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Posted: 22 February 2007 | Subscribe Online

writes Mithran Samuel

Expansion of direct payments and individual budget schemes look likely. The policy of extending cash for care schemes was promoted by health secretary Patricia Hewitt and her ministers during 2006. However confusion exists over the variety of initiatives and take-up is variable. Direct payments and individual budgets are universally applauded but doubts about the viability of implementation persist. Risk, cost, and professionals' attitudes towards the schemes are all issues.

Key policy documents highlighting cash for care schemes in 2006 included the health and social care white paper in January and a review of the social care workforce Options for Excellence in October. The latter mentions remodelling social workers’ roles to improve outcomes but is short on detail.One of the areas that might impact on roles is direct payments and individual budgets.


So what exactly are direct payments and individual budgets?

Direct payments are cash payments given to service users in lieu of community care services they have been assessed as needing, and are intended to give users greater choice in their care. The payment must be sufficient to enable the service user to purchase services to meet their needs, and must be spent on services that users need.

Like commissioned care, they are means-tested so assume that, in many cases, people will contribute to the cost of their care.

Direct payments confer responsibilities on recipients to employ people or commission services for themselves. They take on all the responsibilities of an employer, such as payroll, meeting minimum wage and other legislative requirements and establishing contracts of employment.

Some of these services can be contracted out and many councils have commissioned support organisations to help service users handle these responsibilities.

Individual budgets differ in two respects from direct payments. Firstly, they go beyond social care, to cover Supporting People, Disabled Facilities Grant, Independent Living Fund, Access to Work and community equipment services. And secondly they set an overall budget for all of these services, which users can choose to take as cash payments, services or a mixture of both.


As a result, they provide a potentially good option for people who do not want to take on the responsibilities of a direct payment.

Background

Direct payments were introduced by the Community Care (Direct Payments) Act 1996 and came into being in April 1997 for adults of working age. They were extended to older people in 2000.


Since April 2001 direct payments have been available to carers, parents of disabled children and 16- and 17-year-old service users. Availability has also been extended to people with short-term needs, like those recovering from an operation, and to Children Act services to help disabled parents.

In April 2003, regulations came into force requiring councils to offer direct payments to all people using community care services. They do not apply to long-term residential care or services directly provided by councils, while they cannot be given to an agent to manage services on behalf of a person who lacks capacity.

Individual budgets were first mooted in January 2005 in a paper by the Prime Minister's Strategy Unit, and seen as a way of personalising services.

However, at the time a similar idea was already being piloted by the In Control Programme, which was set up in 2003 by Mencap and the Department of Health’s Valuing People Support Team and initially targeted at people with learning difficulties.

In Control is based on allocating a budget to an individual, on a self-assessment of their care needs, and enables them to choose the best mix of services and/or cash to suit their needs or wishes.

Individual budgets were taken forward in the March 2005 adult green paper and in November of that year the Department of Health announced they would be piloted in 13 councils.

The pilots are geographically spread, with some covering a wide range of client groups and others covering just one or two. The pilots are receiving support from a team from the DH’s Care Services Improvement Partnership and people who have been involved with the In Control scheme.

The pilots are also being evaluated by a team from the Personal Social Services Research Unit, York University’s social policy research unit and King’s College London’s social care workforce research unit

Take-up

Take-up of direct payments has risen significantly in recent years but still remains low as a proportion of people receiving services.

As of March 31, 2006, 32,000 adults and older people in England were receiving a direct payment, up from 22,100 the previous year. In Scotland, payments rose from 1438 to 1829 between 2005 and 2006.


However, just two per cent of the 650,000 eligible older people in England were receiving a payment in March 2006.


Relatively low take-up has been explained in two ways – the reluctance of local authorities to promote direct payments and bureaucratic barriers they place in the way of take-up; and reluctance on the part of service users to take them up due to the real or perceived burdens they bring.


On the latter point, the introduction of individual budgets is designed to reduce people’s reluctance to take control of their care by lowering the demands in terms of employing and managing people.

However, a 2004 report by the Commission for Social Care Inspection found many barriers originated from councils including:

• Lack of information for service users.

• Low staff awareness of direct payments and what they are trying to achieve.

• Patronising attitudes on the part of staff about the ability of people to manage a direct payment.

• Inadequate or patchy advocacy or support services for direct payment users.

• Unnecessary and bureaucratic paperwork.

There is no doubt councils are getting better on direct payments but the step change in take up demanded by government and independent living activists has not happened yet.

Cost

One potential reason for this is the cost of direct payments. A report by the Audit Commission in May 2006 found direct payments were a net cost for each of 10 councils studied.

While savings were made through service users taking responsibility from care managers for finding and administering care, the research found that these were more than offset by the costs of supporting users and providing training to staff.


It suggested that the only way councils could save money was by making the value of direct payments lower than the price of an equivalent level of commissioned care. However, in practice this may not penalise service users because they may be able to buy in services at a cheaper cost than councils by using smaller agencies or family and friends.


When councils commission providers they typically have to pay a premium to cover management and infrastructure costs.

Risk

Another key issue in the direct payments debate is around risk. Independent living activists have long argued that to have true independence, service users should be able to employ who they want to care for them.


Adult protection campaigners, while admitting the importance of independence, have argued that people employed as personal assistants should face the same employment checks as others to ensure users’ safety.


Currently there are no plans to force direct payment users to submit those who they employ to checks. The government resisted attempts to impose checks through the Safeguarding Vulnerable Groups Act 2006, which will create a vetting and barring scheme for people working with adults and children by 2008.


But the debate is unlikely to die in a hurry as it is being considered as part of the roll-out of registration in the social care workforce. While direct payment employees are not due to be registered from next year, when the register is opened up to domiciliary and residential care staff, discussions continue over whether they should be included.


Doing so would compel a service user to only employ a registered person.

Find out more

Direct Payments Help In Rotheram UK by Rotheram Social Services

Direct payments for people with mental health problems: A guide to action


February 2006


‘We want to give people greater choice and control over how their needs should be met…it is clear that direct payments give people that choice and control.’

What are direct payments?


This guide is about the payments that are made to individuals who have been assessed as needing social care services in order that they can make their own arrangements to meet their needs.


Direct payments guidance: community care, services for carers and children’s services (direct payments) guidance England 2003 (Department of Health – DH) says:


‘The purpose of direct payments is to give recipients control over their own life by providing an alternative to social care services provided by a local council. A financial payment gives the person flexibility to look beyond ‘off-the-peg’ service solutions for certain housing, employment, education and leisure activities as well as for personal assistance to meet their assessed needs. This will help increase opportunities for independence, social inclusion and enhanced self-esteem.’


Disabled people led the campaign for direct payments as a means of achieving the choice and control necessary to achieve independent living.3 The principles of independent living are consistent with the concepts of recovery and social inclusion, and the operation of the


Care Programme Approach (CPA):


‘Effective care co-ordination should facilitate access for individual service users to the full range of community supports they need in order to promote their recovery and integration.’


Direct payments were originally introduced at the discretion of each local authority:


• for disabled adults of working age in April 1997;


• for older people in 2000;


• for carers, parents of disabled children and for 16 and 17 year olds (young adults) in 2001.


Since April 2003, regulations have been in force that require councils to make direct payments to those people who are able to choose to have them and who wish to have them.

Direct payments for people with mental health problems:


A guide to action


There are some people who are currently excluded from receiving direct payments. These are people whose liberty to arrange their own care is restricted by a court order or legislation, including certain sections of the Mental Health Act 1983.6 These restrictions are currently being reviewed within the social care Green Paper, Independence, Well-being and Choice. There are some things that direct payments cannot be used for, such as longer-term residential care or to purchase services direct from the local authority.

