Agenda item

Kerry McCrossan, Assistant Director for Adult Social Care provided a summary of the report on Direct Payments.

Direct payments were about people commissioning their own care, and the Officers present were really passionate about facilitating this duty, which was part of the Care Act 2014 and which really supported the Council’s strengths-based approach to social care. 

There were a number of ways to receive direct payments and the pre-payment account provided a bespoke card and payments went directly in and could be monitored. To provide options, managed and traditional accounts were also possible.

The Agenda included a web-link to videos on the Council’s website, with examples of people who had benefited from the choice and control given to them by direct payments, although not everyone would want this responsibility.

The rate of pay for a personal assistant was competitive, and therefore also cost effective for the Council.

Misuse of direct payments was very rare, therefore the benefits outweighed the risks, and staff would work with any individuals who had not fully understood the rules. 

Through the Direct Payments Programme which had been ongoing over the past two years, Officers had worked extremely hard to make the process as seamless as possible to increase take-up. The aim was to roll out the developments across all staff channels, through mandatory training, staff briefings and promotional material.

A key area of work was to expand a register of personal assistants (PAs) and a standardised rate was being worked on to make the role more attractive. PA Micro-enterprises was another huge piece of work scheduled for the next two years to develop small, community-based micro-enterprises which would expand options for people who were receptive to direct payments but did not want to be an employer themselves.

Statistically the Council had been one of the lowest performers in direct payments regionally and nationally. The latest benchmarking data would not be released until August, however it was hoped that the programme in Worcestershire would have had a positive impact and it was important to note that this work had not been put on hold during the Covid pandemic. It was hoped that the fact that performance in Worcestershire had dropped less than 1% during the pandemic indicated that performance was now closer to its comparators.

The Chairman invited discussion and the following main points were made:

·       The Panel Chairman was pleased to hear about the work to promote direct payments and the staff training programme.

·       The Panel was advised that direct payments were reviewed with the same regularity as other services; every 12 months or when a change or issues arose – reviews also provided an opportunity to raise the option of a direct payment.

·       Direct payments were means tested, exactly like other services.

·       In terms of promoting direct payments to individual and families, the Directorate wanted to expand opportunities before people reached the point of needing support, for example through training staff, availability of leaflets and developing the website, as well as during the first conversations which took place.

·       The Carers Allowance was a separate thing to direct payments.

·       It was very important that any services bought through direct payments met the needs of the individual concerned and any concerns would be talked through with them. A review also took place within six weeks of a Direct Payment starting.

·       Monitoring was explained, and pre-payment accounts were automatically monitored, and any alerts or issues raised with the social worker.  Monitoring was slightly more difficult for traditional bank accounts however individuals were asked to submit information quarterly and there were also annual financial audits.

·       When asked about the capacity and efficiency to respond to any issues or concerns, the Officers explained that there were two different ways a person would be responded to, depending on the issue; a frontline social worker may respond on the same day and agree further actions, or for financial issues there was a new enhanced service which would respond, whereas in the past the Council had not always been able to respond as quickly.

·       In response to a follow up question, performance information to show how efficiently any issues from service users were responded to would be available in six months’ time when service developments were embedded.

·       Although the maximum value of contingency funds which individuals receiving direct payments were permitted to accrue was six weeks’ worth, there was flexibility, depending on the situation.

·       Officers were in the process of agreeing targets for take-up of direct payments, pending national targets, ideally at a figure of around 30% however what was clear was that they should be offered to everyone once next steps had been progressed.

·       Where a PA was self-employed, there was guidance and support available and the Council had a responsibility to check that arrangements were in order.

·       Panel members felt development of the PA concept was very positive in building a relationship and trust.

·       Officers wanted to reach a position where social workers had access to a pool of PAs, which may include those currently working as carers, and recent adverts had been successful.

·       The pre-payment account was preferred by Officers as it was easy to use and to monitor, however all three types were required to be offered and figures for the percentage of people with each type of accounts would be circulated.

·       Regarding potential risks of care arrangements falling through, the Panel was advised that the majority of PAs were employed by the person as this was the rule for time specific care. It was important to have robust care plan conversations, with a contingency plan, and the Council also had a duty to meet needs and had a frontline team to address emergencies. Nonetheless someone who experienced inconsistencies in care received may be put off and turn to an agency and this was one of the factors behind the work to increase micro-enterprises, which gave access to more than one PA.

·       A Panel member asked Officers’ views as to the main reason people chose not to have direct payments, and was advised that complexity and PA availability were the main factors, hence the work in hand to simplify processes. Communication was also important to combat myths related to the previous service provision.

·       It was explained that the Direct Payment Lead role was temporary but critical and one which the Directorate would like to retain if possible. Overall staff structures for direct payments were being reviewed within the financial envelope available since investment had brought success in auditing and in developing the service.

·       Feedback from staff was generally very positive and had ‘absolutely’ helped shaped developments, including guidance for staff to respond to questions.

·       Comment was invited from the Cabinet Member with Responsibility for Adult Social Care, who looked forward to the Council’s performance statistics being comparable with the national average, and the Officers explained that some areas had been earlier to carry out the innovative work which was now underway in Worcestershire. The Assistant Director emphasised the importance of increasing choice and control, however once elements such as micro-enterprises and the PA pool were in place, the Council would absolutely want to stretch targets.

The Chairman thanked everyone for attending what had been a very informative discussion, and an update was requested in around 12 months’ time.