I have started this topic with an analysis to follow. I have again submitted a FOI request to the London Borough's as attached.
Click here (File updated May 2011)
The request letter is below.
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PDF version LBI additional information
http://benefits.tcell.org.uk/forums/direct-payments
http://tcell.org.uk/forums/control-advice-and-self-directed-support
http://www.cpa.org.uk/cpa/putting_people_first.pdf
http://www.puttingpeoplefirst.org.uk/_library/10_questions_to_ask_if_you...
http://benefits.tcell.org.uk/forums-keywords/benefits/social-care-rights...
http://www.communitycare.co.uk/Articles/2009/04/08/102669/direct-payment...
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Lo...
http://www.dcsf.gov.uk/everychildmatters/healthandwellbeing/ahdc/individ...
http://www.lse.ac.uk/collections/PSSRU/pdf/IBSENSummaryReport.pdf
London Councils collects data on the number of people receiving self-directed support across London, including the use of direct payments and personal budgets.
The headlines on the roll-out of self-directed support in London are:
- 19,306 people receive self-directed support at 30 April 2010, a significant increase of 8,235 people (74%) in the least year
- Of those 14,211 use direct payments, an increase of 3,292 people (30%)
- There are now 7,139 people on personal budgets, an over ten-fold increase over the equivalent figure for April 2009 (610)
- 2,494 parents with children with disabilities receive direct payments, an increase of 854 people (52%)
Ten per cent of adults receiving community based services are using direct payments to manage their own care.[1]
Twenty-three boroughs submitted their direct payments and personal budgets figures as at 30 April 2010. For the remaining boroughs we used the last figures submitted.
[1]Community Care Statistics 2007-08: Referrals, Assessments and Packages of Care for Adults, England, Information Centre for Health and Social Care, Published May 2009.
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London Care Placements Self Directed Support Statistics
London Self Directed Support statistics now available.
29 May 2009
London Councils now collects information from the London boroughs about the number of people receiving Self Directed Support, including the use of direct payments and individual budgets.
Figures for people receiving Self Directed Support at 30 April 2009 are available below.
Self Directed Support in London - April 2009
The direct payments data collection has changed to reflect the new DH NI130 indicator. The collection now records the number of people receiving Self Directed Support across London, including the use of direct payments and individual budgets.
In London 11,071 people receive self directed support at 30 April 2009, with 610 people using individual budgets.
The number of people using direct payments is now 10,919 (direct payments without an individual budget and direct payments through an individual budget), an increase of 28% over the figure at 30 April 2008 (8,522).
Five per cent of adults receiving community based services are using direct payments to manage their own care.
Twenty-two boroughs submitted their direct payments and individual budgets figures as at 30 April 2009. For the remaining 11 boroughs we used the figures submitted in the last collection.
See below for more on:
- Self Directed Support per Borough in April 2009 Opens in a new window
- Self Directed Support per Client group in April 2009
http://www.londoncouncils.gov.uk/services/londoncarereplacementsStats.htm
ILF statitics dated 18th June 2010
| Description | Total |
| Aids related disease | 110 |
| Arthritis (osteo-rheumatoid-still's dis) | 658 |
| Blood disease (inc leukaemia) | 3 |
| Brain damage (inc head injury) | 961 |
| Cancers-tumours | 70 |
| Cardio-vascular(inc heart disease) | 80 |
| Cerebral Palsy | 2981 |
| Cerebro-vascular (inc stroke) | 747 |
| Dementia (inc Alzheimers) | 86 |
| Down's syndrome | 1045 |
| Epilepsy | 435 |
| Friedreich's ataxia | 173 |
| Huntington's Disease | 119 |
| Hydrocephalus | 55 |
| Lung or respiratory disease (inc asthma) | 61 |
| Mental illness | 123 |
| Motor Neurone Disease | 84 |
| Multiple Sclerosis | 2642 |
| Muscular Dystrophy or Atrophy | 534 |
| Osteoporosis | 55 |
| Other | 1577 |
| Parkinson's disease | 123 |
| Physical malformation limbs-Thalidomide | 30 |
| Polio damage | 104 |
| Severe learning disability | 6099 |
| Spina bifida | 341 |
| Spinal injury | 1314 |
| (blank) | 169 |
| Grand Total | 20610 |
The proportion of service users and carers on personal budgets in England has doubled in the past year, figures published today show.
The NHS Information Centre said 13% of disabled adults, older people and carers who used community services were receiving personal budgets in 2009-10, up from 6.7% in 2008-9.
The finding reflects a survey earlier this year by the Association of Directors of Adult Social Services and the Local Government Association, which found an 83% rise in the proportion of personal budget holders in the 12 months to March 2010.
Councils in England are expected to have 30% of service users on personal budgets by next March, under targets agreed by Adass, the LGA and the Department of Health. Adass and the LGA said councils were on course to meet this target for people who receive ongoing support, but not if people who receive short-term support were included in the figure.
Other findings showed:
• Employment rates fell from 6.8% to 6.4% for working-age adults with learning disabilities known to social services, from 2008-9 to 2009-10.
• Moves to promote independent living for learning disabled people appear to have gone backwards. A smaller proportion of working-age adults (61%, down from 64.5%) was living in "settled accommodation", such as adult placements, supported housing or living permanently with family, as opposed to care homes, nursing homes or NHS settings.
• There have been improvements in keeping at home older people discharged from hospital; 81.2% of those discharged home were still there after three months, up from 78.2%
• More carers receive carer-specific services (26.4%, up from 23.1%), when taken as a proportion of service users who recieve community-based support,
• Waiting times for social services assessments have improved, with 81.3% waiting four weeks or fewer, up from 79.8%.
Related articles
Community Care's special report on the state of personalisation
Councils set to miss personal budgets target
One in 13 learning disabled people in paid work
http://www.communitycare.co.uk/Articles/2010/08/12/115084/Personal-budge...
Guidance on direct payments For community care, services for carers and children’s services England 2009
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di...
We have now considered your request for information you asked for.