The purpose of this guide to action


This guide sets out good practice in relation to making direct payments more accessible to people with mental health problems. It is intended to support the efforts that all local authorities, primary care trusts, mental health trusts and non-statutory providers of mental health services and support will wish to make to ensure that direct payments become a standard option within mental health services. The number of people receiving direct payments is currently a key performance assessment framework indicator (AO/C51) for local authorities. Additional information to support implementation will be available through:


• a guide for people who are eligible to use mental health services and for carers (see National Institute for Mental Health in England – NIMHE – in the Further information and resources section);


• the NIMHE Direct Payments Practice Exchange Network (see NIMHE in the Further information and resources section).


The Government is determined that the option of direct payments should be available to all those who are eligible to use them: ‘…you should be discussing direct payments with everyone who is eligible at assessment and review – and in a way that means they see them as a realistic option. I know that isn’t happening in many cases, but now is the time to equip staff with the drive, skills and knowledge to make it happen.’


While indicating a steady overall increase on previous years, official figures for March 2005 (Figure 1) show that almost a quarter of all local authorities in England were not making any direct payments in lieu of mental health services, and a further half were making between one and five. At the same time, five authorities were making between 21 and 30, with three others making 56, 82 and 137. When compared to uptake by other groups, all local authorities can improve access to direct payments in lieu of mental health services.


Even accounting for the widely differing populations between authorities, it is clear that the majority of authorities and their partners need to take significant steps in achieving improved access.

Figure 1. Numbers of direct payments made by local authorities in England to people eligible to use mental health services (at March 2005) Source: Commission for Social Care Inspection


The successful implementation of direct payments within mental health services requires collaboration between all parties involved in commissioning and providing those services, working alongside service users and carers, advocacy organisations and direct payments support services. There is no need for ‘pilot’ schemes; sufficient knowledge on the successful operation of direct payments has been gained. It is time for action.

Towards independent living: promoting recovery and inclusion


Government policy on direct payments is clear:


• Improving the Life Chances of Disabled People 10 describes direct payments as ‘the most successful public policy in the area of social care in recent years’. The report prepares the way for individual budgets for disabled people, to bring together the services to which they are entitled and give them greater choice over the mix of support they receive in the form of cash and/or direct provision of services.


• Independence, Well-being and Choice 11 sets the direction for increased access to direct payments for groups where take-up has been low, such as people with mental health problems, in the context of positive risk-taking, adequate information, individually tailored assessment (including self-assessment) and a move towards individual budgets.


• The Direct Payments Guidance 12 provides local authorities with the means to carry out their duty to make direct payments to those people who are eligible and are willing and able (alone or with assistance) to use them. This guidance and subsequent ministerial statements confirm the Government’s intention that all authorities must be making direct payments routinely available to people with mental health problems.

Numbers of people receiving a direct payment


Number of authorities


• The production of this guide, to ‘promote direct payments within mental health services as a means of facilitating greater social participation’, is one of the actions arising from the Social Exclusion Unit report Mental Health and Social Exclusion.13

• Within the Health and Social Care Standards and Planning Framework 2005/06–2007/08 there is reference to mental health services addressing social exclusion through tackling unemployment and social isolation. Direct payments is one approach to achieving this.1

Implementing direct payments within mental health services


DH guidance on direct payments requires every local authority to set up a direct payments scheme to make the payments available. This should include the lead officer for implementing direct payments, the scheme manager (where this is a different person), finance staff who administer direct payments, and arrangements by the local authority to train and support users and potential users of direct payments and all staff who are involved in the offering and making of direct payments.


The direct payments support service is the part of this scheme which provides advice, support, and sometimes training to users and potential users of direct payments. It can be provided directly by the local authority but is generally provided under contract by one or more voluntary organisations or organisations of disabled people. ‘Support provided through voluntary/recipient-run organisations has been shown to be particularly effective and valued by recipients.’


For adult mental health services, the duty on councils to make direct payments to meet social care needs can be incorporated into the CPA, the joint health and social care assessment framework for ‘all adults of working age in contact with the secondary mental health system (health and social care)’, which should provide ‘access, through a single process, to the support and resources of both health and social care’.


The criteria for eligibility to receive integrated mental health services, even where a formal partnership arrangement is not yet in place for the delivery of statutory mental health services, should be based on Fair Access to Care Services.


Most existing literature refers only to ‘social workers’ offering direct payments. The integration of mental health services involves the incorporation of local authority care management within a single process (the modernised CPA) by which all care co-ordinators are responsible for assessing both health and social needs. Thus all care co-ordinators need to be able to offer direct payments.


Figure 2 shows the relationship of these components in the implementation of direct payments as a standard option within the CPA in mental health services.

Figure 2: Straightforward access and support for direct payments for people who are eligible to receive mental health services


Primary care trust/s


Jointly commission mental health services and agree joint eligibility criteria


Local authority

• Jointly commission mental health services and agree joint eligibility criteria

• Provide direct payments scheme

• Commission direct payments support service/s

Local authority direct payments scheme

• Recognises joint eligibility criteria

• Provides information and guidance

• Supports care co-ordinators and managers

• Monitors use of direct payments

Direct payments support service

• Usually non-statutory, functions can be split between different organisations

• Supports people to consider and/or use direct payments

Mental health trust


Applies joint eligibility criteria for health and social care services Identification of ways in which needs can be met Agreement over ways in which needs will be met by a combination of:


Health interventions/ care co-ordinator support Other provided service/s


Direct payments


CPA


• Assessment of health and social needs

• Risk assessment

• Eligibility check for direct payments

A whole system approach


A whole system approach is one which looks both within and beyond mental health service provision at the whole range of services and support that a person with mental health needs might utilise to enable them to live their life as they wish. It is an approach that is vital to the effective development of mental health services, and one which is promoted by the use of direct payments.


Commissioners and senior managers need to work together to ensure that adequate budgetary provision is made available within local authorities and mental health services to:


• meet the increasing take-up of direct payments;


• meet the costs of supporting implementation.


This means that service providers and commissioners will need to consider:


• the implications of increasing direct payment use on existing services and on their contracting arrangements;


• engaging in discussions with all stakeholders about how the requirement to make direct payments can be successfully managed. In addition to the impact on day and support services, this should include the potential impact of direct payments on in-patient and residential care use.


All stakeholders need to be engaged. Whether achieved through an existing or new group, the overseeing of the process of implementing and supporting routine access to direct payments by people eligible to use mental health services should include representation from service user groups, carers’ groups, black and minority ethnic groups, advocacy groups, mental health commissioners, local authority direct payment scheme, direct payment support services, primary care trust/s, mental health trust/s, CPA lead officer and the voluntary and community sector.


It will be essential to establish the relationship of this group to other related forums, such as the local implementation team, the Mental Health Partnership Board, and the arrangements put in place to oversee implementation of the actions required by the Social Exclusion Unit report.

Taking a lead


While the initiative and drive for the development of adequate direct payments schemes will come from many quarters, the leadership should come from the local authorities and primary care trusts who share the lead responsibility for local implementation of the actions from Mental Health and Social Exclusion.20


They are engaged in two separate but interlinked aspects of commissioning for direct payments in mental health services:

• the provision of a generic direct payment scheme by the local authority, and the commissioning (or direct provision in some cases) of direct payment support services as part of this scheme;


• commissioning of the mental health services that make direct payments.

