Direct payments: Answering frequently asked questions
Question 06. How would you set up a direct payments scheme?
A large number of local authorities now have direct payment (DP) schemes. For a scheme to be successful, one of the key messages seems to be that it is extremely important to get elected members, senior managers and finance managers on board. They need to understand the implications and requirements, including the financial ones, to run a direct payments scheme properly.
One of the main issues for councils is to understand the wider implications of DPs for council processes. Offering DP is the easy part. The infrastructure to support this - from the setting up of the DP with the individual and the ongoing support required, to the monitoring of how DPs are used and the adjustment of the budget structure to allow for DPs in areas that have traditionally been block contracts - is all important. An easy guide to setting up would be useful, but the key is to find champions in the organisation to take the issue forward.Leicestershire LA
The evidence from the practice survey shows that differing models of practice regarding direct payments are operating throughout the country, despite government guidance seeking to create consistent practice.
Perhaps two of the key differences are whether or not there is a direct payment support scheme and the level of partnership that exists.
If there are no existing local direct payment support schemes, the local authority should take action to promote and fund a service user-led group to provide these services.
You've got to be bold. Those of us who have made progress on direct payments have done so because we've taken risks and been bold. This was especially so in the early days, as Coventry made the decision to go with direct payments when other authorities were very uncertain about the legality and practicality of the approach, but we felt it was the way forward. We are now well established as a result. We also found a way of making direct payments available to a person with learning disabilities via a direct payment support organisation at a time when it wasn't clear how this could be done without incurring some risk. It's a balance between being bold to enable people and building in safeguards.Coventry LA
Many authorities have established 'champions' in social work teams who have responsibility for development and promotion of direct payments. This is work is being done not just within their teams, but also within their local communities, service user groups and voluntary organisations.
In the short term, this has been an effective way of embracing direct payments, but in the long run, direct payments need to be supported both financially and as part of the infrastructure by senior managers and elected members.
This support could also include the cost of purchasing independent advocacy and direct payment support and advice.
Introducing direct payments requires effective leadership to drive the process of implementation from national direction and guidance through to local leadership, at both a strategic and an operational level. (4)
Other suggestions from the practice survey have included the establishment of regular liaison/meetings between senior managers, service users, voluntary organisations and social services staff, to ensure on-going communication and the resolution of any issues that arise.
All of our senior managers were very committed. Regular meetings between DP users, voluntary sector, social services staff, senior manager from each customer group attended each meeting and a DP champion was introduced. [DP champion is a local authority expert on DPs who could be contacted during working hours.]Hounslow LA
Provided a briefing for elected members and offered a workshop on DPs. Used a video presentation of service users explaining the difference that DPs had made to their lives. Members have since been sympathetic to requests for additional funding and refer service users to us if they come to their surgeries with complaints about care agencies.East Riding of Yorkshire LA
In a paper (14) for the Social Services Research Group conference (2000), Hasler stated that successful implementation of direct payments is based on: outreach
- so people get to know about the option; local support; enthused and informed care managers
- so that referrals are made for direct payments; holistic and realistic community care assessments - so that the overall package is workable.
In an article (15) in Community Care entitled 'Direct to the client', Alison Miller reported on a Cumbria-based direct payments scheme that had won the older people/ intermediate care category in Community Care's awards 2001:
"Fred Wilenius is the service manager. He says: 'We realised it was going to be hard to get people to take on direct payments if we didn't have some sort of support systems in place. People were asking, 'Will there be support available to help me?' "
The main barriers preventing people from using direct payments were that many older adults were worried about the responsibility of becoming an employer, and that social services would abandon them once they took on a direct payment. There was also a dearth of information about direct payments for older adults, and many professionals in the statutory and voluntary sector were not telling their clients about direct payments because they believed they were very unlikely to be interested.
Wilenius says: 'We set up consultation groups - two coordinators were set up to look at direct consultation with users, which seemed to be the best way to find out how to go about promoting direct payments and find out what we needed to put in place for it to work.'
Both the content of the Strategy Unit report 'Improving the life chances of disabled people' (7) and the green paper 'Independence, well-being and choice: Our vision for the future of social care for adults in England' (16) have reinforced the future of direct payments in social care.
Nevertheless, they require the backing of local authorities across the board to ensure they are embraced by social care staff. This also requires senior managers to give their staff permission to test out the guidance, be creative and take some risks.