DH Development Fund Project

 

The Rowan Organisation in partnership with the DH development fund and 8 participating local authorities

 

Executive summary of the findings

 

 

The overall intention of this project was to increase access to direct payments for under represented groups. These were identified as:

 

·        Older people

·        People with mental ill health

·        People with a learning difficulty

·        Children and families

·        Disabled people from the black and minority ethnic communities

 

Further, the project sought to create training directories that could be used by PA employers to source appropriate training for their staff, and to explore the wider issues of the PA role as a career option.

 

The experiences and opinions of 270+ people (including local authority staff, support service staff, direct payment recipients and potentially eligible recipients) were canvassed in pursuit of identifying the barriers that appear to be limiting the take up direct payments amongst the 5 under represented groups.

 

The project worked in partnership with 8 local authorities where the Rowan Organisation delivers the independent direct payment support service. The partner authorities were:

 

·        Blackburn with Darwen

·        Lancashire

·        Staffordshire

·        Milton Keynes

·        Warwickshire

·        Wiltshire (withdrew from the project in April 2005)

·        Thurrock (withdrew from the project in March 2005)

·        Cambridgeshire

 

Each partner prioritised 3 specific under represented groups.

 

The innovative part of this project was the ‘barrier removal’ element which is commonly referred to throughout the report as ‘phase two’.

 

Following the interview and research stage, the development team worked in partnership with the local authorities to deliver specific pieces of work that would actively move towards removing that barrier for service users. It should be noted that many of the barriers that were identified have been highlighted in previous research but were enduring as issues.

 

The full report has been structured to allow readers to examine only the areas of specific interest to them. The following section will summarise the common themes of the identified barriers and highlight the recommendations that have emerged from the project findings.

 

It should be noted that the report was designed to highlight barriers and identify means of addressing them, so by definition it does not pay particular attention to the aspects of direct payments that are going well, nor does it make reference to the many examples of good work being carried out by local authorities and support services.

 

 

The common themes of barriers:

 

Ø     Assessments: are the key to setting people on the right path to succeed in co-ordinating their own support. Where the assessment is not well paced, accessible and fully inclusive there is demonstrable evidence that this disadvantages users in accessing direct payments.

 

Ø     Lack of support and training: when all professionals (including support staff and social workers) have thorough personal knowledge of direct payments, the users benefit from positive support. If the professional is either disengaged with direct payments or has had poor training, the service user does not benefit from encouraging support.

 

Ø     Lack of awareness: many users are left confused by the dual use (by the departments of health and work and pensions) of the term direct payment. This creates an environment where users may not be aware to ask about their entitlement to a direct payment to meet their support needs.

 

Ø     Inaccessible information: is a barrier to initial access if it is inaccessible. This may include being in inappropriate format/language or uses terms that leave users feeling excluded. For example, older people or people with mental ill health may not engage with literature about disabled people.

 

Ø     Lack of budgets and resources: whilst Local Authorities continue to block fund some types of service, there are inadequate available budgets to make direct payments in lieu of direct services. For example, there is demonstrable evidence that people with a learning difficulty are prevented from accessing direct payments because budgets have been pre-allocated to more traditional day services.

 

Ø     Being an employer: once a user is receiving a direct payment, there are issues in being able to compete as an employer in an environment of low unemployment. This includes having enough funds to offer attractive terms and conditions, recruiting and retaining good staff (with no/limited access to training and professional qualifications) and ensuring good support in setting up contracts/job descriptions to stay within employment law.

 

Ø     Decisions about consent: Some social care professionals felt compromised by a desire to empower recipients whilst juggling an expectation to risk manage. The project revealed that stereotypical assumptions about willingness or ability to manage a direct payment has lead to users being deselected before having the chance to make a personal choice.

 

 

 

Recommendations:

 

ü                 Assessments:

Place a section on all assessment forms that requires the assessor to declare that direct payments have been explored with eligible people, with reasons if they do not wish to pursue. The local authority can then measure these reasons to ensure that inaccessibility or discrimination is not a key feature.