Commissioners of mental health services, therefore, need to understand the nature and purpose of direct payments well enough to be able to ensure that they are available within those services in accordance with government policy. In order to achieve this, there needs to be adequate provision for the making of direct payments through the CPA process. Thus all commissioners need to consider working together to ensure that:


• the provision of direct payments to people with mental health needs is actively promoted by the local authority’s direct payment scheme and in the commissioning arrangements for direct payment support services and mental health services;


• a single, joint eligibility process is in place for access to health and social services which is recognised by the direct payment scheme and mental health managers as giving access to direct payments to meet social care needs;


• sufficient funding is available from the local authority to meet the anticipated demand for direct payments;


• the process for securing a direct payment from within mental health services is the same as the process for securing a provided service. This includes approval of CPA assessment decisions, speed and ease of access and the applicability of a financial assessment;


• direct payment support services are able to offer adequate support to people with eligible mental health needs who wish to consider or use direct payments;


• where the direct payment scheme and/or the direct payment support service do not have adequate capacity or knowledge to provide support to people with mental health problems, staff should be recruited or seconded for this purpose;


• adequate training is made available on the local authority direct payment scheme and its operation within the framework of integrated mental health services. This should be provided for all direct payment scheme and support services staff and all mental health service managers and care co-ordinators;


• direct payments are incorporated into the CPA process as a standard option for every assessment and review;


• procedures are in place to ensure that arrangements for the making and receipt of financial payments do not unduly delay the start of direct payments.

All of this work should be undertaken in partnership with the stakeholder group.

Making direct payments accessible to people who might use them

The local authority’s direct payments scheme (and all contracted arrangements it makes to support people to use direct payments) should reflect the eligibility of mental health service users in its literature and promote their access to the scheme in its practice.


The CPA process should provide support for people to find out more before agreeing how their assessed needs should be met. Provision should be in place for interim support arrangements to be made under the CPA if necessary. It should also facilitate the presence of, or access to, an advocate or other direct payment support worker to assist individuals if they wish for it, to look at what their options to meet their eligible needs might be during the assessment process.

‘Councils will wish to ensure that local support services are sufficiently accessible to everyone eligible to receive direct payments…Support services may need to contract-in people with specialist skills as appropriate.’ Adequate information on all aspects of considering and using direct payments should be readily available to those eligible to use mental health services. Practical support should be available at every stage, for example:


• finding out about direct payments;

• considering whether to use a direct payment;

• preparing for assessment or review meetings;

• considering how best to meet needs using a direct payment;

• managing the payment/recruitment and employment or use of agency staff;

• changing the detail of a direct payment or ending one.

Access to training that will facilitate the successful use of direct payments should be made available to people who are eligible to use mental health services. This includes making specific arrangements to ensure that appropriate information and support is available to people whose needs have been recognised as being less well served by mental health services and/or who are less likely to access provided services, such as some people from black and minority ethnic communities.22 Similar arrangements should be in place for those carers of people with mental health needs who are eligible to receive carers’ services.

Making direct payments accessible: staff training and procedures


CPA training should incorporate direct payments as a standard option, including providing staff with adequate preparation and indicating the sources of ongoing support available to enable them to achieve this in their routine practice.


Direct payments fit easily alongside CPA’s four main elements:

Main elements of the CPA How direct payments fit

Systematic arrangements for assessing Identification of eligible social needs the health and social needs of people accepted into specialist mental health services


The formation of a care plan which Offering direct payments as an alternative identifies the health and social care way of meeting these eligible social needs required from a variety of providers


The appointment of a key worker to keep Care co-ordination role remains the same. in close touch with the service user and Monitoring includes contact with local to monitor and co-ordinate care authority finance section. Level of contact with service user (and sometimes with personal assistant/support worker) negotiated as part of care plan Regular review and, where necessary, Option of direct payments remains available agreed changes to the care plan for eligible social needs Guidance to staff should be succinct and unambiguous, particularly in relation to the definition of health care (which involves a clinical/medical intervention) and social care (which includes ‘access to day services, support worker services, respite breaks, non-specialist alternative and physical therapies, education, leisure and employment opportunities’ ).


The additional forms required for securing a direct payment should be integrated into CPA paperwork and kept to a minimum. Training and guidance must include the arrangements for carers’ assessments and the making of direct payments to carers eligible to receive social care services.


Specific training on direct payments for care co-ordinators and managers is also essential and should involve representatives from the direct payments scheme, the finance department and the direct payments support service. Each should explain their roles, the processes in place and how to access support from them at any stage during the offering or making of direct payments. Whenever possible, training should involve contributions from people using direct payments. Formal training should be supplemented by a variety of structured and developmental activities. Individual supervision, team and locality meetings are some of the settings in which different issues can be addressed.


Training should include the use of crisis plans, advance statements and third party support at times of crisis as means of managing risk,25 and the use of self-assessment formats to enable people to be better prepared for assessments and reviews.26 One of the intentions of direct payments is that people are enabled to determine for themselves the best way of meeting their needs:


‘As a general principle, local councils should aim to leave choice in the hands of the individual by allowing people to address their own needs as they consider best, whilst satisfying themselves that the agreed outcomes are being achieved.’


For this reason it is important that there is maximum flexibility around whether particular needs are met through health care or social support, or a combination of the two. Other workers in mental health services, and those who act as advocates for people with mental health problems and carers, should be made aware of the nature and purpose of the direct payments scheme, the place of direct payments within the CPA and the role of the direct payments support service. These other workers will often have the most contact with individuals who might use direct payments, and their knowledge of and attitudes towards


direct payments are likely to be influential. They should be making information on the local direct payments access and support arrangements available to people who use their services.


Where workers support people in preparing for or attending assessment or review meetings, they should consider their role in supporting self-assessment.28


Figure 3 shows how direct payments can be incorporated into the CPA process.


Direct payments for people with mental health problems: A guide to action


Figure 3: Incorporating direct payments into the CPA

Is individual excluded from receiving direct payments?


Explain direct payments scheme and support availableand discuss options of either direct payments ofprovided services, or a combination of both


Does individual feel able to make an informed decision about direct payments?


Ensure individual has opportunity to accessinformation and support swiftly


Can the assessment process be halted untilinformation/support has been accessed?


Agree providedservices forthe interim


Discuss and agreeprovided services


Discuss and agreeany provided servicesrequired


Make arrangementsfor services and inform individual oftheir right to use complaints procedures and provide advocacy contact


Discuss and agree interim arrangements


Reconvene once information/support has been accessed


Does the individual want to pursue direct payments for some or all of their social needs?


Discuss the ways in which direct payments will be used to meet assessed needs


Does the care co-ordinator believe that the individual can meet their assessed needs by the means they propose and that identified risks are manageable?


Quantify support required and make arrangements for payments to commence


Will there be a delay in receiving payments?


Ensure person has full access to available information and support when the direct payments commence


Complete CPA assessment Risk assessment 

Check if excluded from receiving direct payments


Eligible needs

Social activity/support


Discuss and agree how to meet these and/or Health intervention


Discuss and agree provided services


Direct payments for people with mental health problems: A guide to action

Direct payments in practice

People who are eligible to use mental health services (and carers eligible to receive carers’ services) can expect to:

• have a clear statement of the needs for which they are eligible to receive services;


• be given the maximum possible choice and control in how their eligible needs are met;


• be offered the option of direct payments at every assessment and review meeting or have a clear statement of the reasons if they are excluded from receiving direct payments;


• be provided with adequate information about direct payments and sufficient time in order to be able to make an informed choice whether to use them or not;


• be given the details of people who can support them to consider and use direct payments;


• be able to use a mixture of direct payments and provided services if they choose;


• be able to stop using direct payments at any time and return to using a provided service.


In order to achieve this, action is required from managers and care co-ordinators.

Managers need to consider the following:


• promote direct payments as a standard option within the CPA, and ensure it is included within CPA training;


• promote the values of independent living and recovery as core to the provision of services, to support a positive and pro-active approach to direct payments;


• work with the local authority scheme, the support service, service user and carer groups and practitioners to achieve a straightforward and co-ordinated process for considering, applying for and accessing support to manage direct payments;


• ensure that adequate information and training is provided to those who might wish to use direct payments and all care co-ordinators;


• ensure that all teams understand their responsibilities in respect of offering direct payments;


• make specific information available in appropriate formats/languages to all those who might wish to consider or use 

direct payments to meet their social care needs.

This should be consistent with but additional to the direct payment schemes generic information;


• record levels of direct payment uptake by people with mental health problems to inform future planning and set current targets;


• where appropriate, work with commissioners to ensure adequate budget setting/flexibility.

