Direct payments: Answering frequently asked questions
Question 10: How can you ensure that the process runs as smoothly as possible?
Monitoring and review of direct payments
If a service user is struggling with a direct payment, the first issue to be considered is whether additional support can be provided. Different options need to be considered before the direct payment is stopped.
Direct payment service users should have reviews with their care managers at regular intervals, or at their request, to ensure that the package is still suitable for that person's needs.
Legislation allows for the local authority to seek repayment of money, if it has not been used to obtain the type of service or equipment for which it was intended. However, DH [Department of Health] guidance explains that this provision is not intended to penalise genuine mistakes, as opposed to wilful misuse of the money. the legislation and policy underpinning direct payments clearly establishes arms-length arrangements in which the local authority will inevitably exercise more control. for local authorities to be over-prescriptive about how the care package works might threaten to undermine the very purpose of the payment. (12)
In 2000, Scope (22)reported that, so far, monitoring and guidance had been more about finances than the quality of services. This perhaps reflects the concerns that people will run off with the money or misuse it. However, accountability and safeguards are built into the process.
People want to be trusted to spend their direct payment money on the things that they need. They want flexibility and control. (9)
I was told by my social worker: 'Your care package is not fixed in stone - get in touch if you need to inform us about any changes.'
Direct payments user
In Scotland, practitioners were deterred by perceived expenditure and workload implications. and by a fear of loss and control. Others were concerned that service users would misspend their payments on drugs or alcohol. (19)
The Valuing People support team have produced an extremely practical document entitled 'A guide to receiving direct payments from your local council'. (24)In the section 'What do I need to do before I start receiving direct payments?' (pp 25-27), there is a comprehensive list of all of the issues that should be agreed between local authority and service user, and is written for the latter. Adapted for this guide, it includes:
- how often and in what form payments will be made
- the information the local council needs to receive about how the money is spent
- what the money may and may not be spent on, and how much flexibility will be allowed
- what needs the direct payments relate to
- what services the direct payments are meant to cover
- the value of direct payments to be received.
If the service user decides not to carry on with direct payments, then the local council should arrange services instead. If the council does not think the service user can manage direct payments any more, it might decide to stop giving the money and to arrange services instead.
The local council should involve service users in any decisions being made about support and care, and ensure that they know what is decided. Ideally, good practice would require this to be a collaborative and person-centred process.
Difficulties can be minimised by good assessments, clarity (e.g. about what the money can be used for), monitoring, effective support arrangements and by discussing potential areas of difficulty, and how they will be handled, with the user before direct payments begin. (18)
The arrangements made about how direct payments will be used should be reviewed in the same way as traditionally received services. This will establish whether needs are being met and whether they have changed in any way.
Many social care staff are concerned with risk. This was picked up in an article by Sian Vasey in Community Care - ' Our way or no way'(25) - which states:
"From what is known, most individual direct payments schemes work well, but, perhaps inevitably, some probably don't. And when this happens it can create conundrums for social services. Could they or should they intervene, and if so, under what circumstances? With the exception of corruption or other abuses of funds, do they even have the right to 'interfere' in what is an essentially private arrangement between disabled people and the staff or agencies they employ?"
The article discusses how this was a dilemma faced by one practitioner in a particular case. Sian Vasey concludes:
"This case has put the system to the test, but it shows that allowing people autonomy is the right thing to do. When a direct payment is in place, the buck must stop with the disabled person on the issue of employing people and on the issue of making sure their own needs are met."
On one level, it is inevitable that, for some, direct payments will not work for a variety of reasons. However, the same principle can also be applied to the provision of traditional services.
The relationship between the service user and local authority/care manager is key. If it is one of partnership and collaboration, with the proper reviews and checks in place, the risk of things going wrong would be greatly reduced.
There is undoubtedly a role for direct payment support services in this process. They have a part to play in both protecting the rights of the service user and also feeding back issues to the local authority to enable schemes to develop.
This may appear idealistic, and it may not always be possible to achieve. However, these are principles on which independent living and the success of direct payments depend. In many ways, the guidance and legislation is encouraging staff to take risks, be flexible and creative and learn from the experience.
Councils should follow existing guidance on carrying out reviews. The fact that the council is making direct payments rather than arranging services itself does not affect its responsibility to review an individual's care package at regular intervals. As with all services, the projected timing of the first review should be set at the outset. The purpose of the review remains to establish whether the objectives set in the original care plan are being met. It should therefore cover whether the person's needs have changed, whether the use of direct payments is meeting assessed needs, and how he or she is managing direct payments. (26)
Criminal Records Bureau (CRB) checks
If direct payment recipients are employing an individual to care for a child, the local council should carry out checks under the Protection of Children Act through the Criminal Records Bureau. The council must carry out the check free of charge. The same regulation should be applied to disabled 16- and 17-year-olds.
Disabled adults who want a similar degree of reassurance about the suitability of their personal assistants will need to enter into a contract with an approved agency who can request the CRB check. The local council or direct payment support service should be able to offer more advice about vetting potential workers.