Improving direct payments oversight

Improving direct payments oversight aims to share solutions to improve efficiency and reduce unnecessary process in direct payment oversight. It identifies some of the barriers and suggests practical steps to take, including examples from participating councils.

It will be useful to people involved in administering and overseeing direct payments for adult social care and support improvement work. Our work can be used to reflect on your own local arrangements, and consider the ways councils involved in this project have improved their own ways of working.

This report aims to share solutions to improve efficiency and reduce unnecessary process in direct payment oversight. It identifies some of the barriers and suggests practical steps to take, including examples from participating councils. It will be useful to people involved in administering and overseeing direct payments for adult social care and support improvement work. Our work can be used to reflect on your own local arrangements, and consider the ways councils involved in this project have improved their own ways of working.

This is aimed at:

• directors of adult social services, finance directors, council finance managers and their staff
• auditors, information systems designers and administrators
• direct payment support services staff, social workers, people undertaking assessments and reviews
• commissioners
• people who receive a direct payment and their supporters.

Twenty-five years on from the introduction of direct payments it is pleasing to know that councils have made significant progress in supporting people to have more choice and control over their care and support. There is more to do, however, to ensure that the experience of people taking a direct payment is as good as it can be.

There are pressures which may stifle and, in some cases, even unwind the progress made. These include the need to find savings and to manage budgets, to satisfy requirements that the money is spent appropriately, and to set up new direct payments to meet council wide requirements. They have led to the introduction or deepening of processes and constraints that limit the flexibilities and freedoms which people need to be creative and achieve outcomes, to the extent that some have felt this to be oppressive.

It has been helpful to hear about councils that are now determined to do something about this, reversing these trends. The Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) have been pleased to work closely with Think Local Act Personal (TLAP) in convening some of these councils with people who take and manage a direct payment. We hope this resource will support more places to make similar positive changes.

Simon Williams

Director of Social Care Improvement, Care and Health Improvement Programme Local Government Association

People using direct payments and a small number of local authorities shared their experiences and described work to address the challenges through a series of workshops. These included Shropshire Council, Sheffield City Council, Leicester City Council and Essex County Council. See appendix for practical examples of the outputs from their work.

This report has also been informed by a group of senior finance officers, which included Surrey County Council, and a group of people administering direct payments, along with input from ADASS.

In some places peoples’ lived experience of taking and managing a direct payment is falling short of the intentions enshrined in policy. The principle is that people should be able to maximise the choice and control they have over the care and support they are entitled to. An area of frequently expressed frustration is the degree of scrutiny people experience when their spending is reviewed and audited by social care and finance staff.

These experiences are now well documented across Personal Budgets Outcome Evaluation Tool surveys, the Social Care Innovation Network and in Direct Payments: working or not working? See also TLAP’s accompanying publication ‘Making Direct Payments Work’ for guidance and best practice.

Most councils have developed practices to underpin the management and control of their budgets and to account for the money funding direct payments. There is a risk that these practices are not fully compliant with policy or statutory Care Act guidance.

It sometimes feels like cost is the key to packages, not the real life outcomes."

Isaac Samuels, National Co-production Advisory Group

The councils’ task that has appeared difficult to achieve is brought to life in the Care Act Guidance section 12.4 ‘For direct payments to have the maximum impact, the processes involved in administering and monitoring the payment should incorporate the minimal elements to allow the local authority to fulfil its statutory responsibilities. These processes must not restrict choice or stifle innovation by requiring that the adult’s needs are met by a particular provider, and must not place undue burdens on people to provide information to the local authority. An effective monitoring process should also go beyond financial monitoring, and include aspects such as identifying wider risks and issues, for example non-payment of tax, and provision of employers’ liability insurance where this is appropriate.’

During the COVID-19 outbreak, some places allowed more flexibility for direct payment recipients, and have found ways to incorporate more flexible approaches to oversight, whilst also meeting their core financial and legal responsibilities. This approach seeks to be in line with the aspirations and expectations expressed in the Care Act and statutory guidance. It is useful to learn from the experience of these councils.

This work also meets central government objectives to support and encourage the continuation and wider adoption of practices, established during the period of coronavirus outbreak, that reduce unnecessary bureaucracy.

