PLYMOUTH CITY COUNCIL COMMUNITY SERVICES INDEPENDENT LIVING STRATEGY DOCUMENT

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1 PLYMOUTH CITY COUNCIL COMMUNITY SERVICES INDEPENDENT LIVING STRATEGY DOCUMENT Authors: Liz Bawn Kate Jones Page 1 of 10

2 1. Introduction As part of the Modernising Local Government Agenda introduced by Central Government the local authority under the Health and Social Care Act 2001 offer Direct Payments to service users in both adult and childrens services. Increasing the uptake of direct payments is an important part of the new direction for community services set out in the White Paper Our health, Our care, Our say and enables us to meet Plymouth City Council s Corporate Plan, Strategic Objective 1, improving health and well-being there is the over arching statement: To improve the health, well-being and social care of local people, reduce inequalities and help people at all stages in their life to enjoy the best possible health This should include: 1.7 Improve the quality of life and independence of vulnerable people so that they can be at home where possible Plan, commission, purchase and monitor an adequate supply of appropriate, safe and cost effective health and social care And contribute to the following corporate objectives of: Providing excellent and efficient services Putting the customer first Ensuring access for all Improving our capacity to deliver Direct Payments are a different way of delivering some of the existing social services responsibilities. They are an alternative to the traditional service model provided by local councils and are aimed at increasing opportunities for independence and social inclusion. We can no longer expect people to fit into services, services need to be personalised to respond to individual need. Direct payments provide an immediate means of increasing the choice and control individuals have over the way in which their needs are met. Larger scale and more flexible use of direct payments will help organisations, professionals and people using services to create more flexibility and choice in services. Since April 2003, local councils have had a duty to make direct payments available to all those people eligible to receive them and who are willing and able (alone or with assistance) to use them. The law has been changed so that where there was a power; there is now a duty so that councils must make a direct payment to people who can consent to have them. This means that direct payments should be discussed as a first option with everyone, at each assessment and each review. Page 2 of 10

3 It is clear from the wide variations in uptake, both between local council schemes and across the different groups for whom uptake is monitored, that many people are simply not being offered direct payments when they should be. Furthermore, there is evidence that even when direct payments are available, a lack of adequate support or information, or unnecessarily complicated processes are hindering or preventing access. Direct Payments arrangements should empower people and help maximise choice and control. They should be an integral part of the way in which need is met by local councils and partnership agencies across all care groups and service areas. Tactically reconfiguration of how we deliver Direct Payments to the citizens of Plymouth should encourage best value for money and put us in a position to evolve as new government initiatives such as Individual Budgets as set out in Our Health, Our Care, Our Say, and Strong and Prosperous Communities, Local Government White Paper 2006 which talks about expanding the scope of the existing direct payments schemes and piloting arrangements for individuals to have their own individual care budgets; by exploring the options for making greater use of individual budgets this should enable people to have a much greater level of independence and control over their lives. To ensure that the Council can achieve the White Paper requirements and our corporate intentions the Assistant Director for Adult Social Care commissioned a review of how we offer and deliver Direct Payments. We have had dedicated support from a Service Manager for Business Support in this review. 2. Current Position There is a Direct Payments Team consisting of: - A Direct Payment Officer - permanent - A Direct Payment Facilitator permanent - A Direct Payment Facilitator (MH) temporary funded by Mental Health Grant monies - 1 WTE Clerical Officers permanent - 1 Financial Officer temporary - Support from an Admin Support Manager The team is managed by a Team Leader from Tamar locality. There is also a Support Service contract with the Leonard Cheshire Foundation. The remit of the Direct Payment team is to support Care Managers through the process of Direct Payments when service users indicate that they wish to become recipients. Page 3 of 10

4 The numbers of Direct Payment recipients at the time of preparing this paper are: 3. Issues Older People 48 Learning Disability 35 Physical Disability 55 Mental Health 3 Sensory 4 Children 61 Carer 1 TOTAL 207 When the Council began to offer Direct Payments as an alternative to traditional services in 2002 numbers were inevitably low therefore the Direct Payment team had the capacity to deal with the cases generated, providing a level of service that has since become unsustainable as numbers of Direct Payment users have grown. This resulted in a declining number of new Direct Payments coming through and traditional services were being ustilised instead. Nationally we are currently in the bottom quartile for Adults with a Direct Payment. In order for us to attain a suitable band we would need to increase our numbers this year to 244 which would put us in the top quartile and on target for two star performance. Within childrens services we are performing well against our comparator authorities. There also appeared to be a lack of clarity with regard to roles and responsibilities of the Direct Payment Team, Care Managers in Locality Teams and the Support Service which did not appear to have been clearly defined. In January 2005 an automated payment system was introduced which put additional pressure on the Direct Payment team as this was embedded. To address some of these issues the Direct Payment Team were given clear guidance with regard to their roles and responsibilities and work was undertaken with the Support Service to look at variations to their contract, which has been extended to 31 st March 2008 and which more clearly defines their role. 4. Barriers and Solutions to the Take up of Direct Payments Nationally it is recognised that there are real and perceived barriers to choosing Direct Payments. Barriers include: Lack of clear information for people who might take advantage of direct payments Low staff awareness of direct payments and what they are intended to achieve Restrictive or patronising attitudes about the capabilities of people who might use a direct payment and a reluctance to devolve power away from professionals to the people who use the service Page 4 of 10

