Fighting Monsters

So, a week from the start of my journey into a Direct Payments referral and I have sent the appropriate forms, documents and paperwork to the appropriate people.  The figures are being checked and the amount that has been requested matched up against  the Fair Access to Care criteria along with a brief (at this stage) breakdown of what each minute paid will be used for.

As is ironic the person to whom I sent them is  on holiday - but this is not ‘urgent’ so it will wait. I doubt that a week or two will make much difference in the long run. So possibly no update next week!

I have asked the daughter to open a separate bank account for her mother - I like to get this done as quickly as possible. We have some pro-forma letters to send to banks to request that the facilitate the opening of a bank account and don’t perhaps, use the usual criteria that used to make opening a bank account quite difficult for some users. The letter is a result of some consultations between the council and the banks.

The Consumerist at Flickr

We also had a very very brief chat about the process of employing a carer.

As for the Carers DP, that has a different path for authorisation. I updated the Carers Care Plan and Assessment sent it to someone else who coordinates carers services to request payments.

Meanwhile, in a somewhat timely manner, The Social Work Blog writes about a GSCC consultation regarding the regulation of personal assistants who are employed by users of Direct Payments.

Up till now, employees of Direct Payments users have not been required to have the Criminal Records Bureau checks required of all over professionals in the social care sector.

This was partly to allow for a more flexible approach to be taken to employments by users and to cut through some of the ‘red tape’ that might prevent users from employing whoever they want.

Personally, I think that’s all very well for some users who are able to  manage and organise the direct payments but for me, it adds another layer to the barrier to being able to wholeheartedly run with direct payments when working with a more vulnerable user group - particularly, I’m thinking of older people.

I have to claim having a slight vested interest in the debate.

My father is uses direct payments and employs carers directly - he has had directly provided services (without too many details, he has been a user of social services care for many years) and he now has, and has had a direct payments care package for a number of years.

He has currently and has been lucky to have almost consistently, a number of exceptional carers - some of whom I’d like to poach for service users that I work with, but I don’t think he’d forgive me!

But I want to know that he has safe carers. That it isn’t a case that anyone can look at an advert in a newsagent and reply and be working in the home of a vulnerable elderly (sorry dad!) person within days.

Sometimes when I’m at work, people might see me as a detached professional without possibly knowing that I have had quite a lot of experience as an indirect recipient the other end.

And that’s what  I mean when I judge the services I provide against ‘Would I want my dad to go here/get this/have this service?’ It isn’t quite as theoretical a question as it might sound..

Direct Payments is the system of, basically, rather than giving a direct service, providing money to the user of the service to ‘buy’ the care that they need directly.

‘Direct Payments were introduced in the UK

- for adults with a disability in 1997

- for older people in 2000

- for carers, parents of disabled children and for 16 and 17 year olds in 2001

Since 2003, councils have been required to make Direct Payments available to those who are able to choose to have them and who wish to have them’

(Source : Direct Payments for people with mental health problems: A guide to action)

I have worked with Direct Payments a few times although it isn’t something that comes up with any great regularity in the field that I am currently working in - mostly because, I imagine, my work is focused on a combination for the two groups of service users who have found the system of direct payments least accessible - older people and people with mental illnesses.

So working in a team for older people with mental health problems seems to be possibly the least likely place for direct payments to be accessed.

I have instigated a few direct payments packages but not a many. One of the things that I have found the most frustrating is the time-lag between going in to someone and identifying a support need - offering and explaining direct payments alongside an explanation of the direct provision of services.

On meeting potential interest, the boxes get ticked but in the meantime the service is needed immediately - it can and  has taken months to get a direct payment service up and running but in the meantime a direct service is needed to meet the need that still exists - sometimes a carer is employed in the meantime with whom the patient gets on very well - seeing no need to change to direct payments after a few months of building up a relationship.

Sometimes the  delay between setting up a ‘new’ system leads to a complacency to fall back to the ‘default’ system.

But sometimes, occasionally, it has followed through.

I have two reasons for bringing this up at the moment

Firstly, I am starting the process of referring someone for direct payments and her daughter for carers direct payments.

I thought it would be a useful illustration of the time it between someone deciding they need a service to its eventual ‘fruition’ if I can follow it here by indicating the different points in the process as they arise.

I hope I will be proved wrong and that we can get things up and running quickly. I really do.

Bit of brief background, service user and potential user of direct payments has an Alzheimer’s type dementia. She has had this diagnosis for a couple of years and can function fairly well. On meeting her, you probably wouldn’t realise she has dementia until you’ve been talking to her for at least about half an hour when some of the conversation begins to repeat itself. She would certainly have the capacity at present to make decisions about her own care and support packages.

She has been receiving a directly provided care package for a while but some of the elements have proved to be less than satisfactory. She doesn’t enjoy the day services on offer and would probably get more from community activities such as tai chi classes at the local leisure centre. One of the ideas of the direct payments is to look at someone to take her to these kinds of activities rather than her going to the local community day centre.

Her daughter is her main carer and lives locally but not walking distance. Her daughter has a young family and provides a substantial amount of emotional support to her mother, visiting most days and taking her mother to stay with her family many weekends.

I’m hoping that Carers Direct Payments will be able to address some of her needs regarding travel costs between the two houses and possibly some of the domestic care.

It’s been a while since I referred a Direct Payment care package so I called the Direct Payment lead (who I get on well with anyway and always find it easy to talk to) to confirm the procedure to refer.

I sent her an initial care schedule with costings and times attached.

Meanwhile, on the ‘Carer’s’ front, I need still (and hope to today) update the most recent Carers Assessment and Carers Care Plan to include the conversation I had with daughter to include Direct Payments for Carers as an outcome.