Key areas of concern to address:

• initial information for those using direct payments
• how a personal budget is set, including a fair contribution, determining the direct payment
• the level of flexibility around how a direct payment can be used
• accounting for the money including contingency
• reasonable expectations of those actually using or organising direct payments including family members, recognising that they are often employers
• having a supportive culture that sees direct payments as a positive option and written and verbal communication that reflects this
• initial set up time
• oversight of direct payments in a way which values co-production.

It is difficult to balance simplifying processes that satisfy people and make taking a direct payment straightforward with the need to satisfy council requirements for budgetary control and assurance that direct payments are being used appropriately by people. We have looked for places that are seeking to achieve this.

We have learned from some of the places on this journey, even if they are just starting the process. They have shared experiences and produced some resources co-productively with people that could benefit others seeking to improve their direct payment offers. Councils have found it helpful to share experiences with each other. See examples in the appendix.

Any change to processes requires the support of the wider council at a senior level.

Assessment, resource allocation, care and support planning and reviewing are critical associated processes that frame what direct payment monitoring workers do and the procedures they use in their work. More work is needed to understand the impact of current assessment practice on these processes and how they often seem to frustrate the purposes of making a direct payment to people in lieu of services.

Clarity about what is and isn’t allowed, what ‘the deal is’ between people and the council, and more human communication about monitoring processes have emerged as a good starting point for detailed improvement work and co-productive conversations with people.

Priorities

• information and clear expectations
• setting a personal budget
• what a direct payment can be used for
• balancing choice and safety
• accounting for the money
• shortening the set-up time
• culture and language
• co-production and governance

Information and clear expectations

Initial information for people thinking about using direct payments, and setting clear mutual expectations – the ‘deal’.

• Information will be based on local policy and practice but should be checked for Care Act compliance.
• There should be clear information about what responsibilities will be taken by people using direct payments, what processes they need to follow, and what the council will do.
• Information should include where people can get support both from the council and from others, so they know they won’t be on their own.
• Shropshire, Essex, Leicester and Surrey Councils are working on ‘guides’ for people and workers.
• Surrey County Council have a good working relationship with a user-led organisation which advises, supports and gives guidance relating to direct payment recipients and personal assistants.

Setting a personal budget

Setting a personal budget, including how a support plan is turned into a costed personal budget, and how charging and contributions are applied to get to a net budget, which is the actual amount of a direct payment a person has to spend.

1. This may include a calculation based on notional hourly rates multiplied by the number of hours required, but this should not lock a direct payment recipient into paying these rates or having to follow the detailed support plan to the letter. More detail below for what a direct payment can be used for.
2. The support plan should describe the agreed outcomes to be achieved, and not constrain the direct payment recipient or provider of support to follow a prescribed pattern of support.
3. Charging policies should consider any time requirements in calculating and reviewing a fair charge. People said there are often delays in getting direct payments set up and waiting for these calculations to be completed.

What a direct payment can be used for

What a direct payment can be used for, including any appropriate exclusions.

A direct payment should be achieving the agreed outcomes based on eligible needs; beyond that there should be caution about blanket exclusions for their use. This will need to be explained in any initial information.

• There should be flexibility over time in how it is used to achieve an outcome. An example given was Shropshire identifying x hours per week for physical exercise rather than specifying swimming – so people can change the exercise to cycling or other physical activities without needing to go back for authorisation.
• Councils should avoid changes in rules about the use of direct payments, unless consulted on and recipients given time to make any adjustments.
• There have been comments about practice in some places that has gradually eroded people being able to use their budgets for anything other than personal assistants. This needs further investigation.

Balancing choice and safety

Are there any necessary processes to ensure that direct payment recipients are not being exploited or potentially causing unacceptable risks to themselves?

• Councils retain a duty to ensure that people are not exposed to unacceptable and unmitigated risks, whilst still seeking to maximise choice and control for that person. Risks may include the broad range of safeguarding risks and also some risks specific to using direct payments, such as those for an individual employer.
• Some of these risks should be identified and addressed on a person-centred basis in the support plan.
• Other risks will be addressed through policies and procedures within the direct payments scheme, and is part of a support function. An example is employment advice and sample employment contracts.

