Involving service users and carers in social work education
Payments for involvement
In this section:
"The issue of payment is exercising us all." (senior lecturer in social work)
The principle of paying for service users' and carers' time and expertise, travel and other expenses is widely accepted. It is one of the conditions of partnership that service user organisations have clearly spelt out, as shown by the examples earlier in this guide.
There is a lot of variation across service user and carer groups and individuals in what they expect and, indeed, charge. In addition, there are no nationally agreed rates of payment for their work in higher education. Rather, each HEI has to develop and negotiate its own policy and procedures within the organisation and with potential and current partners. As a result, there are a range of differing approaches to the amount and practicalities of payment. Service users and carers working with more than one university or college may be paid at different rates and in different ways for the same activity.
The SCIE project shows that payments are widely regarded as a very complicated area. Both the programme providers and some of their potential service user and carer partners identify payment as a key implementation issue. A common and realistic concern, based on early experiences, is that meaningful involvement throughout the degree has substantial resource implications. This anxiety arises in the context of difficulties of providing the course within the current budgets, and limited development funds. Estimates of additional costs vary but figures in the region of £15,000 have been quoted. Before discussion with potential partners begins, some agreement has to be reached about payment within the university. The issues for consideration are the payments that will be offered, what they will cover, and when, how and to whom they will be paid.
The options for remuneration include:
- Payment at visiting lecturer rates: many new programme providers have opted for offering service users and carers the same fee for their teaching inputs that they offer to external lecturers, guest speakers and consultants on existing social work courses. These vary and may be based on hourly, half-day or full-day rate or be a flat fee to cover contact and preparation time. Fees often quoted are £20 per hour, £25 for a half-day and £50 for a full day for contributions to teaching sessions. Some organisations pay different fees for different activities, for example from £5 to £10 per hour for planning meetings, the higher rates for teaching, and in the region of £240 per day for written work or consultation. They may offer this fee to individuals or to organisations. For example, the Wiltshire and Swindon Users’ Network have agreed to be paid the external lecturer rate for the delivery of teaching sessions and £5 an hour for other work such as preparation and attendance at meetings. In addition, there is verbal agreement for some work to be paid at consultancy rate.
- Payment at rates charged by participants’ organisations: some service user and carer groups have worked out what they want to charge and negotiate a price for specific pieces of work on that basis. Some charge flat rates such as £175 to £250 per halfday and £500 for a full day, irrespective of how many members are involved,or £50-£100 per person for an event. Others suggest between £5 to £25 an hour paid to the participants or to the group. Yet others have negotiable terms or sliding scales for different activities and partners. Their charges typically cover overheads for administration, training, preparation and support, and claims from their members that they take responsibility for settling. The contributions from the university or college in the form of meeting rooms, office space and administrative support may be taken into account in agreeing the actual fee. Some organisations prefer an annual grant or lump sum, including a management fee to cover most of their contributions. Estimates vary but sums of £5,000 and over for a pool of 8-10 service user or carer trainers have been quoted. Payments to organisations for practice learning opportunities, including student placements, are separately arranged.
- Limited payments: in order to allow for the financial circumstances and preferences of some service users and carers, limited 'exgratia’ payments and allowances may be offered (35). These may be seen as the middle point on the continuum from 'no payment’ at one end, to 'full payment’ at the other end. Such payments may be made annually or spread out over the year. Advice on this option should be obtained from a reliable source.
- Payments 'in kind’: instead of cash payments, some organisations arrange activities for participants and their families, including children and young people, or offer gift vouchers or assistance with equipment that helps an individual to contribute to the courses. Opinions are divided about the appropriateness of this approach with adults. However, there is agreement that children should not be paid in cash and other ways without permission from their parents or guardians. Again, reliable advice on these options should be obtained.
In practice, a combination of arrangements and some flexibility will be required, especially where several organisations and individuals are involved. This approach raises dilemmas about consistency and equity. A single or simple solution seems unlikely for the following reasons.
First, although paying fees for time and expertise is widely regarded as best practice by both the service user movement and public bodies, there are many views on payment and on their importance. Some people want to be paid in full to emphasise their equal standing with other partners, and cannot afford or do not wish to participate without payment. Others would like limited payments and allowances in recognition of their contribution. Yet others will work as unpaid volunteers in the spirit of public service and inclusion, emphasising the non-financial gains it may bring to them and to the quality of social care in the long run.
Second, service users’ and carers’ financial circumstances are varied. Some are selfemployed service user or mental health survivor consultants and trainers who rely on the taxable income from this activity. Others are living on retirement pensions or claiming other benefits. Those on disability, employment and other benefits are subject to the national earnings limits and volunteering rules that specify how much additional income can be earned per week without affecting income support, housing and other benefits.
