opinion – and people still object – even if you monitor annually!

    What’s deemed onerous to the service user? The term is woolly and it can mean different things to different people

    Confusion over the wording in the question – should it read ‘ is it light enough to allow greater DP usage?

    It seems to be saying if we make the monitoring more light touch would this encourage DP use? – I don’t agree!

    It’s all about how it is handled – i.e. doing a risk assessment and making it easier for people to administer their DP

    Barriers exist to those in financial difficulties – especially vulnerable clients – they wouldn’t be able to cope with a DP. Debt is a big problem

    We do see a lot of clients in a caring role – and so anything which makes it easier in terms of lighter touch monitoring would be good for carers

    Another barrier to DPs is the changes to all the benefits – a lot of their patients are all on PIP (Personal Independence Payment) for their DLA. There have been a lot of changes to this and the eligibility – and a lot of people are being refused – and so a consequence of someone not getting PIP might mean tat they more people might be eligible for DPs

    What kind of monitoring arrangements should we have in place to encourage people to take up DPs?

    Yes – general agreement that there should be flexibility on how often we reconcile DPs depending on people’s skills and level of responsible

    It’s a risk management thing – on how light do we go?

    What is needed is a clear understanding on all sides around the parameters which a DP can be used so if this was in place this might help

    Agreement – it would be good to have a list of what could be included. There’s always the ‘seeking permission ‘ aspect – as to how a DP can be used.

    until you get the agreement on what a DP can be used for – then you are afraid to spend it on that – which restricts flexibility.

    With the DLA – nobody checks this and it’s a trusted arrangement – But with DPs – if we don’t check, it’s back to the LA and if the money hasn’t been used for care – then the LA has to provide the care and support on top of this. It’s about striking a balance between protecting public funds but not having too onerous a system to put people off.

    Example from ASC – where a carer had to seek permission from their practitioner when they wanted to make a change to how they provided the care

    It would be helpful for the LA to provide some guidance as to how Support Plans should be structured – so that if the service user is clear what flexibility they have

    There is an issue around what is down on the SP – and whether the expenditure can be identified as meeting those outcomes

    It should be about the individual making the choices

    It should be moving away from the bureaucracy – and the permission aspect –

    As a practitioner – you would like to have a conversation to ensure that the change in what the DP is spent on is still meeting care needs

    Agreement that we should be less prescriptive

    Having clear outcomes what the family wants to achieve – this would provide some protection about how that money has been spent
    Suggestion as to how the Department of Health can help with this
    i.e. How do we as an LA – create some consistency with the quality and content of support plan

    If the DH could provide training on good, robust support plans – would create this consistency in terms of standard provision
    12.81 regulation – Can’t have a must and a should when talking about the same issue.

    If someone is going to employ someone -There are statutory responsibilities if you are an employer – and so this should be a must. This relates to 12.81 – should be a must – in terms of the LA having to take reasonable steps to inform people of their obligations when they terminate someone who was working for them when their DP ends

    Summary
    Clarity needed on what a DP can and cannot be used for

    Strong agreement from all in the room on this.

    Need to create a balance – in terms of – Support Plans not being too prescriptive – and the Service User having flexibility over what it can be used and not having to ‘seeking permission ‘ – as to how a DP can be used – balanced with the practitioner being assured that support needs are being met.

    Department of Health to help nationally with this – Guidance / training on good, robust support plans – would create this consistency in terms of standard provision

    no – leads back to the suitability of the person in the first place to receive a DP and the importance of explaining to the person DP on their behalf what it should be used for – when reconciliations come in they are often very brief – often refer to things being purchased. Not wanting to remove a DP from someone but seeing misuse of sums is very difficult – we need to the balance between choice and control right

    Sometimes the LA does not explain the correct use of DPs well enough
    Misuse of DP – very small minority

    Acceptance and tolerance? Lack of clarity? – we know that one of biggest barriers to DP is all the monitoring

    Was general agreement that there is a lack of clarification when setting up the DP payment – no one goes into great details. Social workers do not have much time to explain and high turnover of staff means it is often difficult to ask a constant person questions over the use of DPs – people often inadvertently end up spending it on the wrong things due to poor explanation when the Direct Payment is set up -Consensus on this point from SCC & Coalition reps
    SCC could fix this – is there something in the guidance that DH could make compulsory for LAs?

    each case needs to be looked at for risk to individual and LA and that should inform proportion of DP – SCC consensus that we would like to see this from the DH

    would like more guidance from DH – about how we could ensure choice
    Agreement that national consistency is needed –especially for portability

    agreement about risk – review according to risk – assess cases for risk

    Is there anything else people would have liked to have seen around DP to feedback to DH?

    Suggestions (from what carers have said):
    Respite and cost of respite
    Access to advocacy
    Chance to meet other carers
    Crossroads – 2 hrs a week
    Carers wanted someone to do the paperwork – agreement from coalition reps
    link between DPs and respite is important – being able to pay for respite by DPs – not sure has to be in DH guidance but in terms of Surrey’s response we need to think about this – more people would use DP for respite
    respite does mean many different things (i.e break, Crossroads, little and often) – now there is such a choice for people, is getting a bit lost – it means a lot of things to different people
    SCC need to do more around improving the advice and information around respite and DPs

  6. Anonymous says:

    Cannot see how less monitoring would ensure effective use of public money. Also concerned about how clear the regulations are about who can have a direct payment in particular people who may be deemed as self-funders who are currently sign posted – should we be offering the direct payment and invoicing for contributions based on the local authority charging policy?