5 Inadequate or patchy advocacy and support services for people applying for and using direct payments Inconsistencies between the intention of the legislation and local practice Unnecessary, over-bureaucratic paperwork with complicated processes. Problems in recruiting, employing, retaining and developing personal assistants and assuring quality. The burden of responsibility Fear of Independence Compatibility of Direct Payments with wider commissioning activity Tensions between protection and risk many care professionals have a protective instinct that limits the risks undertaken by those people in need of our services which can impact adversely on an individuals independence and prevents empowering people to take control of their lives. There are however solutions to these barriers. In December 2006 the Care Services Improvement Partnership published a self assessment and action planning guide for local authorities and their partners. From this toolkit there were six clear elements: Leadership - Direct Payments should be promoted as part of standard practice within the council s social care service, including those provided in partnership with other agencies, such as mental health services. Straightforward Systems - Have standard administrative and financial procedures that apply equitably and transparently to the process of obtaining social care services Learning and Development - That there be a training strategy designed to ensure that all relevant staff have sufficient knowledge in order for Direct Payments to be a first option for the meeting of individuals social care needs Communication - The availability and benefits of Direct Payments need to be effectively communicated to those who might wish to consider and/or use them and others who may support or advise them. Guidance to staff needs to be clear and enabling. Comprehensive Support - The making and use of Direct Payments is adequately and effectively supported. This is one of the most critical factors in the successful implementation of Direct Payments and Support Service should be integral to our strategy. Page 5 of 10

6 Commissioning - The development and adoption of appropriate commissioning strategies is essential to support the increasing uptake of Direct Payments, moving away from traditional block contracting arrangements and developing more creative and flexible arrangements with providers led by service user preferences. 5. Proposal for the Future In 2006 Childrens Services commissioned an officer to provide an overview of barriers and solutions and to make recommendations for action that should increase the take up of Direct Payments for children with disabilities. Many of the recommendations in this report compliment those proposed by Adult Social Care and our intentions in this document are reflective of a joint approach to Direct Payments by Adult Social Care and Childrens Services. Direct Payments will become mainstream within Care Management and the Children with Disabilities Team. For staff this will mean that they will meaningfully and confidently offer Direct Payments as a first option each time they undertake an assessment or review; all service users wishing to avail themselves of a Direct Payment will then have their Careplan forwarded to the Support Service where it will then be progressed via the Support Brokerage (see section 8.1). 6. Proposed Model To enable this intention the Direct Payment Team will be reconfigured; with roles and responsibilities of this Team and those of Care Managers/Fieldworkers and the Support Service being clearly defined. The Team will be known as the Independent Living Team in order to encompass our continued development of Direct Payments and our intended move towards Individual Budgets and Self Directed Care. 6.1 Independent Living Team This team will consist of: An Independent Living Development Manager who will manage the strategic implementation, overview, development and monitoring of Direct Payments, Individual Budgets and Independent Living Fund in relation to Service Users. This will be a strategic post and the post holder will in the first instance: - Advise Team Leaders on Direct Payment Delivery - Set and monitor objectives - Identify learning and underpin training for all levels - Identify guidance issues - Identify financial issues Page 6 of 10

7 - Evolve to and be responsible for guiding Adult Social Care towards Individual Budgets and Self Directed Care. An Independent Living Facilitator whose role will be to add capacity to the Support Brokerage arm of the Support Service; promote the concept of independent living for service users amongst care manager and fieldworker colleagues and provide them with mentoring and support to enable this to happen. The post holder will be managed by the Independent Living Development Manager. A Monitoring Officer who will undertake aspects of monitoring to include financial monitoring for Direct Payments, Individual Budgets and some aspects of contract monitoring. The monitoring officer will also be involved in developing appropriate systems and processes for a `light touch approach to monitoring whilst protecting the financial interests of the Council. This post holder will be managed by the Independent Living Development Manager. An element of Administration support will be required for to support this team. 6.2 The Locality Teams Team Leaders will be responsible for championing Independent Living with their workforce and challenging appropriately Careplans where no evidence that Direct Payments have been genuinely considered by the assessor with the service user. Care Managers will be responsible for discussing fully and offering Direct Payments as the first option whilst undertaking an assessment or review with a service user. 7. Training To equip Team Leaders, Care Managers and Fieldworkers and all those involved in Direct Payments with their knowledge and understanding and to feel confident in their ability to support service users with making informed choices there will be appropriate training. This will incorporate awareness of the legislation, breaking down barriers, best practice, maximising ILF funding, practical exercises and service user involvement. Training will not be static and will evolve as we move towards Individual Budgets. 8. Support Service A Support Service is integral to our strategy and provides support for prospective and existing Direct Payment recipients. A new Support Service specification for April 2008 March 2011 is currently being drawn up and the tendering process has commenced. Elements that will be contained within the specification include, aid with recruitment, holding a PA Register, operating a Banking Service and Support Brokerage. Page 7 of 10

