Report to Community Support and Education Scrutiny

AGENDA ITEM 6

BOROUGH OF POOLE

REPORT TO COMMUNITY SUPPORT AND EDUCATION SCRUTINY

18 OCTOBER 2005

REPORT OF HEADS OF SOCIAL SERVICES

(ADULT COMMISSIONING AND CHILDREN AND FAMILIES)

DIRECT PAYMENTS

1.PURPOSE OF REPORT

To advise Members on the actions being undertaken to continue the development of the use of Direct Payments in Poole.

2.RECOMMENDATION

2.1That Councillors note the above report.

3.BACKGROUND

3.1The Community Care (Direct Payments) Act 1996 gave Local Authority Social Services the power to make cash payments to individuals to enable them to arrange, purchase, and manage the community care services which they had been assessed as needing.

3.2The aim of Direct Payments is to increase service users' independence by giving them more control over the way community care services they receive are delivered.

3.3The Act confirms the principles of independence, choice, and flexibility, as paramount in the way individuals' needs are met. These monthly cash payments help people who want to manage their own support to improve their quality of life. They enable people to employ personal assistants or purchase services, and give them an opportunity to be fully involved in family life and engage in work, education and leisure.

3.4The Government is concerned to increase the number of people who receive Direct Payments and to ensure that people from all client groups have access to the choice that Direct Payments brings.

3.5The Government is monitoring local councils' progress in achieving this goal through the performance indicator (PAF C51 KT BVPI 201).

3.6 A report was taken to the January Scrutiny Committee proposing a small Working Group of Councillors be formed to look more closely at the effectiveness and usefulness of Direct Payments in Poole. Councillors Hillman, Bulteel and Meachin have been allocated to this Working Group.

4.WHO CAN BE CONSIDERED FOR A DIRECT PAYMENT?

• Disabled People aged 16 and over;
• Those with parental responsibilities for disabled children;
• Carers aged 16 and over in place of carers' services;

4.1The term "disabled" includes people with any kind of impairment: for example, those with a physical or sensory impairment, learning disability, and people's impairment arising through illness or old age.

4.2Payments may only be made if the person agrees and is judged to be capable of managing the payments. All service users continue to have a choice of whether to receive services directly.

5.WHAT CAN DIRECT PAYMENTS BE USED FOR?

5.1Direct Payments can be used to purchase services which the person has been assessed as eligible to receive. People can receive a Direct Payment for:

• Personal assistance at home or in the community;
• Respite and short term breaks;
• Day opportunities;
• Support with employment
• Support with caring

6.ADVOCACY AND SUPPORT ARRANGEMENTS

6.1Poole Rights Organisation on Disability (PRO Disability 01202 723301) provides an independent support service which ensures advocacy, advice and support is available for people who are considering Direct Payments or who are already in receipt of Direct Payments.

6.2 PRO Disability was successful in bidding for a Grant from the D.O.H. to develop Direct Payment services in Poole. This has supported significant developments in the past year, with a notable increase in uptake by Service Users of Direct Payments.

7.MONITORING OF DIRECT PAYMENTS

7.1The monitoring of the Direct Payment is the direct responsibility of the Service User, Adult Social Services Commissioning Finance Team and the allocated Care Manager.

7.2A separate bank account must be established to receive the Direct Payment, and a letter of agreement is signed between the Unit and the Service User. This Bank Account must either be the Service Users, or they can utilise a specific “Service User” Bank Account set up by PRO Disability. Each recipient of Direct Payments, or their allocated representative, (e.g. PRO Disability) must provide the Unit Finance Team with monthly returns indicating how their Direct Payments have been spent. The purpose of this return is to ensure that the recipient is receiving the payments on a regular basis while at the same time ensuring that the monies are being spent on the service as agreed.

8.NUMBERS OF DIRECT PAYMENTS USERS

8.1National Performance Indicators (P.I.’s) are the means by which the Government checks on how well we are doing in a number of key areas of performance, including Direct Payments. A formula is applied to our performance figures (e.g. the numbers of people on Direct Payments) and a Performance Indicator result produced that we can use to fairly compare ourselves with other authorities. This “P.I. result” is also used to give us a “band rating”, 1 being poor, and 5 being excellent.

8.2 At the start of the D.O.H. grant funded project there were 27 Service Users utilising Direct Payments. This gave us a 2 band rating on our Performance Indicator. (At this time, we were below average across the south west region.)

8.3 At the end of the financial year 2004/5 we had 68 Service Users, and a

Performance Indicator rating of 3 bands. (Provisional figures show we are now average across the south west region but we are awaiting final confirmation of all local authority figures.)

8.4 We now have 103 Service users, have passed the 4 band Performance indicator rating and PRO Disability are receiving referrals at a rate of 3 or 4 per week.