  7. Anonymous says:

    Some 40 local authorities are now actively using prepaid cards to make direct payments and there is overwhelming evidence that their use reduces cost, increases the effectiveness of managing the direct payments budget and are beneficial to service users, thus effectively balancing choice and monitoring and driving increased take up of direct payments.
    12.56 Modern prepaid cards act as ‘lite bank accounts’ offering direct debits, standing orders and instant payments to bank accounts or other cards. As such they are no different to paying ‘cash’ (very poor term) into a bank account and make the second part of 12.56 redundant. That is, unless the term means the actual payment of cash which is something that is very risky and expensive to manage and something that most Councils are actively trying to move away from.
    12.57 Our Council network members take a very firm line on this. The person has the right to choose who fulfils their care needs but the Council retains the right to transact its business in the way in which it deems is most effective and provides sensible use of taxpayers money. Prepaid cards in themselves place no restriction on the choice of care provider.

  8. Anonymous says:

    There is a clear difference between measures aimed at ensuring choice is not stifled – other posts here make clear that funding authorities are struggling to give up control – and measures to ensure effective use of public monies.
    12.56 The reference to Prepaid bank accounts with a debit card facility (Prepaid cards is perhaps an unhelpful shorthand) “they should not be provided as the only option to take a direct payment, the offer of a cash payment should always be available if this is what the person requests.” introduces an extraordinary level of risk into the act. Local authorities are working hard to end cash dispensing because it is correctly identified as fraught with danger.
    The “mechanisms” which are referenced are rapidly becoming best practice in provision of Direct Payments, and provide the most effective method for real time monitoring, and facility for protection of the public purse without limiting choice and control for the user. Those with of long experience of managing the provision of Direct Payments are aware that this part of guidance would provide an avenue for a small number of agents, who have found DHSS controls highly effective, opportunities for misuse of funds which will prevent controls to ensure effective use of public funds, and must be revised.
    The prepaid systems are also developing effective data measuring to help develop the market for user choice in care support and therefore enhance opportunities for flexibility and innovation rather than reduce them.

  9. Anonymous says:

    Money where I live is given to employ a person for a certain number of hours per week, with expenses as an employer (insurance, tax, postage stamps, payroll provider). The only flexibility seems to be that of an employee working fewer hours one week to be made up by more hours another week.
    The payroll provider can’t deal with hours fluctuating between 4-week periods & auditor/ checker from local authority is only interested in neat consistent paperwork.

  10. Anonymous says:

    The guidance does not focus on sufficiently, or give clear case studies on the extent of the flexibility that direct payments should give. In some respects it seems weaker than the existing guidance. The reality of the situation is currently that local authorities really struggle to give up the control that is required to allow people to find innovative solutions. Often random rules and policies are cited as a reason, which have no legal basis or exist in a formal way. Case studies will give a clearer indication of the extent of flexibility that should be given. The current situation is similar to the eligibility criteria, i.e it is a post code lottery which is not uniformly rolled out across the country.

    It needs to be considered that good practice is patchy across the country, and without strong guidance will continue to be so. A visit and discussion with disabled people and carers locally would give many examples of this.

    Of course public money needs to be spent on the outcomes identified but how these are achieved should largely be down to the individual. A clear resource allocation linked to needs and outcomes will support this to happen.

    An example of a recent meeting I attended included a manager saying the budget must be spent on day services and respite……. this is a long way off where we need to be.

  11. Anonymous says:

    The effective use of public monies comes from the outcomes being achieved by the use of the personal budget as per the Support Plan. The authority should not be monitoring what the money is spent on as long as the outcomes are being achieved in a legal way.

    One way choice is stifled is not signing off a Support Plan unless every penny is accounted for beforehand, as happens in our local authority. This takes away the flexibility to decide that one outcome now needs more money to achieve and deciding which outcome is now of less importance. Choice and Control is vital if people are to take up direct payments and excessive monitoring will put people off.

  12. Anonymous says:

    There is a lot of emphasis within the guidance on ensuring the responsibilities as an employer when employing individuals directly which may be onerous to many people. The Act and this Guidance mention the responsibility of the LA to provide information and signposting to volunteer and user led services that can help with the administration tasks but but they have no direct responsibility for ensuring such services are available and easily accessible which exposes the uptake and success of DP to the existence of and accessibly to volunteer based services. This seems to me to be a considerable oversight unless formal commissioning and monitoring is involved, although this is not required by the Act.

    Further, the guidance misses an opportunity to highlight the possibility and perhaps benefits of buying all of some services from those who are self employed. Additionally, what responsibilities and good practice this might require, for example, proper invoicing and checking registration of the individual or company with HMRC.

  13. Anonymous says:

    The duty of care is to enable people to meet their care needs. Having enabled them, it is going beyond the duty of care to police how they do it. For people with the capacity to manage their own affairs, excessive monitoring is inappropriate and an abuse of the basic human right to independence and privacy.
    The assurance of “effective use of public monies” mentioned in the guidelines should go no further than simply noting that the individual is not presenting as an emergency case for social or legal intervention – the same degree of monitoring that applies to other citizens receiving state help such as benefits, pensions, etc.
    A few people will fail, yes, just as some people in the general community fail and have to be rescued. But trying to prevent that by imposing rules and monitoring on DP recipients that would be unacceptable for other citizens is discriminatory.

  14. Anonymous says:

    Lack of choice and flexibility and over-bureaucratic processes is ‘sucking the life’ of out of personal budgets. Having choice and control is the whole reason people wanted one in the first place so to see creativity and flexibility stifled is soul-destroying. Budget holders need to be trusted more.