We have a supportive role to play and we ensure that clients have access to the [local] user led organisation for advice and support too. We ensure that we have a culture that is supportive and aware of potential problems - that we could, if needed, step in to safeguard and advise"

Surrey County Council

Accounting for the money

Accounting for the actual money, including pre-paid cards, managed bank accounts, year-end reconciliation, dealing with unused funds.

• There should be simple ways for direct payment recipients to record how the direct payment is being used and to account for the money. A practical example is standard template reconciliation sheets that people could use.
• Managed bank accounts have a role to play, but there may be risks of the accounts not having enough funds, sometimes due to people not paying in their contributions.
• Prepaid cards are also useful, as long as they are not used to inappropriately restrict categories of spend. Councils should be working to minimise on-costs of these cards and consider a variety of platforms.
• There should be clear rules on contingency funding, which balances the need for direct payment recipients to plan prudently for unexpected or large costs against the need for funds not to accumulate to an unjustifiable amount.
• Councils should consider the cost benefit ratio of detailed auditing of receipts for small amounts of expenditure.
• There should be early and more intensive support for new direct payment recipients to ensure that they are accounting for funds in the correct way, with the aim that in most cases it can then become lighter touch. Support can include peer and user led support.

Shortening the set up time

Often, when someone expresses that they want a direct payment, they are not even offered an interim package - if they want to employ, the DP doesn’t start until the PA is recruited."

Jenny Hurst, London SDS Forum

Initial set up time can be an issue, and councils and direct payment recipients should work together to shorten this.

• Councils might support direct payment recipients to find personal assistants more quickly. For example, proactively and collaboratively establishing a pool people can choose from, or working with local skills and employment partnerships to promote being a personal assistant as an employment choice.
• The need for proactive action is illustrated by one example given of a council where it takes six weeks to set up a direct payment versus getting a contracted provider within 24 hours.

Setting up the direct payment is quite a quick process, helping the client to find the appropriate service can take some time. We have been working closely with the user led organisation to develop a collaborative way in supporting people. We have done a recent recruitment drive with them to engage with PA’s and use a PA finder."

Surrey County Council

Culture and language

Culture and language are important. How can councils communicate in a way that does not make direct payment recipients feel like cheats, and how can they be treated as real customers while also being asked to meet mutual expectations?

Think about the language – are direct payment recipients customers or partners? The language used will influence the relationship.

Shropshire Council provided an example of saying ‘eating/drinking what’s good for me’ rather than the Care Act language of ‘maintaining a healthy diet’."

Examples of rewriting letters from Leicester City Council demonstrate how this can be addressed co-productively

Co-production and governance

How do councils and direct payment recipients work together in a mutually respectful and co-produced way?

• Co-production needs to be at all levels – individual, family, peer/more formal support, policy and strategy.
• The governance and partnership structures can be used to receive feedback from people and agree any necessary changes at an overall level.

At an individual level, co-producing support plans and ensuring they are person-centred and outcomes focused could save a lot of time, reducing plans and budgets going to and fro between the person and the council until they reach agreement. People should be able to attend assessments and reviews with clear ideas up front.

‘We are engaging in a co-production report to look at the culture, the service outcomes, the administration and functionality around direct payments. Looking to future proof our service and ensure that the support and outcomes give the optimum choice and control for our clients. Feedback that we have had about the letters being sent out was they were too long and complicated and people didn’t read them. So we will be amending our style, creating more headlines and then giving relevant links to websites for more information.’

Surrey County Council

This report is intended for councils to reflect with local stakeholders on how direct payments work locally and what might be improved. Examples in the appendix might be a helpful place to start, together with TLAP’s Making It Real framework for what good care and support looks like.

The role of the LGA and TLAP is to support the sector to continually improve, usually by shining a light on good practice and helping to make connections between those leading examples and those places that want to improve. Get in touch if you need help with this. Our aim is to articulate what’s needed to enable people to arrange the care and support which best meets their needs and aspirations in line with the original intentions of the Care Act, whilst enabling councils to meet their obligations.

My experience of Shropshire is that a key driver is the amazing leadership."

Kate Sibthorp, National Co-production Advisory Group

You may read the full report on TLAP's website: Improving direct payments oversight