Service User Group / 30.09.04 / 31.03.05 / 30.09.05
Older People (65+) / 3 / 11 / 21
Learning Disabled People (18-64) / 8 / 30 / 44
People with Physical Disabilities (18-64) / 13 / 20 / 28
People with sensory Impairment (18-64) / 1 / 2 / 2
People with Mental Health Issues (18-64) / 1 / 2 / 3
Carers of Disabled Children (Children’s Services) / 1 / 3 / 5

9.ACTION PLAN

9.1Adult Social Services, in partnership with Pro-Disability are aiming to increase the numbers of people receiving Direct Payments to over 180 people by the end of this financial year, (achieving a 5 band P.I. rating) and to continue to raise the profile of Direct Payments through the following actions:

• A Direct Payments Project Group has been established, including involvement by Service Users. This Group is deciding how best to continue to publicise and encourage the uptake of Direct Payments, and has been working to an agreed plan that aims to promote and provide Direct Payments to all Service User and Carer groups.
• To network with other authorities and Direct Payments support services to learn from Best Practice elsewhere;
• The Fair Access to Care Policy expects staff, following assessment, to offer Direct Payments;
• A question to prompt the offer and monitor this practice is included in the current assessment documents;
• New Direct Payments training has been delivered to staff and managers, and further training is planned.
• Continual development of our support service to introduce effective methods of addressing service users’ comments about ease of using Direct Payments. Developments have included PRO Disability setting up a service user’s bank account for people who do not want to open a separate one themselves; a financial support service to help service users keep financial records and complete the necessary returns; and a support service for recruiting Personal Assistants.
• Ensuring new Direct Payments service users are given information about employment law to ensure they undertake the necessary checks and risk assessments, and understand employment issues relevant to employing Personal Assistants.
• Ensuring Direct Payments service users can undertake CRB checks (Criminal Records Bureau) on potential Personal Assistants before final decisions are made.
• Evaluation of the D.O.H. funded project has just commenced by the National Centre for Independent Living, and will be taken forward with involvement of the Councillors working group established by the Scrutiny Committee.
• This evaluation will be used to determine the funding and type of service required to maintain an effective Direct Payment Support Service, to continue the development of Direct Payments once the D.O.H. grant ceases at the end of this financial year.

9.2 Councillors Hillman, Bulteel and Meachin have individually visited PRO Disability, and have met with the Manager of PRO Disability and the Principal Officer with the lead for Direct Payments in the Borough of Poole, Neil Smurthwaite. It was agreed the best way to scrutinise Direct Payments would be through involvement with the D.O.H. Grant evaluation process, due to be led by the N.C.I.L. (National Centre for Independent Living).

9.3A small amount from the D.O.H. Grant has been set aside by PRO Disability to extend the NCIL evaluation, to cover all DP service users (not just those who have received a Direct Payment since the Grant was allocated). Adult Social Services Commissioning have also contributed to this money, to ensure the evaluation will supply adequate information for projecting the Direct Payment Support Service needs, once the Grant finishes in March 2006.

9.4N.C.I.L. have just recently clarified their evaluation process, and we will be deciding on the overall evaluation method, with the Councillor working group, shortly. The first draft of the terms and conditions for this evaluation are attached.

Neil Smurthwaite

Principal Officer Adult Social services Commissioning

15th September 2005

Community Support and Education Scrutiny Committee

Direct Payments- Councillors working party

Chairman’s report – Councillor Mary Hillman

Background

At the Community Support and Education Scrutiny Committee meeting on 4th January 2005 it was agreed to form a Councillors Working Group to scrutinise the Social Services work in establishing and developing services for people interested in using Direct Payments “in time to be involved in the annual evaluation of the project in October 2005”. It was noted at the time that PRO Disability had been awarded a Government Grant to develop Direct Payment services, and that a target had been set of 100 new people to be receiving Direct Payments by the end of the project in March 2006.

Some concern was expressed by fellow Councillors about how many people might be interested in Direct Payments, and it was agreed that the Working Group would look into this.

Activity undertaken by the Working Group

Members of the Working Group visited PRO Disability individually, and were introduced to the staff working there, most of who are on temporary contracts due to the nature of the funding provided by the Grant.

We were especially pleased to see that 2 of these posts were targeted at making life much easier for service users interested in Direct Payments. One of our concerns is people’s ability to manage the finances themselves, opening separate bank accounts, and completing necessary returns for the Council. One of the posts at PRO Disability is to support Direct Payment service users in undertaking this work and subsequent reports show that this service is proving to be both helpful, and popular. We are also pleased to note that this post is gradually becoming funded by the Council. New Direct Payment service users are given a small sum of money as part of their Direct Payment to purchase this service. In this way, the original grant funding for this service is being replaced with Direct Payment funding, and will therefore be self-sustaining beyond the life of the grant.