Paying for Long Term Care in England
The Putting People First Consortium, in conjunction with Solla, Age UK and Counsel and Care, has published a leaflet explaining how to get trusted advice in relation to personal finances and paying for care.
The leaflet can be accessed here. A covering letter from Jeff Jerome, National Director Social Care Transformation can be accessed here
Putting People First : Workforce Study
The Putting People First Consortium has gathered preliminary information from some key authorities to document their progress in transforming their workforce to make it fit for purpose. The findings from this brief study are reported here along with Appendix A Team structures and Appendix B Job descriptions. The information may also be used to shape a more detailed future study.
Finance Systems and Putting People First
In order to support the development of finance systems appropriate for personalisation, the PPF Consortium has published a document setting out the core principles and requirements as a common standard that councils and IT providers can refer to. The document can be viewed here.
Progress in meeting the PPF Milestones 2010
Results of the second quarterly (Jan - March 2010) milestones self assessment
Progress in the delivery of Personal Budgets 2010
In March 2010 ADASS and the LGA conducted a survey of councils to measure the progress on the roll out of personal budgets. The results of the survey, along with information from council quarterly self assessment returns were presented by Jeff Jerome, National Director, Social Care Transformation, at the ADASS Spring Seminar. Please see links below
Letter from Jeff Jerome to DASS ( includes headline findings)
Slides summarising the results of the survey and milestone self assessments
Slides summarising some of the work in the National Delivery Support Plan
Results of the first quarterly (Oct - Dec 09) milestones self assessment.
Personal Budgets:Council Commissioned Services
The Putting People First (Local Government) Consortium have published an advice note on personal budgets and council commissioned services here. See also Appendix A for opinion on the legal implications and the covering letter sent to DASS from Jeff Jerome.
Research - IAA for people who fund their own social care.
ADASS, SCIE and JRT have commissioned research into the provision of information and advice for people who fund their own social care. The first stage of this research is now available here.
Putting People First - Joint National Delivery Support Plan
This plan sets out, in summary, national level acivity being undertaken by the partners of the Transforming Adult Social Care delivery co-rodination group (DCG). The plan, and a spreadsheet containing information on publications being developed and those already published as part of the National Delivery Support Plan, are both updated bi-monthly. The plan and the publications list can be found on the Putting People First website at http://www.puttingpeoplefirst.org.uk/content.asp?contentid=258
Putting People First - Supporting Delivery
Documents released at NCAS Conference '09
At NCAS Conference this week ADASS and partners released a series of documents aimed at supporting councils with the implementation of Putting People First. You can access the documents below.
Common Resource Allocation Framework
Common resource Allocation Framework (& appendicies 1-3)
Personal needs questionnaire (appendix 4)
Questionnaire scoring sheet (appendix 5)
Financial Framework (appendix 6)
Spreadsheet tool with test data (appendix 6)
Spreadsheet tool blank (appendix 6)
Personalisation and the law: implementing PPF in the current legal framework
Implementing PPF in the current legal framework
Supplementary guidance: section 2 Local Government Act
Making progress with PPF: self-directed support
Self-directed support
Operating models: learning from early adopters
Operating models (& appendicies A-B)
Evaluation dashboard (appendix C)
Resource Allocation System monitoring tool template (appendix D)
Much of the work of the National Director will be governed by the Department of Health publication Putting People First.
Progress measures for the delivery of Transforming Adult Social Care services - September 2009
Personalisation briefing for commissioners
The Social Care Institute for Excellence (SCIE), in partnership with ADASS and the Putting People First team, has published a briefing on the implications of personalisation for commissioners. At a glance 06 Personalisation briefing for commissioners includes examples of how councils have revised their commissioning strategies to support personalisation. This is the first in a series of briefings on personalisation for different groups of professionals including housing providers, domiciliary care providers and personal assistants. For details visit: http://www.scie.org.uk/adults/personalisation.asp
Transforming Adult Social Care Delivery Support Architecture
May 2010
ADASS / LGA Putting People First survey National report
May 2009.
ADASS / LGA Putting People First survey Regional Reports
June 2009
The Personalisation Agenda: Threats and Opportunities for Domiciliary Care Providers
Lucianne Sawyer CBE, August 2008
The principal duties of the National Director
http://www.adass.org.uk/index.php?option=com_content&view=article&id=328
In January 2008, a circular went out to local authorities from the Department Health (DH). This set out information to support the transformation of social care, as outlined in the Health White Paper, 'Our Health, Our Care, Our Say: A new direction for community services' in 2006. It describes the vision for development of a personalised approach to the delivery of adult social care.
This major programme is being introduced under the auspices of ‘Putting People First’, published by the DH in December 2007. This document is the concordat with the Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS), the NHS and others.
It is a shared vision and commitment to the transformation of adult social care over a period of three years. Key elements are:
- prevention
- early intervention and re-enablement
- personalisation
- information, advice and advocacy.
Councils will be required to move to a system of personal budgets for everyone who is eligible for publicly-funded adult social care support. They will also be required to provide universal information, advice and advocacy services for all who need services and their carers. This is irrespective of eligibility for public funding.
Social care reform grant
To support the transformation there is a new social care reform grant, consisting of:
- £85 million in 2008/09
- £195 million in 2009/10
- £240 million in 2010/11.
This will go to local authorities as a ring-fenced grant. Two million pounds is being kept back for sector-led support at a regional level. One million pounds is earmarked for DH and national activity over the three-year period from April 2008.
The LG Improvement and Development, ADASS and LGA will work together as a sector-led consortium at national level to support the change agenda.
Transforming adult social care delivery support architecture – June 2010 (PDF, 12 pages, 378KB)
The Transforming Social Care Circular – on the DH website
The Putting People First concordat – on the DH website
Progress measures for the delivery of Transforming Adult Social Care Services
The Association of Directors of Adult Social Care (ADASS), Department of Health (DH) and LGA have been jointly discussing a framework that enables local authorities to view their progress for the Putting People First transformation programme. The need for such a framework came from both the findings of the ADASS/LGA 'Measuring Progress' survey, reported in April, and also from regional and national feedback. This has highlighted the absence of any published markers to enable authorities to judge their pace of change, particularly in the wider national and regional context.
