Disabled People and Direct Payments Dissemination Seminar

1. Disabled People and Direct Payments Dissemination Seminar

2. WELCOME & INTRODUCTION

3. Disabled People and Direct Payments: A UK Comparative Study Findings from Scotland Sheila Riddell, University of Edinburgh Charlotte Pearson & Victoria Williams, University of Glasgow

4. DPs: Funds paid by LAs to community care users to purchase own services Dual interpretation: (a) Means of empowering service users as ‘co-producers’ (b) Form of ‘creeping privatisation’ Hence controversial Background

5. Fit with community care goal of providing ‘mixed economy of care’ Resulted from long-standing campaign by disabled people Community Care (Direct Payments) Act 1996 – enabling legislation Succession of regulations extending access Community Care & Health (Scotland) Act 2002 – mandatory for all LAs to offer DPs to those assessed as requiring community care services Development of DPs

6. ESRC-funded cross-UK comparative study 2004-2006 Collaboration between Edinburgh, Glasgow and Leeds Universities Mixed research methods – interview & questionnaire surveys, statistical analysis, local authority case studies The research

7. DPs as new form of welfare Influence of disability movement DPs & impact of devolution Themes explored in research

8. What are the key differences in direct payment policies, implementation strategies and practices in Scotland, England, Wales, and Northern Ireland, and within each country what variations are apparent at local level? To what extent have direct payment policies had an impact on forms of welfare production and consumption? What has been the impact of direct payments on the identities of disabled individuals, groups of disabled people, support workers and family members? Research questions

9. Number of people receiving direct payments 2001-2005 by user group Official Statistics (1)

10. Number of people receiving direct payments 2005 by user group and age Official Statistics (2)

11. Value of direct payments by user group 2001-2005 Official Statistics (3)

12. Number of people receiving direct payments in 2005 by local authority and user group Official Statistics (4)

13. Direct Payments users in each country/province of the UK (number and rate per thousand people with LTID) Official Statistics (5)

14. Management of DPs within Las Designated direct payment posts in less than a third of all local authorities. Performance indicators and local targets for direct payments only used in six Scottish authorities. Almost all authorities without targets were resistant to them and instead emphasised the need to ensure that users were fully informed about all service options. Around two thirds of local authorities saw the 2003 changes, rather than the 1996 Act, as the main policy impetus. Telephone survey findings (1)

15. Local labour markets and recruitment of personal assistants Problems in recruiting home care staff, but DP users had not reported difficulties in finding personal assistants. In several areas where difficulties emerged, authorities had raised their hourly rates to make personal assistance more attractive. Concerns about budgetary constraints & impact on existing services Relatives employed in ‘exceptional circumstances’. Telephone survey findings (2)

16. Disability activism & support organisations 21 authorities reported some input from local disabled people – but not major driver. 7 authorities stated that disabled people had no input- difficulties in generating interest from users. 2 authorities unaware of any involvement of local disabled people 13 out of 30 LAs described support organisation as ‘user-led’. Telephone survey findings (3)

17. Training and publicity Approaches to staff training varied considerably Where designated staff in place, more comprehensive training. In other areas, training restricted to one-off events and ad-hoc information drives. In most authorities, information leaflets and frontline staff most common sources of information for potential users. Concerns about over-publicising DPs and impact on service budgets. Telephone survey findings (4)

18. The use of direct payments In around two-thirds of authorities, DPs made available only to cover personal care needs. The remaining third stated that there were no restrictions in terms of the type of tasks that might be covered. Difficulties in defining and quantifying ‘needs’. Direct payments often signed off by senior personnel – additional bureaucracy. Two-thirds of authorities felt that DP users likely to receive more favourable services than traditional provision – regarded as problem. Telephone survey findings (5)

19. Rural area, pockets of deprivation. Devolved care management and widespread use of spot contracting allowed flexibility in assessment & care packages – conducive to development of DPs. Practitioners and direct payment users relied heavily on the support organisation for information and advice. Practitioners were generally not resentful of the lead role played by the support organization. Most DP users heavily supported & would have liked even more support than they were receiving. Case Study: Scottish LA 1

20. Practitioners were concerned that financial management might be too arduous a task for service users, but this did not appear to be the case. Practitioners and users thought monitoring practices unsatisfactory. Practitioners unhappy about financial monitoring – support org to play fuller part. Concern that the disabled person might be isolated if their care was solely provided in the home. Sometime confusion over ownership of DP – family member or disabled person. Family members felt DPs gave them more autonomy in controlling quality of care. Case Study: Scottish LA 1

21. Urban area, V high levels of deprivation & limiting long term illness. Some doubts expressed by staff about feasibility of DPs. Senior managers felt that new funds needed from Scottish Executive to grow direct payments - likely to generate increased demand for council services. Separate cash-limited DPs budget restricted development. Practitioners aware of budgetary constraints – a perception that requests for DPs took a long time to be agreed. Access to training manual & case study examples - but practitioners believed training inadequate. Case Study: Scottish LA 2

22. Practitioners & service users believed paperwork unduly cumbersome – workload issues. Some care managers felt disempowered – loss of contact with service user. Can service users act as responsible employers? General concerns: accountability for public money; the risk of abuse of ‘vulnerable adults’; the employment of unsuitable personal assistants who might harm other household members; the delivery of substandard care; the practitioner’s loss of control; liability should something go wrong; service users’ ability to manage funds competently; unfair treatment of personal assistants. Case Study: Scottish LA 2

