Contact: Lucy Butler, Tel: (01962) 845612; e-mail: lucy.butler@hants.gov.uk

1. Summary

1.1 This paper sets out the reasons for the current Direct Payments Review, identifies the process used in undertaking the review and seeks Cabinet's permission to consult on the "case for change". This report needs to be considered by Cabinet as it affects both Adults and Children's Services and has implications for the Financial And Benefits team who are part of the Treasurer's department.

2. Recommendation

2.1 That Cabinet approves the proposal to consult on a range of specific areas related to the Direct Payments process and associated roles and responsibilities outlined in Section 6 of this report.

3. The law and Direct Payments

3.1 Direct Payments is an Adult Services and Children's Services scheme whose purpose is to give clients control over their own lives. It achieves this by making a financial payment to clients enabling them to employ the people or services they choose to provide the assistance that they are assessed as needing. The scheme has enabled disabled people to live more independently since 1981. There are currently around 900 people receiving Direct Payments in Hampshire.

3.2 Direct Payments are an alternative to the direct provision of care by Adult Services and Children's Services provisions such as care attendants, home care, day care, residential care etc. With directly-provided care, the Care Manager/ Care Coordinator controls provisions whereas Direct Payments put the client in control.

3.3 Originally, the category of persons eligible to receive Direct Payments was fairly limited. This category has now been expanded by the Carers and Disabled Children Act 2000. Local authorities are now empowered to offer Direct Payments to an expanded category of persons, which includes:

_ A person with parental responsibility for a child with a disability

_ young people with disabilities aged 16/17 years

_ carers including young carers who undertake a substantial caring role

_ Older and disabled people aged 16 and over

3.4 Government guidance issued in 2003 has placed a duty on local authorities to offer direct payments to most people eligible for social care services. This means that social workers must give qualifying clients the opportunity to use Direct Payments if they wish to purchase the agreed services that form their package of care.

3.5 Direct payments will only be offered where a client has been assessed as having needs which meet the eligibility criteria set out by the Adult and Children's Departments, and where they do not fall within the limited category of persons to whom the duty to offer Direct Payments does not apply (broadly, persons whose liberty to arrange their care is restricted by certain mental health or criminal justice legislative provisions). Although there is a duty to offer Direct Payments to the vast majority of clients, they are under no obligation to make use of the scheme, and may elect to have directly-provided services. The care manager must also be satisfied that the clients need for services can be met by means of a Direct Payment.

3.6 Although all (there are a few exceptions including certain categories of mental health clients) clients are able to receive Direct Payments, not all are legally able to employ their own Personal Assistants but are able to purchase care from agencies / day centres etc.

4. Approach to the Direct Payments review

4.1 The review has identified current issues relating to policy, process, the lack of clarity in relation to roles and responsibilities and the way the Council has implemented policy through care management. It has also sought best practice from a number of other organisations including Bedfordshire, Essex, Kent, and Lincolnshire County Councils, Milton Keynes Unitary Authority, The Benefits Agency, Association for the Directors of Adult Social Services and the Department of Health. Ideas for a revised set of service requirements and new processes have been examined in collaboration with client representatives and officers, including representatives from the legal and audit practices.

4.2 In response to this evidence, the project team is currently preparing a `Case for Change', to be presented to both Adults and Children's Department Management teams. This will be used as the basis for the consultation process and will include an assessment of the various options, weighing up risk and implementation and operational costs against stakeholder benefits.

5. Current spend on Direct Payments

5.1 Adult Services are predicted to spend £7.7 million on Direct Payments and receive £0.7 million in client's contribution. This leads to a net cost of £7 million averaging a weekly payment of £188 for each client.

5.2 Children's Services are predicting to spend £0.54 million on Direct Payments averaging £76 per week for each client. Within Children's Services, budgets are being realigned to reflect the Children in Care Commissioning Strategy, which includes children on the edge of care. Direct Payments are one aspect of the current budget planning work that will support this strategy.

5.3 It is likely in the future that there will be greater uptake in Direct Payments with the move to self-directed support in Adult Services. We are currently undertaking work with a national agency to financially assess the impact of this.

6. Process areas to be taken to consultation

6.1 The authority has an obligation to carry out a financial assessment of all clients who are in receipt of care services under the Fairer Charging Policy. The `Financial Assessments and Benefits Team' (FAB) team, within the Treasurer's Department perform financial assessments on behalf of Adult Services Department. The position of the financial assessment within the overall application process means that the client contribution cannot be collected until this has been completed and the client is notified. Because Direct payments are paid in advance and there is frequently a delay in setting up Direct Payments, the first payment to the client normally includes a backdated element. Although clients, once assessed, are informed of their contribution upper limit, the Council has no ability to backdate contributions or to claim the client's contribution until a formal letter of assessment has been sent out which can result in a loss of income.

6.2 The lateness within the process of financial assessment (the current average is 18 working days) means that clients are unable to make fully informed choices about their care. Anecdotal evidence from Care Managers has shown that clients' sensitivity to financial obligations is high with many dropping out of the assessment process once they have been informed of their limit. No data exists on what proportion of clients are exiting the process as a result of establishing their contribution but the quicker the Council can help clients make informed choices about their care the better, allowing for earlier signposting to other wellbeing services.