The following document was sent out to council directors setting out "personalisation milestones" that they, alongside staff and local stakeholders may be assessed against if they offer personal budgets and care reviews.
Milestones for Putting People First (PDF, 5 pages, 143KB)
Debate on the use of direct payments to pay for sexual services has been ignited following the revelation that four councils condone their use.
A freedom of information request submitted by disabled sex campaign group TLC Trusts found that four councils condoned the use of council money to pay sex workers.
The news has sparked outrage in the national press with the Sunday Telegraph, the Daily Express and the Daily Mail decrying the use of taxpayers' money to pay for sexual services such as lap dances and trips to Amsterdam.
The debate about the use of personal budgets for sex, a morally and legally grey area, has been raging on CareSpace for several months and was covered in-depth by Community Care last week.
http://www.communitycare.co.uk/Articles/2010/08/10/115069/service-users-...
http://www.communitycare.co.uk/Articles/2010/08/16/115092/sex-and-person...
A 'man of 21 with learning disabilities has been granted taxpayers' money to fly to Amsterdam and have sex with a prostitute.
His social worker says sex is a 'human right' for the unnamed individual - described as a frustrated virgin.
His trip to a brothel in the Dutch capital's red light district next month is being funded through a £520million scheme introduced by the last government to empower those with disabilities.
They are given a personal budget and can choose what services this is spent on.
The man's social worker, who spoke on the condition of anonymity, said his client was an 'angry, frustrated and anxious young man' who had a need for sex.
'He's planning to do more than just have his end away - he's having a holiday,' he said.
'He has been to two sexual health and sexual awareness courses and basically wants to try it.
'The girls in Amsterdam are far more protected than those on UK streets. Let him have some fun - I'd want to.
'Wouldn't you prefer that we can control this, guide him, educate him, support him to understand the process and ultimately end up satisfying his needs in a secure, licensed place where his happiness and growth as a person is the most important thing?
'Refusing to offer him this service would be a violation of his human rights.'
Paying for sex is not illegal but soliciting sexual services, kerb crawling and paying for sex with women who have been coerced into prostitution is.
The social worker added: 'Who says he can't do what he wants? We can't place restrictions on a young man who wants to experience the world.'
The trip emerged in data from Freedom of Information requests which revealed that many councils are using the money from the government's Putting People First scheme to pay for prostitutes, visits to lap dancing clubs and exotic holidays.
Another man who has a brain injury has even had sex work built into his council care package.
This is designed to teach him to become sexually 'self-reliant' after his wife left him and took all their money.
It has increased his confidence and restored his faith in women, care workers said.
Critics yesterday said the use of taxpayers' money to fund sex trips abroad as 'deeply worrying'.
In Greater Manchester and Norfolk, social care clients have used their payments for internet dating subscriptions.
In one year, a man from Norwich who suffers mental health problems received a holiday to Tunisia, a subscription to an internet dating site, driving lessons and expensive art materials.
This was on top of state benefits. He claimed he needed 'some time out, some rest and a change of scenery' after a mental breakdown.
He also argued that a break in Tunisia with a friend was cheaper than a week in institutional care.
A survey by The Outsiders and TLC Trusts - groups which campaign for the sexual rights of people with disabilities - found most local authorities said they did not 'condone' transfer of their funds to pay for sex.
But of 121 councils who responded, 97 per cent said they had no offical policy on the topic.
Instead, they left decisions to the discretion of their social workers and junior managers.
Nevertheless, 53 per cent of the councils were said to have a strategy that 'explicitly empowered' disabled people to pursue their sexual aspirations.
Neil Coyle, director of policy at Disability Alliance, said most people with disabilities did not want or expect the state to pay for sexual services.
'Public bodies don't exist to find people sexual partners,' he said.
'When people go to councils for help, they are looking for essential services to maintain some level of dignified existence - help to dress and wash.'
Matthew Elliot, chief executive of The Taxpayers' Alliance, said: 'Many taxpayers will be appalled and offended that money intended for social care has been used in this way.
'What's more, it's deeply worrying that this scheme has been so vulnerable to these abuses.
'It's essential that where public funds are involved, there are the sort of checks and balances in place that prevent money being wasted in this way.'
But Liz Sayce, chief executive of disability network Radar, agreed with the social worker the desire for sexual relations was a matter of human rights.
Cases involving payments should be carefully examined on a 'case by case' basis, she added.
A Department of Health spokesman said: 'Money allocated through Putting People First should be used by councils to help people to live independently.'
http://www.taxpayersalliance.com/media/2010/08/daily-mail-councils-pay-f...
'Our health, our care, our say' identifies direct payments as key to personalised services. The Department of Health and the Care Services Improvement Partnership have published this guide to help councils and their partners identify solutions to the process, policy and procedural issues as part of the programme to increase uptake of direct payments.
- Download Increasing the uptake of direct payments (PDF, 1233K)
- Download assessment and action planning forms in word-processable format (RTF, 147K)
- Download assessment and action planning forms in Portable Document Format (PDF, 35K)
- Download letter from DH and ADSS (PDF, 46K)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
On the 9th November 2009 significant changes were made to regulations governing Direct Payments. New regulations came into force which extends Direct Payments to people who lack capacity to consent and to people with mental health problems that are subject to mental health and certain criminal justice legislation. This section contains links to information reflecting these changes.
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A summary of changes to direct payments
This leaflet produced by the Department of Health provides a summary of the changes to Direct Payments brought about by the new regulations in 2009. -
Guidance on direct payments: For community care, services for carers and children's services
This new DH guidance provides information on how local councils might operate direct payments. It reflects the changes brought about by the new regulations and supersedes the 'Direct Payments guidance:... -
Response to the consultation carried out in 2008 on the extension and revision of Direct Payments Regulations
This document summarises the responses to the government consultation carried out in 2008 regarding regulations to implement the extension of direct payments. -
Regulations relating to the Community Care, Services for Carers and Children's Services (Direct Payments) (England) Regulations 2009
This link takes you to the statutory instruments relating to The Community Care, Services for Carers and Children's Services (Direct Payments) (England) Regulations 2009. Furthermore, two sub-sections... -
A guide to receiving direct payments from your local council
This booklet is an updated guide of useful information for people who are interested in finding out about receiving direct payments from their local council. -
A guide to getting direct payments from your council - Easy Read version
This booklet is the Easy Read version of the updated guide for people who are interested in finding out about receiving direct payments from their local council. - Direct Payments key publications from the Department of Health
http://www.puttingpeoplefirst.org.uk/Topics/Browse/DirectPayments/DPExte...