Assessors/care co-ordinators need to consider the following:


• assess people’s eligible needs and record them clearly before beginning the process of discussing how those needs might be met;


• support those they work with to build their future around their aspirations and abilities, and work through risk assessment procedures to minimise risks to an acceptable level wherever possible;


• always check whether or not a person is excluded from receiving direct payments;


• offer the option of direct payments to all those who are eligible to receive them at every assessment and review;


• ensure that all people eligible to receive mental health services are made aware of how to access information and support to consider and/or use direct payments;


• be fully aware of DH’s guidance, the local authority direct payments policy and the operation of their local authority’s scheme/s, and of how to get support and advice for themselves about direct payments.

Acknowledgements


We would like to thank all the individuals and organisations who were consulted during the development of this guidance. In particular we would like to thank Julie Charles, Tina Coldham, Pauline Heslop and Donna Lawrence for their individual contributions, and members of the following organisations: Equalities National Council, Health and Social Care Advisory Service, National Centre for Independent Living. We would especially like to thank Robin Murray-Neill, who has been central to the development of this guide.

Local authorities: Cambridgeshire, Essex, Hampshire, Lancashire, Leicestershire,


Lincolnshire, Norfolk, Peterborough, Suffolk, West Sussex


Mental health trusts: Norfolk and Waveney, North Essex, South Essex, West Sussex


Direct payments support services: Essex PASS, Suffolk PASS


Advocacy services: Independent Living Advocacy (Essex), East Suffolk Advocacy Network,


Equalities, Southampton Centre for Independent Living


Mental health policy/practice: DH, NIMHE, Social Inclusion Team, CSIP Regional


Development Centres, Social Care Institute for Excellence, CPA Association


Further information and resources


Department of Health


tel (020) 7210 4850

email: [email protected]

www.dh.gov.uk

Information on policy and guidance can be found by visiting the DH website.

Directgov


www.direct.gov.uk


Information about accessing government services, including financial support, can be found on the Directgov website.


Equalities National Council for Disabled People and Carers from Black and Minority


Ethnic Communities


Waltham Forest College


707 Forest Road


London E17 4JB


tel/fax (020) 8527 3211


email: [email protected]

Equalities’ work includes support to people to obtain direct payments.


They have produced a video on the subject called ‘Breaking Barriers’. Details are available from the address above.

Health and Social Care Advisory Service

King’s Fund

11–13 Cavendish Square

London W1G 0AN

tel (020) 7307 2892

email: [email protected]

www.hascas.org.uk

The executive summary of Direct Payments, Independent Living and Mental Health:

An Evaluation can be obtained free of charge from the website or by contacting the address above.

In Control


Programme Co-ordinator


Valuing People Support Team


36 Rose Hill Drive


Mosborough


Sheffield S20 5PN


www.in-control.org.uk


In Control is a national programme to change the organisation of social care in England so that people who need support can take more control of their own lives and fulfil their role as citizens. The In Control pilot sites include some links which are open to people who use mental health services.

Joseph Rowntree Foundation

The Homestead

40 Water End

York YO32 6WP

tel (01904) 629241

www.jrf.org.uk

The Joseph Rowntree Foundation has funded a large amount of work on direct payments.

Summary and sometimes full versions of its reports, including Implementing Direct Payments in Mental Health: New Directions, can be obtained free of charge from the website.

National Centre for Independent Living

4th Floor, Hampton House

20 Albert Embankment

London SE1 7TJ

tel (020) 7587 1663

www.ncil.org.uk

The National Centre for Independent Living publishes a number of useful guides to using direct payments, many of which are available free from its website, including

Direct Payments for Mental Health Service Users/Survivors: A guide to some key issues by Pauline Heslop. The website also has an invaluable discussion forum.


National Institute for Mental Health in England (NIMHE)

National Social Inclusion Programme: Direct Payments Eastern Development Centre

654 The Crescent

Colchester Business Park

Colchester

Essex CO4 9YQ

tel (01206) 287588

fax (01206) 287597

email: [email protected]

The direct payments project within the National Social Inclusion Programme works through the NIMHE social inclusion leads at each of the eight Care Services Improvement Partnership (CSIP) Regional Development Centres, to promote direct payments as a standard option for people eligible to use mental health services. It provides support to all organisations and individuals with an interest in this.

The National Social Inclusion Programme website, www.socialinclusion.org.uk, will include electronic versions of this guide and the guide for service users and carers.

The Direct Payments Practice Exchange Network will support the implementation of this guide. It is open to all and can be accessed by joining the NIMHE Knowledge Community:

http://kc.nimhe.org.uk

or by contacting the address above. NIMHE is part of CSIP

www.csip.org.uk

Social Care Institute for Excellence (SCIE)

Golding’s House

2 Hay’s Lane

London SE1 2HB

tel (020) 7089 7102

www.scie.org.uk

SCIE has published Direct Payments: Answering Frequently Asked Questions, a guide for practitioners and their managers, finance managers and senior managers. It offers creative and innovative examples of how the legislation on direct payments can be successfully applied and answers a range of frequently asked questions. This guide contains a large number of practical examples on every aspect of direct payment provision and use. It should be read in conjunction with this guide to action. It is available from SCIE at the address above.

Additional literature not referred to in the text


Butt, J, Bignall, T and Stone, E (2000) Directing Support: Report from a workshop on direct payments and black and minority ethnic disabled people, Joseph Rowntree Foundation/YPS, York.


Commission for Social Care Inspection (2004) Direct Payments: What are the barriers? CSCI, London.


Gillinson, S, Green, H and Miller P (2005) Independent Living: The right to be Equal Citizens, Demos, London available from www.demos.co.uk


Hasler, F (2003) Clarifying the Evidence on Direct Payments into Practice, NCIL, London available from www.ncil.org.uk

Hasler, F and Stewart, A (2004) Making direct payments work: Identifying and overcoming barriers to implementation, JRF Research into Practice Series, Pavilion, Brighton.


Leece, J (2003) Direct Payments, Practitioner’s Guide Series, Venture Press, Birmingham.


Maglajlic, RA, Bryant, M, Brandon, D and Given, D (1998) Direct payments in mental health – a research report, Breakthrough, 2 (3).


Mental Health Alliance (2005) Towards a better Mental Health Act: The Mental Health Alliance Policy Agenda available from www.mentalhealthalliance.org.uk


National Institute for Mental Health in England (2005) NIMHE Guiding Statement on


Recovery, January available from www.nimhe.org.uk

Took, M (2002) Advance directives, statements and agreements and crisis cards, Rethink Policy Statement 51, November.

References


1 Department of Health (2005) Independence, Well-being and Choice: Our vision for the future of social care for adults in England, DH, London.


2 Department of Health (2003) Direct Payments Guidance: Community Care, Services for Carers and Children’s Services (Direct Payments) Guidance England 2003, DH, London, September.


3 See, for example, Coventry Independent Living Group (CILG) Statement, in Barnes, C, McCarthy, M and Comerford, S (eds) (1996) Assessment, Accountability and Independent Living: Confirmation and Clarification of a Disability Led Perspective, The Report of a Conference organised by CILG and Coventry Social Services Department,Coombe Abbey, Coventry, 23–24 May 1995. See also Prime Minister’s Strategy Unit(2005) Improving the Life Chances of Disabled People, Cabinet Office, London.


4 Department of Health (1999) Effective care co-ordination in mental health services: modernising the Care Programme Approach. A Policy Booklet, DH, London.


5 Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2003.


6 According to the Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2003, a person is excluded by virtue of the Mental Health Act 1983 if:

d) placed under guardianship in pursuance of –

(i) an application made in accordance with section 7 of the 1983 Act; or

(ii) an order made under section 37 of the 1983 Act;

e) absent from hospital with leave given in accordance with section 17 of the 1983 Act;

f ) subject to after-care under supervision within the meaning of section 25A of the 1983 Act;

g) a condition imposed in accordance with section 42(2) or 73(4) (including such a condition which has been varied in accordance with section 73(5) or 75(3)) of the 1983 Act.