23. Senior managers believed the direct payments budget would increase as demand grew. Practitioners felt frustrated when funds were not immediately available when a direct payment was agreed. Service users perceived a lack of enthusiasm for direct payments and believed the council did not want to make a success of the initiative. Case Study: Scottish LA 2

24. Two central arguments used to promote DPs : Means of empowering disabled people Means of delivering flexible, personalized and cost-efficient services – hence contentious. Take up in Scotland significantly lower than in England Large differences by LA & user group. Seen as potentially destabilising existing provision. Training for front-line staff patchy - social workers report lack of knowledge and confidence. Widespread anxiety about accountability & workload issues. Conclusions (1)

25. Concerns about how local authority can guarantee a high quality of care. Social workers often worry about users’ financial management ability. Service users believe they can manage with support. Growth in the number of people managing direct payments on behalf of others – issues of ownership. Local authority case studies illustrate the micro-cultures within particular settings which either inhibit or support DPs development. Conclusions (2)

26. Factors Aiding and Hindering Implementation of Direct Payments Paul Swift, Foundation for People with Learning Disabilities Michael Hill, Health and Social Care Advisory Service

27. Focus of MASC direct payments study • Study commissioned under the Modernising Adult Social Care (MASC) research initiative • Focus on the progress of the modernisation agenda in adult social care • Evaluation of the process and impact of modernisation mechanisms and policies on direct payments implementation. • Key interest in relative importance of factors aiding and hindering implementation within national direct payments survey .

28. Factors aiding and hindering implementation • List of factors constructed with reference to central government drivers and research literature on direct payments and policy implementation • Both local authority and support organisation respondents were asked to tick where factors applied • They were asked to rate whether the factors were ‘helpful’ (‘unhelpful’), ‘important’ or ‘critical’ • Main focus of analysis on frequency with which factors identified rather than on weighting assigned

29. Categorisation of factors • Influences from central government • Factors influencing the overall disposition of local authorities • Factors influencing local authority operational arrangements • Supporting influences stemming from the voluntary sector • Demand from service users and carers • Wider features of the policy environment

30. Main aiding factors (England)

31. Central government performance monitoring (66%) Local political support (66%) A direct payments development fund award (56%) Targeted support within the direct payments support service (56%) Availability of people to work as personal assistants (55%) Strong local voluntary sector (53%) Flexible commissioning strategy (49%) Support from the National Centre for Independent Living (NCIL) (41%) Central inspection and regulation of LA services (40%) Other aiding factors (selected by many English LAs)

32. Two items rarely mentioned • Ring fenced budgets for direct payments (25%) • Support of public sector trade unions (12%)

33. Scotland: aiding factors • Six of the top seven critical aiding factors same as in England • Exception was demand from service users and carers which was generally rated as important • Six out of eight Scottish councils also indicated the availability of people to work as personal assistants and having a strong local voluntary sector as facilitating implementation • The weight given to these factors varied across councils

34. Main hindering factors (England)

35. Other hindering factors (selected by English LAs) • Lack of demand from service users and carers for direct payments (40%) • Competing priorities for policy implementation (38%) • Inadequate training and support for front line staff (38%) • Lack of accessible information for service users and carers (32%) • Incongruence of direct payments policy with other Local Authority duties (31%)

36. Scotland: hindering factors • Less significance was given to staff resistance as a hindering factor • The other two key factors identified by English local authorities cited by majority of Scottish councils as hindering implementation • Scottish councils gave greater weight to lack of service user/carer demand for direct payments and to competing priorities for policy implementation

37. Do the factors explain local authority performance differences? • Comparing ‘performance’ – a note of caution! • Measure of performance derived from 2004 direct payments figures for adult care groups per 100,000 population • Early findings for English local authority sample: • In general, higher performing authorities were more likely to identify aiding factors • Results for hindering factors were less clear • Work in progress using a range of statistical techniques suggests the particular importance of local authority commitment • Percentages reported here each side of the median

38. Outputs related to main aiding factors (England only)

39. Outputs related to other aiding factors where differences large

40. Outputs related to hindering factors

41. Conclusions • Many more aiding than hindering factors identified by English local authorities • Central government drivers (modernisation mechanisms) have had some impact • However, greater importance of the overall disposition of local authorities and their operational arrangements suggested • Evidence of a tendency for the higher performing authorities to identify more aiding factors but more mixed results on hindering factors

42. Evaluation of the Direct Payments Development Fund Implementation Vanessa Davey, PPSRU, London School of Economics

43. The Implementation of Direct Payments A Local Authority Perspective Jack Blaik Senior Social Worker

44. A History • The Social Model and the California Net • Hampshire and the Escape Committee

45. Edinburgh and 1984 • The user led origin • The interim response • Issues of growth and consistency • The limits on vision • The DLA boundary

46. 84 to 97 and beyond • The unresolved issues • The Duty of Care and the management of risk • The employer assumptions • The doubtful meaning of Consent • Ability to manage-and by 3rd Parties • Equivalence with Service Provision • Charging from flat to gradient

47. Unresolved issues • Review- including Audit • The ILF interface • Budgetary source and the confinement of the Ring • Support for users • Support to staff • The information deficits

48. Unresolved issues • Across the Boundaries • Beyond the ILF- ATW, Health, THB/SP • The illegitimate base • The submariners compass • The Power to offer • 1997 and the DP Act

49. 1984 to 1997 • Growth in numbers to 65 • Growth in spend to £1.4 million • Demand from “others” • Development of a Procedure • The subversion of DLA • National trends and the English examples

50. Beyond 97 with the SE • UK Guidance • SE Guidance to the rescue! • The advent of DPS • The advent of the Duty in 2003 • The need to extend to all on a secure basis