I have submitted a further email to SCIE to seek confirmation on the number of people accessing PD/DP.
Recent coverage of Direct Payments has suggested that the Department of Health and councils need to tighten or clarify the use of this care service initiative. Neither Radar nor Disability Alliance agrees with the sentiment of recent coverage.
Direct Payments make a significant and positive difference to the lives of thousands of disabled people and their families. Direct Payments are used to help families with personalised, essential support. Direct Payments can also represent a more cost effective method for providing the vital support some disabled people need. A wheelchair user can organise support to help them get up in the morning at the right time to get to work, rather than wait for a traditional one size fits all service to arrive too late to get to work. Individual solutions like this can help disabled people participate in society – maintaining tax contributions for example - by removing red tape and enabling people to make the decisions that are right for them. Direct Payments come with requirements on individuals and are part of an agreement with people aimed at achieving outcomes (eg managing good health, avoiding hospital).
Neither of our organisations condone illegal activities or sexual exploitation. But some disabled people experience greater difficulty in having sexual relationships and this is a source of deep frustration and unhappiness. Disabled people, like all citizens, experience sexual feelings and have a right to pursue those feelings in socially appropriate ways. Having the ability to avoid isolation through opportunities to make friendships and relationships is a valuable purpose of the support some disabled people receive. Disability Alliance and Radar agree that how public resources are used should not generate barriers to maintaining or developing relationships and avoiding isolation.
We believe that the discussion about whether councils can allow Direct Payments to be used in very rare circumstances to pay legally sanctioned sex workers is a complex and sensitive issue. The debate raises societal and ethical questions on attitudes towards disabled people and ‘asexuality’. But the inference that Direct Payments might be used to routinely pay for illegal sex is not supported by evidence.
Recent national media coverage risks damaging the excellent reputation Direct Payments have and overshadows the very real fear surrounding the future of care services with such significant public expenditure cuts expected across the country. Disability Alliance and Radar support investment and reform of care services, with more significant user-control of resources focused on maintaining lives, finding and keeping employment, gaining qualifications and sustaining or developing social networks to help reduce the isolation endured by too many disabled people and their families.
The current numbers are as follows. These cover both personal budgets and direct payments. We do not record specific conditions within these categories.
Learning Disability 40
Mental Health 8
Physical Disability 108
Older People 358
Total 514
LB Sutton FOI response
SCIE Guide 10: Direct payments: answering frequently asked questions
Notes
1. Skinner, A., Fleming, J. and Christy James, J. (2004) 'Direct payments: Learning from implementation' (unpublished), Centre for Social Action, De Montfort University.
2. Carlin, J. and Lenehan, C. (2004) Direct experience: A guide for councils on the implementations of direct payments in children's services, London: Council for Disabled Children.
3. Abbott, D. (2003) 'Direct payments for young people' (accessed 31 August 2005).
4. Joseph Rowntree Foundation (2004) 'Implementing Direct Payments in Mental Health', York: JRF.
5. Oliver, M. (1990) The politics of disablement, London: Macmillan.
6. Department of Health (1996) Community Care (Direct Payments) Act, London: Department of Health.
7. Strategy Unit (2005) Improving the life chances of disabled people, London: Cabinet Office (accessed 12 July).
8. Holman, A. (1999) Funding freedom 2000: People with learning difficulties using direct payments, London: Values Into Action.
9. Commission for Social Care Inspection (2004) Direct payments: What are the barriers? London: Commission for Social Care Inspection (accessed 12 July 2005).
10. Leece, J. (2003) Direct payments practitioner's guide, Birmingham: Venture Press.
11. Joseph Rowntree Foundation (2004) Making direct payments work for older people, York: JRF.
12. Integrating Community Equipment Services (2004) Community care direct payments and equipment, Department of Health (available at , accessed 12 July 2005).
13. Department of Health (2005) 'Direct payments and health', London: Department of Health (accessed 12 July).
14. Hasler, F. (2003) 'Clarifying the evidence on direct payments into practice', National Centre for Independent Living, September.
15. Miller, A. (2002) 'Direct to the client', Community Care, 24 January, p 42 (accessed on 6 Deecember 2005).
16. Department of Health (2005) Independence, choice and well-being: A green paper on adult social care, London: Department of Health.
17. Dawson, C. (2000) Independent successes: Implementing direct payments, York: JRF.
18. Welsh Assembly (1996) Community Care (Direct Payments) Act 1996 revised policy and practice guidance, Cardiff: Welsh Assembly.
19. Joseph Rowntree Foundation (2002) A user-controlled best value review of direct payments, York: JRF.
20. Ladyman, S. (2004) Speech at National Council for Independent Living AGM, 10 September (personal communication).
21. Department of Health (2004) Community care statistics 2003-2004: Referrals, assessments and packages of care, England, London: Department of Health.
22. McMullen, K. (2003) 'The direct approach: Disabled people's experience of direct payments - summary of key findings and key recommendations', London: Scope, p 8.
23. Witcher, S. et al (2000) Direct payments: The impact on choice and control for disabled people, Edinburgh: Scottish Executive Central Research Unit.
24. Department of Health (2003) A guide to receiving direct payments from your local council (accessed 31 August 2005).
25. Vasey, S. (2001) 'Our way or no way', Community Care, 13 July, pp 32-33 (accessed 6 December 2005).
26. Department of Health (2003) 'Direct payments guidance: community care, services for carers and children's services (direct payments) guidance England' (accessed 31 August 2005).