The other post we are pleased to see in place, is the recruitment support post. We are conscious of the significant problems involved in employing people; CRB checks, employment law, etc. and it is reassuring to see these being addressed.

The Councillors then met with Belinda Thompson, manager of PRO Disability, and with Neil Smurthwaite, lead officer for Direct Payments within Adult Social Services. We discussed the best way for the Councillors Working Group to scrutinise the development of Direct Payments services within the Borough. We were pleased to hear that the National Centre for Independent Living (NCIL) had been contracted by the Department of Health, to evaluate the use of the DOH Grant given to organisations across the Country, including PRO Disability. We agreed the most effective way to be involved, would be to be part of this evaluation. We agreed that Belinda would clarify with NCIL when and how they were planning to conduct this evaluation, and that we would then meet again to decide how best to be involved. There was a delay on the part of NCIL in clarifying how they are undertaking their evaluation, but this has finally been decided, and the Councillor Working Group are due to meet again with Belinda and Neil in November to decide on the next steps.

In the meantime, we have received reports from Neil, and have been on the circulation list for information, and updated plans regarding the Direct Payments project, and have been pleased to note the steady increase in Direct Payments over these past 9 months, bringing the Borough of Poole up to band 4 (out of 5) of the national Performance Indicator level. We have been especially pleased to see that due to the steady rate of new referrals, a new target has been set for Direct Payments, equivalent to the national band 5.

Like all Councillors, we were very interested to hear during the Community Support Overview Group meeting on 21st July directly from Ms. Lynne Fisher, a Direct Payment service user, about her experience of using Direct Payments. Ms. Fisher stated very clearly how Direct Payments had completely changed her personal circumstances. In her words, it had “given me my life back”. Ms Fisher stated that from her personal contact with other service users, she knew that Direct Payments was not for everybody, but that for some people it was absolutely the best way of receiving services, and she both praised Poole for its current work in developing Direct Payments, and also encouraged us to continue to properly and adequately support this method of providing services.

Next steps

The Councillor Working Group will be very involved over the next few months in the evaluation of the Direct Payments project. We will be paying special interest to service users satisfaction, and what else needs to be in place to properly support those people who wish to use Direct Payments as a preferred method of obtaining services to meet their assessed needs.

We are also concerned to ensure that these support services will be in place once the Government Grant has ceased in March 2006. We are reassured to hear from Neil that this has already been identified as necessary by Adult and Children Social Services and will be considered as part of their budget setting process.

Councillor Mary Hillman

3/10/05

Direct Payments in Poole

EVALUATION - DRAFT SPECIFICATION

We are seeking to conduct an evaluation of the use of Direct Payments in Poole, and the effectiveness of our information and support services.

Aspects of Direct Payments we wish to evaluate are:

• For people using Direct Payments:

-The National Centre for Independent Living will be conducting a survey of new service users (people taking up Direct Payments since September 2004), asking the first three questions below. We want to expand on this by asking all of the questions below to Direct Payments service users who started before September 2004. We will also be seeking to undertake some follow-up one-to-one interviews to ascertain further information - 25 face-to-face interviews.

We are commissioning a skilled and informed consultant to lead on this work, and would like to involve Councillor Bulteel, Councillor Hillman and Councillor Meachin in the face-to-face interviews, and subsequent analysis.

(Initial thoughts - consultant 25 interviews including Councillors joining 3 interviews each.)

-For these follow-up interviews to explore some of the above themes further, especially:

~How well are we doing making Direct Payments easily available?

~How well are we doing making Direct Payments well-known?

~How well are we doing making Direct Payments attractive?

~When did you start Direct Payments?

~How were you supported when considering Direct Payments?

• How helpful was this?

• What else would you have liked?

~Has Direct Payments changed the way you live (for example, do you have more choice and control over your life, and the things you do?). Please give some examples.

~What else would you find helpful in informing you about Direct Payments?

~What else would you find helpful in setting up Direct Payments?

~What else would you find helpful in maintaining your Direct Payments?

• Staff:

Interviews then to be conducted with PRO Disability staff, Care Managers, Finance staff, DPPLIG and some other appropriate senior staff exploring issues of:

-How easily available and helpful is current information?

-How clear are the set-up procedures?

-What is communication like between Direct Payments service users, Social Services, PRO Disability, Management and the Finance Team?

We estimate approximately 20 face-to-face interviews.

• Benchmarking/learning from Best Practice

To evaluate Borough of Poole’s Direct Payments service with other local services and with nationally-recognised Best Practice. To produce comparative information and to make recommendations about necessary services and reasonable price.