7 See ref. 1 above.


8 Ladyman, S (2004) Transcript of speech by Health Minister Stephen Ladyman MP at ‘New Directions in Direct Payments for People who use Mental Health Services’,

Joseph Rowntree Foundation/Health and Social Care Advisory Service Conference, 18 May, London.


9 See Hasler, F, Campbell, J and Zarb, G (1999) Direct Routes to Independence. A guide to local authority implementation and management of direct payments, Policy Studies Institute/National Centre for Independent Living, London; Spandler, H and Vick, N (2004) Direct Payments, Independent Living and Mental Health: An Evaluation, Full Report, Health and Social Care Advisory Service, London.


10 Prime Minister’s Strategy Unit (2005) Improving the Life Chances of Disabled People, Cabinet Office, London.


11 See ref. 1 above.


12 See ref. 2 above.


13 Social Exclusion Unit (2004) Mental Health and Social Exclusion: Social Exclusion Unit Report, Office of the Deputy Prime Minister, London, June.


14 Department of Health (2004) National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06–2007/08, DH, London, May.


15 See ref. 2 above.


16 See ref. 4 above.


17 Department of Health (2002) Fair Access to Care Services – Guidance on Eligibility Criteria for Adult Social Care, DH, London, May.


18 Throughout this guide to action, where we have used the term ‘care co-ordinator’, the information is relevant to all health and social care workers carrying out assessments of eligibility for services and CPA/community care planning duties in respect of mental health needs.


19 See ref. 13 above.


20 See ref. 13 above.


21 See ref. 2 above.


22 New Directions developed a process that started with service users learning more about direct payments and then enabled them to participate with front-line staff in addressing the barriers. See Newbigging, K and Lowe, J (2005) Implementing Direct Payments in Mental Health: New Directions, Pavilion/JRF, Brighton.


23 Adapted from Department of Health (1999) Effective care co-ordination in mental health services: modernising the Care Programme Approach. A Policy Booklet, DH, London.


24 Extract from Norfolk and Waveney Mental Health Partnership Trust (2004) Using Direct Payments in Norfolk’s Integrated Mental Health Services: Implementation Guidance to all Care Managers/CPA Care Co-ordinators/Locality & Team Managers.


25 For excellent working examples see Heslop, P (2001) Direct Payments for Mental Health Living, London (available from www.ncil.org.uk).


26 See, for example, Leader, A (1995) Direct Power: a resource pack for people who want to develop their own care plans and support networks, Pavilion, Brighton; Markovits, P (1996) The Avon Mental Health Measure: A User-Centred Approach to Assessing Need, South West MIND, Bristol; National Schizophrenia Fellowship [now Rethink]/Royal College of Psychiatrists (2000) CUES (Carers’ and Users’ Expectations of Services) – Service User Version/Carers’ Version. This guide is available from: Royal College of Psychiatrists, Multi-Centre Audit Team, College Research Unit, 6th Floor, 83 Victoria Street, London SW1X 7EE, tel 020 7227 0840 or: Research Department, Rethink, 30 Tabernacle Street, London EC2A 4DD.


27 See ref. 2 above.


28 See ref. 26 above.

Crown copyright 2006

Produced by COI for the Department of Health 272191 1p 1k Feb06 (CW) This publication is available on the website www.dh.gov.uk/mentalhealth

Dear Reader,


Not the cheeriest news this month. The Welfare Reform Bill gives private and voluntary sector organisations the power to cut claimants benefits when the new Employment and Support Allowance comes in. The fact that these same organisations will only get paid by results - claimants attending interviews, drawing up action plans and getting jobs - means that the threat of sanctioning claimants benefits may become an important tool for generating private sector profits.


Then there's the news that all current incapacity benefit claimants will be moved onto the new Employment and Support Allowance, contrary to previous reassurances from the DWP. Plus, in a staggering bit of unjoined up thinking, the DWP has issued new guidance saying that reimbursing volunteers for their lunch when they are doing voluntary work is not a legitimate expense payment and the money will be treated as earnings. A cunning way of encouraging claimants to try voluntary work as a first step back into the labour market.


On the plus side, DWP doctors have been reminded that they shouldn't check claimants underwear for evidence of incontinence. In addition, Benefits and Work is publishing a new guide for members - 50 ways to challenge a DLA/AA medical report - more details in the underwear article below. And for members, there's a new forum where they can work together to carry out research and create information to try to get some of the worst elements of the Welfare Reform Bill thrown out - more details in the Private Sector article below.


It looks like being a long, hot summer . . . except in Somerset where it's currently pouring down.


Good luck,


Steve

PRIVATE SECTOR TO PUNISH SICK AND DISABLED CLAIMANTS

Sweeping powers are to be given to unaccountable private sector and charity staff to cut sick and disabled claimants benefits. The shock new powers are contained in the Welfare Reform Bill laid before parliament on 4th July. Under the terms of the bill private and voluntary sector staff will summon claimants for repeated work focused interviews, oblige them to draw up action plans and to take part in work related activities. If claimants fail to satisfy the requirements of their private sector 'advisers' those same staff will be able to impose cuts in claimants benefits. The same organisations, at least one owned by a multi-millionaire, will be paid by result, depending on how many interviews their staff carry out and how many claimants they get into work.

http://www.benefitsandwork.co.uk/benefits/unspun/49_private_sector_powers.htm


DWP THREATENS VOLUNTEERS WHO LUNCH

The DWP has put claimants benefits in jeopardy, as well as breaking a compact made between the government and the voluntary sector, by issuing new guidance which says that payments to volunteers for the cost of lunch will be counted as earnings, not expenses. The guidance claims that basic benefits payments, such as income support, already cover the cost of claimants' lunches. The 49 page document chillingly warns claimants to "Remember, for benefit purposes, a person who is paid for their time isn't a volunteer. If you get anything more than your expenses, we will treat everything that you get paid as earnings . . .".

http://www.benefitsandwork.co.uk/benefits/unspun/48_volunteers_lunch.htm


DOCTORS TOLD NOT TO CHECK CLAIMANTS UNDERWEAR

Using the Freedom of Information Act, Benefits and Work has obtained a copy of the pack being used by staff teaching Examining Medical Practitioners (EMPs) how to complete the new DLA and AA medical reports. Astonishingly, in relation to continence, trainers are told that the key point that they need to convey to doctors is that:

"For the opinion on Continence it remains inappropriate to check underwear. Any opinion here should be based on what the EMP knows about the Claimants medical condition".

http://www.benefitsandwork.co.uk/benefits/unspun/50_underwear.htm


ALL CLAIMANTS TO BE FORCED OFF INCAPACITY BENEFIT

The DWP has surreptitiously gone back on its word by ruling that all current incapacity benefits claimants will be forced onto the new Employment and Support Allowance. This means that many people currently regarded as having conditions so severe that they are exempt from even having to have a medical assessment will, in the future, have to undertake work related activities or have their benefits cut. In addition, the DWP has now ruled that whilst waiting to be transferred, all existing claimants will be obliged to draw up a return to work action plan and take part in compulsory work focused interviews.

http://www.benefitsandwork.co.uk/benefits/unspun/47_all_IB_claimants_%20to_migrate.htm


AGE DISCRIMINATION: IS YOUR ORGANISATION READY?

A one day course delivered by Holiday Whitehead, employment barrister.

28 September / 19 October. 10am - 4pm Bristol


With the introduction of the Employment Equality (Age) Regulations on 1 October 2006 all employers will be required to adopt the requirements of the new Regulations with regard to many of their employment practices. This one day course provides a detailed overview of the new Regulations and highlights areas of particular concern for organisations, including recruitment, retention, dismissal and retirement.