27. Department of Health (2002) Circular LAC (2002) 13 Fair Access to Care Services (FACS) guidance, London: Department of Health.
28. Scope and Essex Coalition of Disable People (2002) The good practice guide for support workers and personal assistants working with disabled people with communication impairments, London: Scope and Essex Coalition of Disable People.
29. Ridley, J. and Jones, L. (2003) 'Direct what? The untapped potential of direct payments to mental health service users', Disability and Society, vol 18, no 5, pp 643-58.
30. Joseph Rowntree Foundation (2004) 'The importance and availability of peer support for people with learning difficulties accessing direct payments' (accessed 11 July 2005).
31. Holman, A. (2002) 'Direct payments: Commentary and review', Tizard Learning Disability Review, vol. 7, no 4, pp 17-20.
32. National Centre for Independent Living (2005) Everything you need to know about getting and using direct payments, London: NCIL.
33. Department of Health (2004) Direct choices: What councils need to make direct payments happen for people with learning disabilities, London: Department of Health.
34. Joseph Rowntree Foundation (1999) Implementing direct payments for people with learning difficulties, York: JRF.
35. Heslop, P. (undated) Direct payments for mental health users/survivors: A guide to some key issues, London: National Centre for Independent Living.
36. Vasey, S. (2000) The rough guide to managing personal assistants, London: National Centre for Independent Living.
37. National Centre for Independent Living (2005) Everything you need to know about getting and using direct payments, London: NCIL.
http://www.scie.org.uk/publications/guides/guide10/notes.asp
(NB. All news items related to direct payments and individual budgets added to this website since December 2008 have been included in the Latest News section of the website and have not been included in the list below).
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A guide to receiving direct payments from your local council - a route to independent living - 17 March 2008
Guide published by the Department of Health offering advice to people who are thinking about or who are already getting direct payments from their local council social services department. It also includes information on where people can go for extra help.
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Personalisation Self-Assessment Tool - March 2008
CSIP has published a tool to help councils understand how to transform social care systems into a self-directed support model. Social care directors can register to receive advice and practical support. Other guides are planned to be launch during Spring 2008, following findings and lessons from implementing direct payments, individual budgets and InControl.
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Action and Learning Sites - 3 March 2008
The Department of Health is providing £750,000 in grants to 12 organisations across England over the next year to become a user-led Action and Learning Site.
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Social Care Bulletin - 29 January 2008
Bulletin published by the Department of Health with up-to-date information on the latest policy news and initiatives.
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The state of social care in England 2006/07 - 29 January 2008
Report published by the Commission for Social Care Inspection on the inconsistencies of how local authorities decide who needs help and what people are entitled to receive.
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Transforming social care - 17 January 2008
Local authority circular published by the Department of Health describing the development of a personalised approach to the delivery of adult social care. It also includes the Social Care Reform Grant Determination with details of the new ring-fenced grant to help councils to develop this new system in the next three years.
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Personal care budgets and extra £520 million to transform care for older and disabled people - 10 December 2007
Social Reform Grant announcement from the Department of Health.
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Putting People First - A shared vision and commitment to the transformation of Adult Social Care - 10 December 2007
The Government has launched the Putting People First programme to fund the implementation of individual budgets.
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Valuing People Now - 4 December 2007
Consultation paper to seek views on the priorities for learning disability for the next 3 years. Deadline: 28 March 2008.
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Health and Social Care Bill - extension of direct payments - 16 November 2007
This Bill was introduced into Parliament on 15 November 2007. It contains measures to modernise and integrate health and social care, including the extension of direct payments.
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Increasing the take up of direct payments - 13 November 2007
Project developed by the Department of Health to support local councils and their partners to improve access and uptake of direct payments.
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Extending the availability of direct payments - 13 November 2007
Work being carried out by the Department of Health on extending the scope of direct payments to those currently excluded.
- CSIP film: 'The power of personalisation' - October 2007
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A guide to receiving direct payments from your council: a route to independent living - 31 August 2007
Guide published by the Department of Health to offer advice to people thinking about direct payments or for people already receiving direct payments.
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Independence, choice and risk: a guide to best practice in supported decision making - 25 May 2007
Best practice guide published by the Department of Health for anyone involved in supporting adults using health and social care.
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Direct payments solution set - 21 May 2007
Sharing of solutions of what works to promote or provide direct payments compiled by the Department of Health.
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Direct payments Uptake Project: An easy words leaflet - 22 March 2007
A guide published by the Department of Health to enable people with direct payments to work with councils to make sure more people receive direct payments.
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Disability: Banks and accessibility - 15 February 2007
Article on the difficulties disabled people face when they need to open and use a bank account.
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Increasing the Uptake of Direct Payments: an assessment and action planning guide for local councils with social services responsibilities and their partners - 21 December 2006
Guide published by the Department of Health and the Care Services Improvement Partnership to support councils and their partners implementing solutions to increase the uptake of direct payments.
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In Control pilots help disabled people improve their lives - 2 November 2006
Evaluation of the In Control pilots.
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Report from In Control - 12 October 2006
Summary of a report on In Control's first phase 2003-2005.
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Joe Public leading a welfare revolution - 11 October 2006
Article on the InControl project.
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Relentless optimism - creative commissioning for personalised care - 12 September 2006
Report published by The Commission for Social Care Inspection on commissioning more personalised care services, considering the barriers and ways of moving forward.
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London Bulletin: It's time to get personal - 31 August 2006
Article published on the ALG London Bulletin on Individual Budgets.
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Individual Budgets Newsletter - August 2006
First Individual Budgets newsletter with information and updates on the pilots.
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Individual Budgets - August 2006
Information on the piloting of individual budgets.
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Direct Action - 16 August 2006
Individual budgets pilots build on direct payments and include a range of different support funds.
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Blue Badge parking map - 31 July 2006
Interactive online parking map enabling disabled people to search for parking bays across the UK, by postcode or town/area name, by location on a red route or by nearness to an accessible petrol station.
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Independent living for disabled people - 13 July 2006
Independendent living services for disabled people are going to be reviewed.