 

ü                 Support and training:

 

a.                Mandatory, regular training on direct payments for local authority professionals, including social workers, finance staff, commissioning officers and managers. Full inclusion of direct payments in the social work degree would go some way towards mainstreaming direct payments as an equal method of meeting assessed need. The meaningful inclusion of an existing direct payment user, particularly from an under represented group, can support the process of challenging assumptions and encouraging positive thinking about potential benefits.

b.                Compliment formal training with peer mentoring  and in house support in order to build confidence and address fears of social care staff.

c.                Use of good quality support for in depth, accessible support in accessing and succeeding in using direct payments, including employment processes. Whilst this project did not specifically research this issue, it concludes from various expressed opinions that this support is best delivered from an external source (ie distinct and separate from care management). This is reinforced in the DH guidance notes, where local authorities are encouraged to consider ways in which they can offer support in connection with Direct Payments. However support is provided, it should encompass appropriately trained staff in all aspects of cultural differences and communication differences to ensure access for all disabled people. In order to achieve this, local authorities need to make reasonable provision from budgets to purchase/provide good quality support

 

ü                 Awareness:

 

Clearly, disabled people cannot make a choice about whether or not direct payments are the right thing for them if they are not aware of it. The project has demonstrated that specific training for users and potential users gives people the power of information to be asking the right questions in pursuit of accessing direct payments. Similarly, professional who are clear and well trained about the benefits of direct payments are better place to ensure that all eligible people are presented with the choice.

 

ü                 Information: should be presented in meaningfully accessible formats, and enough time allocated to each interaction with professionals to ensure that all disabled people have an equal chance to make a well informed decision. Information should not exclude people who may not view themselves as disabled, with particular attention paid to older people and parents of disabled children. A reliance on written information excludes those who do not/cannot read and so alternative audio/visual formats should be made available.

 

ü                 Budgets:

 

a.                The project team presented to the All Party Disability Group, calling for tighter central government directives to local authorities about block funding services. Block funding creates an inflexible budget structure which is not in keeping with direct payments and demands training and awareness raising for commissioning officers and budget managers.

b.                When calculating the cost of delivering services through direct service or direct payment, budget managers should consider the additional cost elements including proper cover for absent PAs and a move towards preventative, social support (as opposed to crisis intervention).

 

ü                 Being an employer:

 

The project further presented to the APDG that PAs should be afforded a career structure in order that direct payment users can offer competitive terms and conditions as an employer. Affording DP users an adequate budget for all considerations is key to ensuring that employers can build in good contingency plans in the event of sickness/annual leave.

 

ü                 Consent:

 

Local authorities should develop clear, transparent policies regarding consent so that social care professionals can make reasonable, accountable decisions that do not unfairly exclude large sections of the disabled community.

 

Conclusion:

 

Many of the identified barriers were already known from previous research and from local authority knowledge. However, that they were still presenting as issues for some service users would indicate that a satisfactory resolution had not been achieved.

 

This project was intended to create a programme of development and improvement beyond the life of the funding and therefore some barrier removal work has been started but cannot be reported as concluded as the time of writing this report.

 

Significant work has, however, gone into awareness raising and training. In partnership with Values into Action, 16 training sessions for people with a learning difficulty were delivered across the 4 partner areas that had prioritised this group. This training is described in more detail in the learning difficulty chapter under ‘training’.

 

Project workers have also targeted existing groups of users and presented information about direct payments.

 

The support organisation has commenced development and improvement work on the accessibility of information and literature.

Training in accessibility of information has been bespoke designed for support staff and local authority staff and will be sourced from an appropriate provider in the coming months.

 

The culmination of 18 months of work on this project is this report and the ‘good practice’ guide. It has been designed for readers to dip in to sections that are relevant to their interests.

 

On behalf of the Rowan Organisation, we would like to acknowledge the commitment shown by partners in engaging with this project in pursuit of improving services for direct payment users. Significant positive work is already ongoing within these local authorities which are not well highlighted in a report that is focussed on barriers.

Our thanks go to the people who donated their time to the project by consenting to be interviewed. It was the intention of the report to represent your views and we thank you for sharing them.

And to the project team, who have worked tirelessly in a difficult work environment.

 

Our thanks and appreciation.