The earnings rules are regularly reviewed and revised, and organisations and individuals can find it difficult to keep abreast of their content and how to interpret them. A project at King’s College London tackled this issue by producing two separate guides on the payments and benefits issues, one for service users and survivors, and the other for managers paying those involved, and adding updates (36). The Mental Health Foundation (37) has published A fair day’s pay: A guide to benefits, service user involvement and payments. This offers guidance for organisations before starting user involvement, advice to service users who are considering becoming involved in improving mental health services, and outlines the permitted work rules. Its appendices give additional information for employers, sources of information for service users on benefits rules, and information on who’s who in dealing with benefits. The Mental Health Foundation emphasises that the relevant legislation is constantly changing, that where the details are important you should obtain confirmation from a reliable source, and that organisations should always seek independent legal advice in this complex area of employment and other relevant law.
The need identified for such guides underlines the uncertainty and anxiety about payment issues across service provider, user and carer organisations and among individuals.
The view that the benefits rules hinder involvement has been drawn to the attention of government by service users and by organisations with a remit to develop it. This is a national issue that is wider than payment for participation in social work education. It cuts across government departments, including the Department of Health, the Department for Work and Pensions and the Benefits Agency, and requires attention at the highest level if the issues are to be resolved equitably. At the request of the Parliamentary Under Secretary of State for Community Care, Shaping Our Lives National User Network is producing a SCIE-funded report on why benefits rules make it hard for service users to have a say in social care services.
It is standard practice to cover all travel expenses incurred by the participants and by personal assistants accompanying them. Public transport costs, taxi fares and car mileage allowances at the HEI or participants’ organisations’ rates are paid. The problems centre on the need to produce receipts and the timing of payments. As many participants may travel long distances and need taxis there and back, the transport costs alone for one meeting may be substantial, varying with the composition and size of the group. For example, transport costs for a meeting with 8-10 people may be between £100 and £200.
Offers of payments to cover childcare, substitute carers and personal assistance are required and accepted practice. The costs depend on the individual’s own arrangements, where they live and the employment situation. For example, payments to personal assistants of £7 an hour have been quoted. The cost of a carer or helper through a private agency varies between £10 and £20 and a typical charge in London is £14.50 an hour.
Service users and carers also incur other expenses in preparing their inputs into the courses. These include the costs of telephone calls, postage, faxes and photocopying. Most organisations offer to cover these expenses.
The above list may help to illustrate the reasons why universities are concerned about the adequacy of resources for full service user and carer involvement. If service users’ and carers’ fees, travel and other expenses are paid, then a planning meeting with 8-10 people may cost at least £300 in direct payments to participants. The costs of accessible venues, equipment, and refreshments must also be calculated. In addition, service user and carer organisations need a budget for preparing contributions with their members and for supporting and training their trainers. As the report prepared for the Department of Health by Carers UK and City and Guilds Affinity38 points out, these costs should be balanced with the benefits of service user and carer involvement.
Many service users and carers are benefits claimants or live on small incomes. They do not have the reserves to pay for taxis and rail fares, claim them back and then wait a month or more for reimbursement. Some do not have bank accounts and need cash payments. Many participants need their travel and other expenses there and back paid in cash on the day of the event and therefore do not have the receipts for the return journey. Some need the taxi fare paid on arrival. Claim forms are not always user-friendly and they are timeconsuming to complete and send off. Understanding and meeting these practical needs is essential if trusting relationships are to be built up and sustained.
Paying service users and carers promptly and flexibly is at odds with the arrangements for paying fees and expenses in universities and colleges. Almost all the responses to the SCIE survey commented on the difficulties that they have encountered in this area. A lot of time has been spent on seeking and finding solutions, and on meetings at senior level with finance sections. Universities and colleges have to exercise tight control over expenditure and they apply the same procedures to many departments. They may require receipts for every item, and pay one month or more in arrears. Some universities pay external lecturers only through the payroll and requests from service users for a different arrangement have been refused. They must be sure that their payment arrangements do not contravene the benefits and tax rules. Tackling these rigidities is testing the ingenuity of everyone involved. Solutions take a long time to achieve. One approach is that service user and carer groups have their own accounts and draw the money in advance so that they can pay expenses on the day. This arrangement may be combined with the payment of an annual, quarterly or monthly fee to cut down on invoicing and avoid delayed payment. Other approaches include special budgets and accounts within departments. One of the responses to SCIE stated:
"There has been no difficulty about the principle of paying people for involvement in development activities etc. However, cash payments have tested the flexibility of institutional arrangements but a resolution to this is emerging - it may involve installing a safe!”
We have emphasised that getting the practical aspects and details of service user and carer involvement right is an essential part of the process of building up trust and robust relationships. Mistakes may be made along the way and have to be rectified. As with ease of access, prompt and acceptable payment arrangements are key to the success of recruiting service user and carer trainers and retaining them.