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Personalised care - 10 July 2006
The English Community Care Association says that people using direct payments or individual budgets will need independent living advisers instead of care managers.
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Direct payments in Norway and the UK - 6 July 2006
Comparative study of direct payments systems.
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https://www.londoncareplacements.gov.uk/?q=content/news-direct-payments-...
Patients will be offered more choice and control over their healthcare with the launch of the first direct payment scheme, Care Services Minister Paul Burstow announced today.
Eight Primary Care Trusts will begin to road test direct payments for personal health budgets. This will allow Primary Care Trusts to give the money for someone’s care directly to them, allowing individuals to decide how, where and from whom they receive their healthcare, in partnership with the local NHS.
Previously, personal health budgets could only be held by a Primary Care Trust or third party.
The cost of providing direct payments will come from existing funding within PCTs. Direct payments can be paid to patients in a number of ways, including monthly direct payments or a lump sum for a one off purchase such as a piece of equipment.
The scheme is designed to help individuals with a range of health conditions including people with diabetes, stroke, heart disease, end of life care and mental health conditions.
People can use their personal budgets in a number of ways. For example, one patient who suffers from chronic pain following removal of a spinal tumour uses her personal health budget for long term, extensive massage and hydrotherapy sessions to relieve chronic pain without the side effects of painkilling drugs, drowsiness and disorientation.
Another patient’s personal budget enabled him to spend his last few months at home with his daughter and grandchildren. The budget was used to provide flexible care while his daughter was at work, rather than the more traditional four times a day short visits.
Piloting direct payments is part of wider programme testing personal health budgets. More PCTs will be authorised to offer direct payments over the coming year. The pilot programme will inform decisions around how to proceed with wider, more general roll-out.
Care Services Minister Paul Burstow said:
'This is an important step towards putting patients at the heart of everything the NHS does.
'Direct payments have real potential to improve the lives of individuals with long-term health needs by putting treatment choices in their hands. That is why we are driving forward the commitment in the Coalition Agreement to extend access.
'There is strong evidence from the social care sector that direct payments help achieve better outcomes, and give people more choice and control over the care they receive. It also encourages a more preventative approach. It is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive.
'Direct payments will not work for everyone or for all patient groups or services, but we want to identify whether, for whom and how they could offer an opportunity to help achieve the best health and wellbeing outcomes. That is why we are developing this pilot programme.
'It will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services.'
Notes to Editors
The authorised PCTs are:
(Lead PCT: Conditions or services included in pilot)
Doncaster PCT: Continuing healthcare and mental health
Eastern and Coastal Kent PCT: Continuing healthcare, end-of-life care, maternity, and mental health
Central London (joint bid from Hammersmith and Fulham PCT, Kensington and Chelsea PCT and Westminster PCT): Continuing healthcare, stroke, COPD, diabetes and long term neurological conditions
Islington PCT: Continuing healthcare (in limited circumstances, with expansion subject to further approval)
Merseyside (Joint bid from Knowsley PCT, Liverpool PCT and Sefton PCT): Mental health
Oxford PCT: Continuing healthcare and end–of-life care
Somerset PCT: Children in transition to adult services, learning disabilities, long-term neurological conditions
West Sussex PCT: Carers of people who have recently been diagnosed with dementia, children in transition to adult services, continuing healthcare
These pilots will run until 2012.
A personal health budget involves:
- An individual knowing how much money they can spend on their health care (their budget) before discussing and deciding what care and services they want.
-
The PCT and the individual agreeing a care plan which sets out:
- what the individual’s health needs and desired outcomes are;
- the amount of money in their budget;
- how this money will be spent to meet the individuals needs/outcomes. - Regular review of the care plan (at least once a year), and monitoring of how the money is spent. The money should meet the full cost of the agreed care plan.
The direct payment sites are all part of the Department of Health personal health budget pilot programme, which involves around seventy PCTs across England.
The cost of direct payments will be borne out of existing funding streams. In most cases PCTs are carving money out of the relevant condition specific budget. The evidence from social care suggests that personal budgets are cost neutral across the system.
Direct payments offer older people the option of receiving a cash payment in lieu of community-based social services so that they can choose, manage and pay for their own social care. They were introduced in 1997 for adults of working age, and in 2000 were extended to people aged 65 and over. Since April 2003, local councils have had a duty to make Direct Payments ‘where individuals consent to and are able to manage them, with or without assistance’.
Direct Payments can currently be used to pay for personal assistants, or to purchase goods or services – although not from the local authority. The money can be used to pay for care from close relatives and friends who do not live in the same household, and this is a common choice. In exceptional circumstances, Direct Payments can be used to pay a relative who does live with the care recipient, but only if the local council agrees that this is the only satisfactory way of meeting the care needs. Separately, Direct Payments can also be paid to carers after a Carer’s Assessment and the money used to buy in carers’ services that have been assessed as being needed by the carer.
At their best, Direct Payments offer choice, control and flexibility for the older person receiving social care. In 2004, a survey for the Commission for Social Care Inspection (Commission for Social Care Inspection 2005b) found that 73 per cent of all respondents aged 15+ agreed that ‘the person needing the social care and help should receive money from the government/council which they use to choose which care services they receive’.
Women were more likely than men to think this (76 per cent versus 69 per cent respectively) and people who either received social care themselves, or knew people who did so, were more likely to agree (79 per cent).
This study examines the issues related to 16- and 17-year-olds managing direct payments and what information and services exist in this area.
Summary
Download as PDF, 4 pages, 0.06 MB
The Carers and Disabled Children Act 2000 extended access to direct payments to 16- and 17-year-old disabled young people. A project carried out at the Norah Fry Research Centre, University of Bristol, sought to collate the work going on in this area; to highlight the main issues facing young disabled people who would like to access direct payments; and to produce a resource with and for young disabled people to promote take-up. Key findings were:
- The extension of direct payments to 16- and 17-year-olds aims to provide opportunities for young disabled people to increase their independence and choice.
- Some young disabled people saw direct payments as a potentially significant means to achieving greater autonomy and control but they were also concerned about the obstacles they would confront in trying to access them.