For further details, download a flyer in Word format:

http://www.benefitsandwork.co.uk/book/age_discrimination.doc


You are welcome to forward this newsletter to anyone you think may be interested in the contents. If you have received this newsletter from someone else and would like to sign up yourself, you can do so for free at:

www.benefitsandwork.co.uk/site/updates.htm


(c) 2006 Steve Donnison. All rights reserved.

An introduction to Direct Payments in mental health services:


Information for people eligible to use mental health services and carers.


“If we make people's personal ambitions, people's own desires and hopes and dreams the centre of planning the support they need, we liberate people, we transform lives, we make things possible that previously seemed impossible... let's make sure that we get that message out there to every single person who is using care services in this country.”


Stephen Ladyman MP (2003)

Introduction

What are direct payments?

About this Introduction to direct payments

The name ‘direct payments’ will change from April 2006

Direct payments and you

Why would I want direct payments?

What difficulties might I experience in getting direct payments?

Who can receive direct payments?

What are my options?

What help can I have with direct payments?

Will I have to contribute towards the costs of using direct payments?

What do I have to do to get direct payments?

Preparing for an assessment or review of your needs 1

What can I spend my direct payments on?

Direct payments for carers of people with mental health problems

What should people eligible to use mental health services and carers be able to expect?

People excluded from receiving direct payments

References

Useful Contacts

Introduction

What are direct payments?

“The purpose of direct payments is to give recipients control over their own life by providing an alternative to social care services provided by a local council. A financial payment gives the person flexibility to look beyond ‘off-the-peg’ service solutions for certain housing, employment, education and leisure activities as well as for personal assistance to meet their assessed needs. This will help increase opportunities for independence, social inclusion and enhanced selfesteem.”


Department of Health (2003) Direct Payments Guidance


Direct payments are payments that are made to individuals who have been assessed as needing social care services, in order that they can make their own arrangements to meet their needs. These payments can be made on a regular basis, or on an occasional or ‘one-off’ basis, depending on the needs that they are being made for. They are made by local councils (local authorities), who have the statutory responsibility to meet social care needs. Since April 2003, regulations have been in force that require councils to make direct payments to those people who are able to choose to have them and who wish to have them. For adult mental health services, this duty on councils to make direct payments to meet social care needs should be incorporated into the Care Programme Approach, the joint health and social care assessment framework.


There are some things that direct payments cannot be used for, such as longerterm residential care or to purchase services from the local authority itself. There are some people who are currently excluded from receiving direct payments. These are people whose liberty to arrange their own care is restricted by a court order or legislation, including certain sections of the Mental Health Act 19831. However, these restrictions are currently being reviewed (DH, 2006).


A full list of these exclusions can be found on page 15

About this Introduction to direct payments


This guide has been written to promote the availability of direct payments within adult mental health services, following the Social Exclusion Unit report, Mental Health and Social Exclusion (SEU, 2004). Based on an earlier 'Guide to receiving direct payments' (Department of Health, 2003), it has been compiled with the support of people and organisations involved in mental health services and in a wide range of direct payments activity, from using direct payments, through managing or commissioning direct payments schemes and support services, to researching direct payments.


It is a companion to the Guide to Action published by the Department of Health in February 2006 which can be found at:


http://www.dh.gov.uk/assetRoot/04/13/10/64/04131064.pdf


Direct payments should be offered whenever applicable to all those eligible to receive them, and this guide attempts to bring together learning and good practice from areas which are closest to realising this within their mental health services. However, mental health services and direct payment schemes are at different stages of development throughout the country, and it is important for people to find out how direct payments are being currently implemented in their locality. Where direct payments are not routinely offered and easily available to people eligible to receive them, this guide will provide the means for the situation to be addressed.

The name ‘direct payments’ may change from April 2006


There has been considerable confusion between these social care direct payments and the Department of Work and Pension’s ‘Direct Payment’ of benefit or pension directly into a bank account. For this reason, the Department of Health is consulting on a change of name for social care direct payments, which may come into effect in April 2006 (DH, 2005). After that date, they will be known as either: ‘direct services payments’; ‘individual service payments’; ‘individualised funding’; or ‘personal budgets’.

If you have any difficulty in obtaining information or support, or wish to discuss any aspect of this guide, please telephone 01206 287588 and leave your contact details.


Direct payments and you


Direct payments give you an alternative way of meeting your needs. Rather than using a local day, work or support worker service, for example, that is provided by other people, you can receive money to buy your own support as part of your Care Plan. Direct payments are available where you would otherwise be offered directly provided services to help with housing, employment, education and leisure activities as well as for domestic and daily living tasks and personal assistance. Needs which are met in these ways are called ‘social’ (rather than ‘health’) needs. As long as you have agreed with your care co-ordinator that the ways in which you will use the money will meet your needs, you can decide who you employ or how else you use the money. You can employ people yourself, which could include people you know, or you can be supported by people who work through an agency.


Why would I want direct payments?


If you receive direct payments, you can decide how your needs will be met, by whom and at what time.


You are in control.


If you employ staff directly they will report to you. If you have a contract with an agency, the agency will be accountable to you, not to the local council. For example, you may find that the support worker arranged by the care coordinator cannot come at the time you want. With direct payments, you can arrange for someone to come whenever it suits you. And, if you wish, you can employ friends or relatives to support you in most cases. Direct payments can also be used to meet needs in entirely new and individual ways, such as joining local clubs or societies, purchasing domestic equipment, or travelling to see close relatives. The important thing is that you use the money to meet the needs that were identified at your assessment.


What difficulties might I experience in getting direct payments?


One of the main challenges of providing information in a guide such as this is that each local authority has to make its own arrangements for offering and making direct payments, and there are considerable variations in how this has been done. The bringing together of health and social support in integrated mental health services has been a further issue, with some staff being more well informed than others. Some areas have a considerable number of people using direct payments to meet mental health needs, whilst others have none. There are also variations in who can have a direct payment. In some areas all people who have a care coordinator under the Care Programme Approach (CPA) can choose to have their social care needs met through direct payments (provided they are not excluded from receiving them), whilst in others only those on ‘enhanced CPA’ are being offered them. In some areas each direct payment application is considered by a panel, and there can be considerable paperwork to be completed, whilst in others access to direct payments is little different than to a provided service. Whilst this guide is intended to encourage a greater consistency in the way in which direct payments are available, it is important to find out how your local scheme works, how long an application for a direct payment might take, and whether you are currently able to request direct payments and for what purposes. If you do choose a direct payment to meet all or part of your social care needs, you take on the responsibility for meeting those needs. This means that you must ensure that whatever money you receive is used solely for the purpose of meeting the needs for which it has been given. You will need to keep records and receipts to show how the money has been spent, and complete returns (usually on a monthly or quarterly basis) to the relevant finance department.


Although there will be support available to assist with this, as well as with the recruitment and paying of staff, this varies in each area and so it is important to find out what level of support is available to you before you decide on a direct payment. Of course, you may also use support from family or friends if they are able to provide it, and some people prefer to manage their support arrangements independently, but it is important to be clear about the responsibilities you will be taking on, particularly if you are going to employ people directly. In some areas it has been difficult to recruit personal assistants/support workers, and whilst using workers provided by an agency avoids these and other challenges posed by being an employer, you will need to ensure that the money paid to you will be sufficient to purchase enough support to meet your Your care co-ordinator must not give advice on certain matters, such as employment, and this is why it is vital that you talk direct payments through with someone from the direct payments support service, or other direct payments advisor. They may be able to put you in touch with other people who are using direct payments. Hearing from people with experience of managing direct payments can be very helpful.


Who can receive direct payments?


"There are only very limited circumstances when direct payments would not be offered."