6.3 Stakeholders will be consulted on two key options - firstly that they would accept the council's preference for clients to have the choice of a financial self-assessment, supported by the Council over the telephone and secondly that this assessment is completed much earlier on, in parallel with the potential client's initial contact with the authority. This would work by offering clients a screening at the point of contact which would identify whether clients had savings or were eligible for benefits, thus informing the client and the council on the whether they would need to undergo a full financial assessment. Clients that were identified as needing an assessment would do this themselves over the phone with support from the FAB team. Clients would be expected to provide back up documentation where necessary. Clients would still have the option of having a home visit if they chose and if the FAB team felt it was necessary they would make a decision on whether they would follow up the self-assessment with a home visit. The importance of introducing the idea of a screening tool and self-assessment is that information on potential charges would be shared at a much earlier stage and the process streamlined.

6.4 The benefits of changing the approach to financial assessment include minimising the time during which the Council funds a client's care package when they could be self-funding; better use of resources resulting in more clients being financially assessed and that clients are informed of their contribution for care much earlier on.

6.5 The second key proposal addresses corporate risk. The new process needs to seek an improvement in our understanding of whether a client's Direct Payments are being used appropriately, and must reduce the current levels of financial risk. Changes to the way in which the authority selects who should be audited and with what frequency will be proposed, we will consult on the introduction of a `Direct Payments Risk Assessment'. This will record and combine information on the size of the Direct Payment, the client's perceived ability to manage their Direct Payment and other evidence that will enable a profile to be built up.

6.6 The advantage of using client profiling will result in more clients being able to use Direct Payments as the Council will be able to put support in place, earlier on, if we feel a client may not be fully capable of managing the responsibilities of the scheme, such as managing employers taxation. It will also formally allow the authority to rule out certain clients who are not legally able to receive Direct Payments (e.g. certain categories of mental health clients). Importantly, this change does not conflict with the authority's duty to offer a Direct Payment to all users but ensures that clients presenting as high risk are better supported.

6.7 A third means of ensuring the authority is satisfied that it has equitably and responsibly delivered care through a Direct Payment is by tightening up the controls and governance of the assistance available to clients from Support Worker Organisations such as Enham and SCIL. The consultation will seek feedback on their role and the level of information they provide to clients, including suggestions over how their performance can be more actively managed to ensure clients are able to make informed decisions. This is in line with the authority's desire to work more closely with external agencies and will play an increasingly important part as uptake increases. Specifically, the Council will seek to introduce reporting and performance responsibilities into the agreed contract.

6.8 Fourthly, reflecting care strategies at national level, such as `Our Health, Our Care, Our Say' which outlined the intention of the move towards self-directed support nationally by 2012 if the pilot sites the Government had introduced in 2005 were successful. In response to the White Paper, Adult Services seeks to introduce `Self-Directed Support'. Central Government is pressing for a key change in direction towards the increased choice and control for people who use our services which includes planning for outcomes, not inputs (e.g. hours of care), by 2012. In the run up to this, Hampshire must develop and improve its Direct Payments scheme.

6.9 A key feature of the consultation will be to introduce outcome planning into the Direct Payments process. The consultation will seek responses to proposals to ensure that all clients agree their desired outcomes before agreeing to receive Direct Payments, these will then be monitored at regular points. It is thought that the outcome based model would require the introduction of an additional form to be completed with the care manager that will allow better monitoring of outcomes against care plans. The results of this monitoring will feed back into the risk assessment and may adjust the regularity of future monitoring.

6.10 It will also be necessary to compare the outcomes of the consultation with the corporate governance requirements of the County Council. This will be achieved by consulting both internal audit and legal services so that Members are able to decide whether the proposed changes are acceptable.

7. Consultation Process

7.1 The final design and implementation of these changes will be subject to a 14 week consultation period which is compliant with the Hampshire Compact and will proactively invite users, officers and members to contribute towards both the approach of the consultation process and the solution proposal itself (where appropriate). The project team expects to use a variety of formats to consult with stakeholders, including:

_ Surveys

_ Public meetings and web forums

_ Staff briefings and road-shows

_ Individual interviews with current users

_ User groups using a cascade approach

A separate task group is being set up by Adult and Children's Services to design and deliver the consultation process.

The outcomes of the project will be implemented commencing April 2008.

8. Conclusion

8.1 The Direct Payments Review is at a critical stage and now needs Cabinet approval to consult.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB: the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.

NONE

Appendix 1

Experience of a young woman with a learning disability who received an Individualised Budget as part of the `Dynamite' pilot.

Ms A, a young woman with a learning disability living at home with her parents who both work full time. She was receiving care managed services through a day service. This did not entirely suit her family as her sessions at the day centre finished at 3.30 and her parents did not return home from work until 6pm. They were worried and concerned that she would be safe from 3.30 and Ms A herself wanted to do more things in the local community.

Once Ms A received a Individualised budget she decided to have a mixed package of care. She still attended the day service but not as often. She used some of her budget instead on support to do more activities in the local community thereby building up her confidence and abilities. She also used some of her budget to purchase support from a personal assistant who collects her from her day service at 3.30 and supports her until 6pm until her parents return home. Both Ms A and her parents are much happier with her support and Ms A is now planning to move out of her family home.