- There are a number of potential barriers to the successful take-up of direct payments for young disabled people. These include young people's lack of knowledge about direct payments.
- Social services departments have concerns about how well young disabled people will manage direct payments.
- One of the main ways in which young disabled people might use direct payments is to purchase personal assistance. This raises issues about how the relationship between young disabled people and their personal assistants would be managed.
Background
A 'direct payment' is money given to people assessed as requiring certain kinds of support. It is paid by Social Services Departments. Direct Payments have been taken up by disabled adults as a way of buying individualised support services. Typically they have been used to get support at home and/or to pay for a support worker (often called a personal assistant).
The Carers and Disabled Children Act 2000 extended access to direct payments to 16- and 17-year-old disabled young people from April 2001.
More detailed information about how direct payments work can be found elsewhere - for example, at www.ncil.org.uk (the website of the National Centre for Independent Living) and www.viauk.org (the website of Values Into Action). Box 1 gives examples of existing initiatives in this area.
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For young disabled people, direct payments are a new way to access more independent living and pursue lives with the same opportunities as their non-disabled peers. But they raise some potentially problematic issues, for example:
- how to promote direct payments to young disabled people;
- how to support young disabled people to access direct payments and to manage a personal assistant (PA), if they choose to have one;
- how to deal with the administrative, financial and legal responsibilities of being a direct payments recipient;
- how to respond to questions or concerns that parents of young disabled people might have.
Supporting young disabled people to manage a direct payment
Being a direct payment recipient involves a number of responsibilities. A PA naturally acquires the rights of an employee and there have been concerns about the legality of a 16-/17-year-old taking on the contractual and statutory responsibilities of an employer. However, as with some people with learning difficulties, a young person need not assume responsibility for these matters but instead can arrange for an independent living scheme, for example, to organise this for them. NCIL have said that one insurance company has agreed to underwrite Employers Liability Insurance for 16-/17-year-old young adults (who are in receipt of direct payments and who register as employers).
The views of young disabled people
As part of the project, David Abbott, from the Norah Fry Research Centre, University of Bristol, and April Bird, a freelance researcher, organised a group of young disabled people to meet to produce a resource about direct payments for young disabled people (see Box 2).
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Fifteen young disabled people and PAs came together from across England to meet in London over two Saturdays. Only two members of the group were in receipt of direct payments. Several others were in the process of applying; they had been finding this difficult as there had been many delays and obstacles.
The group felt that the following messages and themes were the key ones which needed to be communicated in order to promote direct payments to young disabled people:
- Direct payments can be a good way of achieving more independence, choice, freedom and control. They can be instrumental in providing an important alternative to residential options.
- Direct payments can change your relationship with your parents - make you less reliant on them and even have a better relationship with them. It doesn't mean however that you have to leave home - unless you want to.
- Direct payments aren't necessarily easy to get and there are anxieties about the process of applying. The group had concerns about needs assessment and whether their own views on what their needs were would be taken seriously. They were also worried that social services departments wouldn't know about it or wouldn't adopt a helpful attitude towards a young disabled person enquiring about direct payments.
- Given the potential barriers it was thought to be crucial to stress that young people would not be alone with the decisions and responsibilities relating to applying for and getting a direct payment. Sources of information, advice and support are really important. Young disabled people could talk to other young people who have already got direct payments or they could talk to older disabled people who could give mentoring support.
- Having a personal assistant could be life-changing in all kinds of ways. It was seen as a quite unique kind of relationship, characterised by gains in independence and especially getting access to a better social life. However, the relationships could be stressful and intense and it could also be very hard to find PAs, especially the 'right' PAs. Common problems were that it was difficult to find and 'vet' PAs; that PAs could come and go from the life of a disabled young person; that it took a long time to train them well; that the boundaries between employer and friend could sometimes be confusing. One young disabled, Muslim man said that it was hard to find a PA who was sensitive to his religious and cultural practice.
The views of parents
It is very likely that a young person will need the active support of their parent or carer in order to access a direct payment successfully. Parents may need to be assured that direct payments do not automatically mean that their son or daughter will want to leave home but may be used to support them at home and/or at college.
The views of the Project Advisory Group
The project was supported by a Project Advisory Group of parents and professionals from local authorities, Connexions, Government and organisations of and for disabled people. The group acknowledged the difficulties that young disabled people could face in accessing direct payments and the concerns that parents and professionals might have about the responsibilities inherent in being a direct payments recipient. Issues of safety and welfare were raised in relation to the PA/user relationship. However, the group recommended that the resource for young disabled people (see Box 2) should primarily focus on what was potentially positive about direct payments without ignoring the possible barriers. What was missing was a resource which promoted the idea behind direct payments.
Advisory Group members were aware that low levels of take-up of direct payments for young disabled people might be due to the scepticism of some local authorities. Some of the issues faced by young disabled people were similar to those faced by adults with learning difficulties. This group also had to work hard to persuade local authorities that they could be effective recipients of direct payments as long as proper support mechanisms were in place.
The Advisory Group also reflected on the particular issues that would face minority groups within the population of young disabled people. Would young people from black and minority ethnic backgrounds find PAs with a similar background or sufficient insight and sensitivity to any needs or requirements specific to their cultural background? Similarly, would young disabled gay, lesbians and bisexuals be able to find PAs who were also gay or who would feel comfortable with the sexuality of the young disabled person?
About the project
This work was co-ordinated by David Abbott at the Norah Fry Research Centre, University of Bristol, with help from April Bird (work with young disabled people), Jan Alcoe (design and layout of 'Living it Up!') and Icon-Tact, Bristol (CD). The project was also supported by a Project Advisory Group of parents and professionals from local authorities, Connexions, Government and organisations of and for disabled people.
Special thanks to the young people who took part in this work: Shabaaz Mohammed, Dave Littman, Anna Morgan, Lucy Mason, Tina Stark, Jade Sempare, Tom Fagan, Maresa MacKeith, Letitia Shaw, Katie Caryer, Lucia Bellini, Wendy Greenwell, Luke Jameson.
http://www.jrf.org.uk/publications/direct-payments-young-disabled-people
This publication aims to tell the story so far about the personalisation of adult social care services. It is intended to set out our current understanding of personalisation and its implementation, exploring what personalisation is, where the idea came from and placing the transformation of adult social care in the wider public service reform agenda.