The majority of people using mental health services have a right to receive direct payments, if they wish to, to meet social care needs for which they are offered or are already receiving support. Your care co-ordinator (who may be a social worker, community psychiatric nurse or occupational therapist) should discuss this with you when they assess your care needs, and at every review. A small number of people, who are subject to legislation which limits their freedom to arrange their own care are excluded from receiving direct payments. This includes people subject to the conditions of some sections of the Mental Health Act, 1983. A full list of these exclusions is shown on page 15. Whilst most people who are assessed as needing social care services have a right to direct payments, no-one should feel pressured to have direct payments if they prefer for services to be arranged by their care co-ordinator.


What are my options?


Choosing direct payments should not need to be an immediate or rushed decision. If you wish for time to find out more or to think about it further, you should be offered services to meet your needs in the meantime. It’s important that you ask questions if you feel you do not have enough information to make your decision. If you accept direct payments, you can change your mind at any time. You will need to contact your care co-ordinator to ask them to stop making direct payments and to arrange services for you instead.


“People who are already receiving services may wish to switch to direct payments. They may also wish to combine a package of services and direct payments.”


If you prefer to receive provided services to meet some of your needs, you can have a combination of direct payments and provided services. This can be used to give you the chance to try out a direct payment before taking on responsibility for arranging services to meet all of your needs.


What help can I have with direct payments?


If you wish to consider or choose to use a direct payment, you will not be left to cope on your own. You can get a lot of help to manage your direct payment. This support is available through specially set up direct payment support services, or can be provided by other people you know. The types of things that people often want help with are:


• considering whether to use direct payments or provided services, or a combination of the two

• making and maintaining their direct payment arrangements

• managing money and keeping records

• recruiting and employing people


In addition to the support available from a direct payment support service, advocacy organisations and other mental health services should be able toprovide information and support, or know who can. You can also receive help from carers or other people who you know who are prepared to provide the support you need. Where you are concerned that you may lose the ability to manage your direct payment at certain times, or where you wish someone else to handle the money on your behalf, the direct payment can be made temporarily or permanently to a third party who will take on day-today management of the finances. Whatever the level of support you require, as the person using the direct payment, you must remain in control of how your needs are met, and you are accountable for the way in which the direct payments are used.


“Many people with an episodic condition can manage direct payments very adequately. Nevertheless, some people may be better able to cope with direct payments if a friend, relative or some other third party is willing to provide greater assistance when their condition worsens. Advance statements should be used as part of the process of managing a fluctuating condition.”


Your local direct payments support scheme should be able to assist in setting up the support you need. You may also want to approach local advocacydeveloping the knowledge and skills needed to provide support with direct payments. The National Centre for Independent Living have produced a useful guide,


Direct Payments for Mental Health Service Users/Survivors: A guide to some key issues. This can be obtained free of charge by service users from:


NCIL, 250 Kennington Lane, LONDON SE11 5RD.


Tel. 0207 587 1663.


Website: www.ncil.org.uk


Will I have to contribute towards the costs of using direct payments?


As direct payments are not additional money, but made in place of the costs of services you might otherwise have used, they are not taken into account for the purpose of assessing income for social security benefits, and are not liable to income tax. If you are charged for using mental health services, then the same charges will apply. Where you would not be charged for using services, then you should not be charged for choosing a direct payment. People who are receiving services provided under section 117 of the Mental Health Act 1983 (after-care) cannot be charged for those services, or for a direct payment made in place of those services.


What do I have to do to get direct payments?


Your care co-ordinator must discuss this option with you when they meet with you to assess or review your care needs, or explain the reason if you are not able to receive direct payments. If you are already using services, you can ask your local direct payments support service or your care co-ordinator about direct payments. Many people considering direct payments for the first time find it helpful to talk to people with experience of using direct payments. Your local council, care coordinator or direct payments support scheme should be able to put you in touch with other direct payment users. Having read this guide you may still have many questions about direct payments. Do not worry. Direct payments are new to many people. All local councils have support services for people wishing to consider or to use direct payment schemes, and these are open to people who are eligible to receive mental health services.


If you are unsure about who to contact in your area, please ring 01206 287588 and leave your number and name and we will get back to you with details.


Preparing for an assessment or review of your needs


You might wish to think about your needs before the assessment. A friend or relative, or someone from the direct payment support service or a local advocacy service may well be able to give you help in doing this. Some people find it helpful to keep a diary for a week before the assessment, recording what they do, how long it takes, and what help they receive, as well as what they would like to be able to do if they had the necessary help. If you decide to do this, take care not to overlook things that do not happen every week. If necessary, you may wish to list the types of needs you have over a longer period. You may be asked to complete a form before the assessment to say what you everything you identify, but this process will help to define your needs in a was help you to complete a ‘self-assessment’, some of these are listed on page 16. If you think you would find it helpful to get advice from a local support group, to help you to prepare for your assessment, your care co-ordinator or local council may be able to suggest groups for you to contact, or you may wish to contact us on the number above, or one of the organisations listed at the back of this guide (pages 17 and 18).


What can I spend my direct payments on?


A lot of people use their direct payments to employ a support worker (or personal Assistant) to meet needs they have for social activity or support.


“It’s very flexible. She comes in the evening and we have a drink and chat and take the dog for a walk sometimes and then I’ll go to bed at whatever time and she might do some cleaning for me or whatever…then she sits up all night and when I get up during the night, I have got someone to talk to. That just gives me a chance to get some sleep, because I don’t sleep very well, and I self-harm quite a lot…Just knowing that somebody is going to come in and spend the night and it gives me a bit of a break, somebody to talk to and I know I can phone her up too.”


“Direct Payments has provided a companion who I get on very well with, we do various things together eg swimming, snooker, pictures, shopping we also go for a drink together. More than anything Direct Payments has given me choices and has helped no end with social inclusion. My companion has introduced me to new friends and I am finding it far easier to socialise with people, my family have also noticed that my social skills are improving all of the time. I would not hesitate in recommending Direct Payments to other Service Users, Direct Payments opens doors and improves lives.”


Correspondence from a direct payments user


The money is for you to use to meet the needs that the care co-ordinator has assessed you as having. Every local council has its own particular scheme, and your care co-ordinator will explain the types of things that the money can and This should not be ‘set in stone’ and should be negotiable. Direct payments are their needs are met.


“One person lives with their sister and family, and every now and then needs a break. Direct payments pay for their train fare so they can travel to stay with their brother when they feel it is necessary. This provides the opportunity for the person to use ‘self-management’ in pursuing their preferred solution to their need for ‘respite’.”


(Example provided by Direct Payments scheme manager)


The important thing is that you use the money to meet the needs that have been agreed with your care co-ordinator, and that you properly account for how it has been spent.


As direct payments are designed to be used flexibly, you may agree with the care co-ordinator a number of options that you can choose from at any one time. This may include managing your payments flexibly as your needs vary. It may also include planning for a crisis or specific event that will require more or different support.


“The flexibility inherent in direct payments means that individuals can adjust the amount they use week to week and ‘bank’ any spare money to use as and when extra needs arise. So long as the overall payments are being used to secure the services they are for and the care plan objectives are met, the actual pattern of ‘service’ does not need to be predetermined.”


Over time your needs may change or new ways in which your needs can be met may well arise, neither of which were considered at the previous assessment/review. You should be able to discuss such possibilities with your care co-ordinator as they arise and modify your care plan accordingly.

“Direct payments can help people to build up their skills and self esteem, get them away from a reliance on services and become involved with their families and community again, rather than being segregated in specialist services. Using direct payments can take away that stigma, instead focusing support around the individual, rather than slotting them into a service that happens to be available.”


Stephen Ladyman MP (2004)


Local advocacy, service user or disabled people’s organisations should be able to offer support if you are not happy with a decision made about what you can use your direct payment for.