8 8.1 Support Brokerage The Commission for Social Care Inspection supports care initiatives which are person centred and which enable people to make informed decisions which give them freedom of choice, promote their independence and safeguard their rights. CSCI s definition of a Support Broker is a support broker as someone who acts independently of the council s social services and is directed by the individual (often with support) to: access an assessment of their care needs; select or put together a care plan which fits their needs; obtain or negotiate and manage funding to pay for the care service; implement the plans; monitor and evaluate the service; build personal networks; mediate and resolve problems; and provide help and advice as long as the person uses care services. This puts people using care services at the heart of decision-making processes so that they can be in control and empowered to make choices about and plan the package of care and support they receive, with the help of support brokers if they wish. Brokerage is a means to do this. It is out intention to incorporate into our Tender for the new Support Service for April 2008 March 2011 Support Brokerage. The organisations successful in their bid for this contract will be required to work with us towards: Developing a Support Brokerage that encompasses all service user groups and identifies services that will meet their required outcomes Prior to April 2008 we are commissioning a short term support brokerage service from 1 st October 2007 until 31 st March 2008 with one off funding from the Department of Health. During this period of time the Support Brokerage will be situated with the Direct Payments Team at Ballard House. Once staff have identified with a Service User that they wish to take up a Direct Payment they should send their completed Careplan to the Direct Payments Team and the Support Brokers will with the Direct Payment Facilitator progress the Direct Payment through. It is intended that the Organisation successful in its bid for the Support Service Tender will continue to undertake this from 1 st April 2008 onwards. The Support Service will also work with the Council during the life of the contract to progress the Independent Living agenda that encompasses Individual Budgets and Self Directed support. Page 8 of 10

9 9. Commissioning It will be essential to develop and adopt appropriate commissioning strategies to enable the ethos of Independent Living become a reality. This will involve moving steadily away from `traditional block contracting arrangements and/or developing more creative and flexible arrangements with providers led by user preferences. The Council will work with suppliers to reshape services to meet changes in demand, technology and demographic trends and to move towards person centred working and outcome based commissioning. This will enable service users to have a strong sense of being in control of their services. 10. Recommendations It is recommended that Direct Payments become mainstream within all care management teams. To reiterate this; staff will meaningfully and confidently offer Direct Payments as a first option each time they undertake an assessment or review; all service users wishing to avail themselves of a Direct Payment. That the Independent Living Development Manager completes a whole system review of current arrangements and develop a project plan detailing how the Council move towards a system of Individual Budgets and self-directed support and expand the function of Support Brokerage. Individual budgets will put far more control in the hands of people, who use social care services, A pilot should emerge from this project plan with resources allocated and services delivered in ways that personalise responses to need, enable people to have choice and be empowered over those responses to need and support people to help themselves. To achieve the recommendations a cultural shift is required so that social care professionals are working to promote self-directed care; and markets will need to be developed to ensure that we have an appropriate range of services to choose from. The opinions, preferences and views of our service users need to be heard; it is recommended that an Independent Living Strategy Board be set up, to include relevant professionals, service users and carers, plus representation from the Support Service. The purpose of the Board would be to engage with our users to enable the development of Direct Payments, Individual Budgets, Self Directed Care and Support Brokerage in such a way that is representative of the views of the citizens of Plymouth who we aim to serve. It is recommended that this Independent Living Strategy Board be chaired by the Head of Service for Modernisation from Adult Social Care. Liz Bawn Service Manager Adult Social Care Kate Jones Service Manager Adult Social Care Page 9 of 10

10 Contributors: Eric Crayford Marion Martin DP Team Craig McArdle Debbie Butcher Team Leader Policy Officer (paper Promoting the Take up of Direct Payments by Children and Young People with Disabilities in Plymouth Commissioning Manager Commissioning Manager Sources of Information: - Direct Payments: What are the Barriers? Commission for Social Care Inspection Report Our Health, Our Care, Our Say, - Department of Health White Paper - CSIP increasing the uptake of Direct Payments - CSCI Support Brokerage: A discussion Paper Page 10 of 10

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