Key points
The report contains the following key messages and recommendations:
- By identifying and transferring knowledge about good practice, SCIE has a special role to play in transforming adult social care services.
- Person-centred planning and self-directed support will need to become mainstream
- It will ultimately mean universal services such as transport, housing and education are accessible to all citizens.
- The personalised system will need to be cost-effective and sustainable in the long term.
- Approaches to early intervention and prevention need to develop further so that people are encouraged to stay healthy and independent.
- The social care workforce will need to acquire new skills.
Context
SCIE is a signatory to the Putting People First concordat which set out the shared commitment to finding new ways to improve adult social care in England. Personalisation means thinking about public services and social care in an entirely different way – starting with the person and their individual circumstances rather than the service. It requires the transformation of adult social care.
Purpose
By identifying and transferring knowledge about good practice, SCIE is playing a full part in transforming social care services for adults. This guide aims to tell the story so far about the personalisation of adult social care services.
Audience
This guide is aimed at frontline practitioners and first-line managers in statutory and independent sector social care services, although it is an indispensable summary for all those interested in this important area.
About the development of this report
Background
This guide is the second version produced to support the personalisation agenda, with the first version published in October 2008. Personalisation is a challenging field because it has continuously developed through research and practice experience since policy inception. It is therefore presented as a report and a 'rough guide', since the evidence base for particular models is not yet sufficiently strong to support strong recommendations for particular practice models. The first edition was extremely well received by the sector, and the guide will be revised to reflect emerging research findings.
Scoping and Searching
Original scopes for the first edition were carried out in January and September 2008; the revised guide is based on scoping and searching in January 2010.
Stakeholder involvement
SCIE has an in-house specialist in personalisation (Senior Research Analyst) who identified additional material (including what were then brand new policy documents), carried out the synthesis, and worked with experts. The Partners' Council consultation informed the work. For the first version, external peer review was undertaken by a Senior Fellow of the King's Fund, and Deparment of Health lead for personalisation was consulted, as were Putting People First Delivery Coordination Group (PPFDCG), and Transforming Adult Social Care Board. The current version was informed by customer feedback, changing policy and new research, with consultation from PPFDCG).
Download Personalisation: a rough guide
- Report 20: Personalisation: a rough guide (720kb PDF file).
- Report 20: Personalisation: a rough guide - easy read summary (1890kb PDF file).
Other resources on personalisation
SCIE has produced a series of Personalisation briefing for specific audiences.
- Implications for commissioners
- Implications for home care providers
- Implications for housing providers
- Implications for carers
- Implications for advocacy workers
- Implications for voluntary sector service providers
- Implications for personal assistants (PAs)
- Implications for user-led organisations (ULOs)
- Implications for residential care homes
- Implications for community mental health services
- Implications for for nursing homes
- Implications for people with autistic spectrum conditions and their family carers
- Implications for community learning disability staff
- Implications for occupational therapists
- Implications for social workers in adults’ services
- Implications for NHS staff
- Personalisation and mental capacity
- Implications of the Equality Act 2010
- Implications for lesbian, gay, bisexual and transgendered (LGBT) people
The number of users with a personal budget and direct payment, by primary user group, as at 1 April 2010is as follows:
|
Age Group |
Client Type |
DP |
PB |
Combined |
Total |
|
18-64 |
LD |
24 |
3 |
35 |
62 |
|
|
MH |
0 |
4 |
24 |
28 |
|
|
PD |
57 |
12 |
118 |
187 |
|
|
Carers |
50 |
|
6 |
56 |
|
|
|
|
|
|
|
|
65+ |
MH |
0 |
8 |
|
8 |
|
|
PD |
7 |
338 |
114 |
459 |
|
|
Other |
0 |
5 |
|
5 |
|
|
|
|
|
|
805 |
Adult social care chiefs are to ask some councils why they have so few service users on personal budgets.
Last week the NHS Information Centre showed wide variations in take-up, ranging from 3.3% of eligible recipients in Somerset to 58.7% in Manchester.
Half of councils had less than 10%, while one in eight had more than 20%.
Jeff Jerome, the national director for social care transformation, who is working through Adass to help councils implement personalisation, said he would be speaking to slow-performing authorities to find out where the problems lay.
However, he insisted they were a minority.
"The variations are undesirable and we are going to have conversations with those councils to move more quickly," Jerome said.
The reasons seemed to lie in difficulties in stimulating the market, or in councils having spent too much time developing systems.
Councils in England are expected to have 30% of service users on personal budgets by next March, under targets agreed by Association of Directors of Adult Social Services, the Local Government Association and the Department of Health.
Adass and the LGA said councils were on course to meet this target for people who receive ongoing support, but not if people who receive short-term support were included in the figure, as is the case in the NHS Information Centre statistics.
Personalisation consultant Jeremy Cooper of iMPOWER said the figures were disappointing but not unexpected as the difference between "the advanced and the laggards" became more evident.
"Forward-thinking councils have realised that setting targets is helpful for driving behaviour, but the simple number on personal budgets isn't the right target," Cooper said.
"Genuine change is being measured by locally set success criteria. These include a range of things, such as the percentage choosing non-traditional packages, the level of savings made at review, the number where social workers have not driven the support plan or the increase in direct payments."
Liz Bruce, strategic director of adults at Manchester Council, said: "Manchester has shown other authorities how to successfully manage it and how to mitigate the risks - and we are proud of the fact that we are leading the way."
Miriam Maddison, director of community services at Somerset Council, admitted the authority had to improve.
"In Somerset all new eligible service users are offered a direct payment and existing service users are offered this option at review," she said.
"We are implementing Putting People First through our You First programme. Our new operating model focuses on rehabilitation as the first, vital phase for almost all service users within a culture that promotes and supports independence, choice and control.
"We anticipate personal budgets being implemented as 'business as usual' by 1 April 2011."
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