Direct payments for carers of people with mental health problems


As a carer you are able to request an assessment of your needs if you provide a substantial amount of care on a regular basis to a disabled adult. You can be offered services to support your caring role and/or to maintain your own health and well-being. If you are assessed as eligible to receive a social care service to support you, direct payments can be offered to you if you provide this care to someone who is themselves eligible to receive a social care service. In general, the same principles, as described above, apply to carers’ direct payments as for other direct payments. Carers’ eligibility is not specific to mental health services, and the way in which payments to carers have been introduced varies considerably. The care coordinator for the person you are caring for, or the local mental health trust, should be able to give you information about carers’ assessments and direct payments. The local authority will have information for all carers on its direct payments scheme.


What should people eligible to use mental healthservices and carers be able to expect?


• To have a clear statements of the needs for which they are eligible to receive services.


• To be given the maximum possible choice and control in how their eligible needs are met


• To be offered the option of direct payments as a way of meeting their social care needs at every assessment and review meeting


• To have it explained if they are excluded from receiving direct payments


• To be provided with adequate information about direct payments to be able to make an informed choice whether to use them or not


• To be given the details of people who can support them to consider and use direct payments


• To be able to use a mixture of direct payments and provided services if they choose


• To be able to stop using direct payments at any time and return to using a provided service

People excluded from receiving direct payments

A small number of people, who are subject to legislation which limits their freedom to arrange their own care, are excluded from receiving direct payments.

This includes people:


• placed under guardianship in pursuance of -

(i) an application made in accordance with section 7 of the 1983 Mental Health Act; or

(ii) an order made under section 37 of the 1983 Mental Health Act;


• absent from hospital with leave given in accordance with section 17 of the 1983 Mental Health Act;


• subject to after-care under supervision within the meaning of section 25A of the 1983 Mental Health Act;


• subject to a condition imposed in accordance with section 42(2) or 73(4) (including such a condition which has been varied in accordance with section 73(5) or 75(3) of the 1983 Mental Health Act.

The Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2003: Statutory Instrument 2003 No. 762

Other exclusions are:


• people who are receiving any form of after-care or community care which constitutes part of a care programme initiated under a compulsory court order;


• offenders serving a probation or combination order subject to an additional requirement to undergo treatment for a mental health condition or for drug or alcohol dependency;


• offenders released on licence subject to an additional requirement to undergo treatment for a mental health condition or for drug or alcohol dependency; and


• people subject to equivalent restrictions in Scottish mental health or criminal justice legislation.


Direct Payments Guidance: Community Care, Services for Carers and Children’s Services (Direct Payments) Guidance England 2003 Department of Health


Reference should be made to the Regulations for full details of the circumstances in which the duty to make a direct payment does not apply.


References


Department of Health (DH) (2003a) A guide to receiving direct payments from your local council: A route to independent living May 2003 London: DH


Department of Health (2003b) Direct Payments Guidance: Community Care, Services for Carers and Children’s Services (Direct Payments) Guidance England 2003 September 2003 London: DH


Department of Health (DH) (2005) Independence, Well-being and Choice: Our vision for the future of social care for adults in England London: Department of Health Ladyman, S. MP (2003) Transcript of speech by Stephen Ladyman, Parliamentary


Under Secretary of State, Department of Health, at National Centre for Independent Living launch event, 30 October 2003, London (from NCIL website: www.ncil.org.uk


Ladyman, S. MP (2004) Transcript of speech by Health Minister Stephen Ladyman MP at ‘New Directions in Direct Payments for People who use Mental Health Services’,


Joseph Rowntree Foundation/Health and Social Care Advisory Service Conference, 18th May 2004, London. London: DH Social Exclusion Unit (SEU) (2004) Mental Health and Social Exclusion: Social Exclusion Unit Report June 2004. London: Office of the Deputy Prime Minister


Spandler, H and Vick, N. (2004) Direct Payments, Independent Living and Mental Health: An Evaluation Full Report. London: Health and Social Care Advisory Service


Executive summary also available: www.hascas.org.uk


Literature on Self Assessment


Leader, A. (1995) Direct Power: a resource pack for people who want to develop their own care plans and support networks Brighton: Pavilion


Markovits, P. (1996) The Avon Mental Health Measure: A User-Centred Approach to Assessing Need Bristol: South West MIND RCP/NSF [now Rethink](2000) CUES (Carers’ and Users’ Expectations of Services) Service User 

Version/Carers’ Version Available from: Royal College of Psychiatrists,


Multi-Centre Audit Team, College Research Unit, 6th Floor, 83 Victoria Street,London SW1X 7EE. Tel 0207 227 0840 or Research Department, Rethink, 30 Tabernacle Street, London, EC2A 4DD


Useful Contacts

National Institute for Mental Health in England (NIMHE)


National Social Inclusion Programme: Direct Payments


Eastern Development Centre


654 The Crescent, Colchester Business Park, Colchester


Essex. CO4 9YQ


Tel: 01206 287588 Fax: 01206 287597


[email protected]

The Direct Payments project within the National Social Inclusion Programme works in partnership with NIMHE’s 8 Regional Development Centres, to promote direct payments as a standard option for people eligible to use mental health services, and provides support to all organisations and individuals with an interest in this.


The National Social Inclusion Programme website www.socialinclusion.org.uk includes electronic versions of the Direct payments for people with mental health problems: A guide to action (DH, 2006) and this guide for service users and carers.


The Direct Payments Practice Exchange Network will support implementation of this guide. It is open to all, and can be accessed by joining the NIMHE Knowledge


Community: http://kc.nimhe.org.uk , or contacting the address above. NIMHE is part of Care Services Improvement Partnership (CSIP) www.csip.org.uk


The Social Care Institute for Excellence (SCIE)


SCIE,


Golding's House,


2 Hay's Lane,


London, SE1 2HB.


Tel: 020 7089 7102

www.scie.org.uk


SCIE has published Direct Payments: Answering Frequently Asked Questions, a guide for practitioners and their managers, and finance and senior managers. It offers creative and innovative examples of how the legislation on direct payments can successfully be applied, and answers a range of frequently asked questions. This guide contains a large number of practical examples on every aspect of direct payment provision and use. It should be read in conjunction with this Guide.


Department of Health

Tel: 020 7210 4850

E-mail: [email protected]

www.dh.gov.uk


Includes electronic version of the Direct payments for people with mental health problems: A guide to action (DH, 2006)


Information on policy and guidance can be found by visiting the DH website.


Directgov


www.direct.gov.uk


Information on accessing Government services, including financial support.


Equalities National Council for Disabled People and Carers from Black and Minority


Ethnic Communities


Waltham Forest College

707 Forest Road

London. E17 4JB

Tel/Fax: 0208 527 3211

E-mail: [email protected]


Equalities work includes support to people to obtain direct payments. They have produced a video on the subject called 


Breaking Barriers.


Health and Social Care Advisory Service


King’s Fund

11-13 Cavendish Square

London W1G 0AN

Tel: 0207 3072892

E-mail: [email protected]

www.hascas.org.uk


The Executive summary of Direct Payments, Independent Living and Mental Health:

An Evaluation can be obtained free of charge from the website or by contacting the address above.


In Control

Self Directed Services: A National Programme to change how Social Care is Organised in England

Programme Co-ordinator Valuing People Support Team

36 Rose Hill Drive

Mosborough

Sheffield S20 5PN

www.selfdirectedsupport.org


The next In Control pilot sites will include some which will be open to people who use mental health services.


Joseph Rowntree Foundation


The Homestead

40 Water End

York YO32 6WP

Tel: 01904 629 241


www.jrf.org.uk


JRF have funded a large amount of work on direct payments. Summary (and sometimes full versions of their reports, including Implementing Direct Payments in Mental Health: New Directions) can be obtained free of charge from the website.


National Centre for Independent Living

4th Floor, Hampton House

20 Albert Embankment

London SE1 7TJ

Tel: 0207 587 1663

www.ncil.org.uk


NCIL publish a number of useful guides to using direct payments, many available free from their website, including the Service User/Survivor Guide to Direct Payments by Pauline Heslop. Their website also has an invaluable discussion forum.