Local Adult Social Services Departments have a legal responsibility to carry out an assessment of the needs of people who are having difficulty leading their lives as independently and safely as they might like, and to arrange services (see Factsheet Getting Help from Adult Services).
For the past few years, there have been 2 options available to you when it has been decided that you are eligible to receive support from this Department.
1. Most commonly, the practitioner in the Department, often called “the Care Manager”
- tells you what type of service you are eligible for, such as 10 hours of home care support per week, or 3 days’ attendance at a day centre
- contacts service providers to arrange this support for you, and writes this in a care plan
- makes arrangements for the finance section of the department to pay the service provider
- arranges for your financial assessment so you know how much you need to pay towards the service
- arranges for you to have at least an annual review, so that everybody can be sure that the service is good quality, and is still meeting your needs
- if you have any problems with the service in the meantime, that you cannot sort out with the service provider, you will be able to contact the Care Manager again, to try and sort things out
- often the Care Manager will also liaise with other organisations such as health services and housing departments and voluntary sector organisations so that you can receive services , as appropriate from them too
2. Although many people needing care and support get a good level of service from their Care Manager, some 10 years ago, organisations representing social care users lobbied for more control over the arrangements and in 1996 a law was passed that enabled people to ask for a DIRECT PAYMENT to arrange the service themselves.
The way that most local authorities operate their Direct Payment arrangements is to carry out all the early stages of the assessment process as usual until the point where it is decided what services will meet your needs e.g. the 10 hours of home care per week as above. At this point you should be asked whether you would like a Direct Payment to arrange the service yourself.
If you opt for a Direct Payment (DP)
- The practitioner will first assess that you are able to understand the concept and practically manage the money, and you will sign a formal undertaking. If you need help in giving consent, it is possible for the undertaking to be with someone supporting you. ( See Guidance on Direct Payments, Department of Health, 2009).
- The amount you get is likely to be based on a set rate for the type of service e.g. the DP rate for an hour of home care may be set at £10.00 per hour, so for the example here, you would be given £100.00 per week.
- The amount you receive will be minus the charge you will be assessed to make for the “service” (it is likely to be the same amount that you would pay if you had a care-managed service). Using the same example, if you have been allocated £100.00 per week to buy your care, but you have been assessed to make a charge of £35.00 per week, the actual amount you will be paid is £65.00 per week.
- You decide how you wish to spend this money. You may simply contact an agency yourself as a care manager would, or you may decide to appoint your own support staff. Although you have some flexibility about this, the adult services department will be looking to make sure that you meet the needs that have been specified in your care plan. If your care plan has shown that 7 hours of the 10 hours should be used to help you get up, washed and dressed each day, you may not use the money to pay for someone to do your shopping instead if it means that you begin neglecting your personal care.
- You need to set up a bank account specifically for receiving and using this budget, and you will need to report regularly to the Department about how you are managing your finances.
- You make the payments to your care / support providers. The DP rate is generally intended to cover all your costs, so you will need to factor in advertising and employment costs of dealing with tax and national insurance if you decide to employ your own staff.
- There is likely to be a Direct Payment Support Scheme in your area, paid for by the local authority, that will help you make the arrangements, and families and friends can also help.
- You can still contact the Department if you have any problems you cannot resolve.
- You will still have, at least an annual review of your needs which will also consider whether you are managing the DP appropriately.
- The practitioner can still liaise with other organisations so that you can know what other support you may be able to access also.
- The DP legislation limits use of the money to community care services only (i.e. it cannot be used for care home payments other than for respite stays) and also limits who can be paid with the money, e.g. some family members.
However, now a third option is developing, and in some parts of the country is quite extensive – this is the arrangement known as PERSONAL ( OR INDIVIDUAL ) BUDGETS.
This arrangement began by being trialled in a few parts of the country in the early 2000s as “In Control” or “Self-Directed Support” projects and in late 2007, achieved Government and cross-Department support in the document “Putting people first: a shared vision and commitment to the transformation of adult social care. Since then the Government has issued targets to local authorities and by 2011 it should be offering personal budgets to 30% of the people coming for support.
Although there are similarities to the Direct Payment arrangements, there are also some differences, the key ones being:
- The assessment process is different, being focused more on what outcomes you wish to achieve in your life than on any problems causing you difficulties.
- There should always be the opportunity for you to carry out a self-assessment, either alone or with help from family, friends. Support agencies are also setting up specifically for this purpose.
- Once your assessment is completed you should be advised of the number of points that can be awarded because of your circumstances.
- The Department then advises you of the personal allocation of money that can be provided to you because of the points - just as in the TV show….”points mean prizes”.
- Once you know the money that you can expect, you will be asked to draw up a support plan detailing how you will use it to achieve the outcomes you described in your assessment.
- When this is approved by the Department, you can get your arrangements going!
Use of the money is more flexible than DPs and often you will be helped to find out whether there are other funding sources that can also be used in this way (the Health Service is currently carrying out a number of pilot projects), so that you perhaps manage the funds together. Similarly, you / your family may want to add to the allocation in some way, to enable a particular outcome to be achieved.
There are now many case studies of how people have used their personal budget in very creative ways to lead a lifestyle that might otherwise have been difficult for them.
The Personal Budget can be used for all services and for support that has not traditionally been viewed as social care, support such as keeping healthy by joining a running group or buying some fitness equipment.
You can choose not to manage the whole of your budget e.g. you might still decide to spend some of it on home care and ask a care manager to make these arrangements, while you organise the rest of it - paying for gym membership, taxis and a personal befriender.
You will still need to have and manage a bank account and provide reports.
You will still have, at least, an annual review of your circumstances.
If you are not offered a Personal Budget, please ask your local authority ‘why not?’ How far they have got in introducing the scheme in your area, and whether they can include you in any forthcoming plans to develop the scheme.
Further Information on the policies and case studies can be found at:
www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/index.htm
www.in-control.org.uk
www.westsussex.gov.uk/ccm/content/social-care-and-health/adults/getting-social-care-support/09-customers-stories/edna-and-joes-story.en
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