Anyway, lets see together how long it takes to get these things up and running..

I first saw on the news over the weekend about the report produced by the Institute for Public Policy Research related to  Personalised Budgets for Carers and it baffled me a little bit.

Don’t get me wrong, I completely think that carers need, deserve and are entitled to a lot more support than is available presently.

The Carers Allowance is, quite frankly, an insult to those who put in so many hours and whose lives are changed by the amount of care that is put in (as well as, on a less emotive level, the amount of money that is saved by both the NHS and Social Services). Also (for what its worth) it’s linked to Disability Living Allowance/Attendance Allowance and is means-tested. All of which contribute to its inefficiency.

But the call for personalised budgets seems to be, as far as I can garner, more or less the same as Direct Payments for Carers - which is explained much better on the Worcestershire County Council site (thank you, Worcestershire - and no, I don’t work there - actually, I don’t think I’ve ever been there!) as follows

‘Support for Carers

A Direct Payment can be provided to enable family and informal carers to purchase the services they are assessed as needing as carers to support them and to maintain their own health and well-being.

A Carers Assessment and Support Plan should be completed to identify the impact of caring on the person’s life along with the support they require to continue caring or to take a break from their caring role.

Carers are able to use Direct Payments to purchase support in any variety of ways including:

• Short breaks for themselves and/or the people they care for;
• Personal assistance within the home;
• Sitting services;
• Social, education and leisure activities;
• Transport costs;
• Equipment
• Relaxation, stress management and holistic therapies.

Some of the intended outcomes of using Direct Payments for carers are:

• Promoting social inclusion through greater opportunities for carers to actively participate in family and community life;
• Greater opportunities for the personal development of carers;
• Promotion of the carer’s health, well-being and coping skills;
• More responsive, timely and consistent methods of providing support, with greater opportunities for creativity;
• Values the essential contribution carers make to family life and the wider community.

Under the service, young people, aged 16-to17-years, are also eligible to receive Direct Payments to support them in their role as young carers and to minimise any difficulties or isolation they may experience in undertaking their caring responsibilities’.

psd @ flickr

I have to say I like the direct payment scheme as it works for carers because it is incredibly flexible. Indeed, I’d say it is the easiest way to provide direct support to carers and in the most visible way - so I’ve got a fair amount of experience using it.

In a lot of ways, it is a lot more flexible than the direct payments provided for service users because it can be used for ‘anything that would support the carer’ - so gym membership, travel costs, parking costs, washing machines - there is the ability to be much more creative. ‘

And it exists now - today and has been used with frequency.

So that’s why I didn’t really understand the call by the IPPR for personalised budgets with no comment about what is actually happening in social services departments to support carers today. Maybe they are calling for more money to be a part of the personalised budgets (a good thing) or more control (although the control can be basically in the hands of the carer themselves), more exposure to issues that matter to carers or less scrutiny from local authorities who provide the funding.

I suppose I’ll have to actually read the whole report rather than just the reporting of it!

I noticed that Sophie Moullin from the IPPR wrote about this in the Guardian and from what she says, I can’t see any difference in the new system she proposes to what is actually, legislatively in place at the moment.

I am absolutely in favour of anything that will help though and if the proposed system will ringfence more money or provide more exposure or utilisation of services then I’m the first person to applaud it.

But to promote the new system which has a lot of links with Carers’ Direct Payments without discussing the failings of that particular system and to look at the issue as if this system didn’t exist, seems not to be giving a true picture of the situation as it is today. Perhaps more needs to actually be done to increase awareness of the system as it exists today and promote use and access to it.

New technology is a wonderful thing. Most of the time. Chip and pin? A fantastic way to improve security for bank cards and accounts. Giros always went missing anyway, much better the ‘direct payment’ with benefits going straight into bank accounts and providing basic bank accounts to ensure ease of access!

These ideas might make sense initially, but having seen the effect of these changing on the day to day lives of older people, particularly those with memory difficulties or mobility difficulties, it has created nothing but headaches and heartaches.

It used to be quite easy with the Giros, a carer could go and pick up the cheque from the post office weekly, maybe doing some shopping on the way back and all is well.

Enter ‘Direct Payment‘ (not Direct PaymentS, mind, that’s another thing entirely!), and you have agencies whose workers are not allowed to be given the PIN numbers for older service users and therefore noone to collect the money or do the shopping. Of course the ease of access for carers has to be balanced against the potential for financial abuse.

Help the aged have done some research on Financial abuse among older people. Personally, I’m surprised that it is the second most common form of abuse in their eyes. From personal experience, it is by far the most common!

It can seem to be an almost impossible balance at times and I’ve certainly felt that I’ve been going round in circles more than once. Banks, of course, quite rightly, insist on speaking to the bank account holder to make any kinds of changes to the account, but when that person is not able to speak on the phone and has poor mobility so is unable to get out and about, it can leave the benefit money trapped in a bank account that can’t be used.

I remember one woman I worked with who was in a similar position. She had a diagnosis of Alzheimer’s and her Pension, Pension Credit and Attendance Allowance were going directly into her bank account.

Her bank card - well, let’s just say, when the card wasn’t lost, the PIN number was. It is possible to speak to the Benefits Agency directly to have payments revert to Giros but it can take a bit of time. We were also reluctant in this case as there was a husband who spent the Giros down the bookies.

Actually, after lots of telephone calls, we went to a local bank (she had poor mobility but between myself and the carer, we had her pretty much safe.. and it wasn’t very far!). When we got to the bank, well, I don’t think the staff knew quite what to do - but they were incredibly helpful and understanding and because the carer had come with us and she had a regular carer - the bank made an arrangement that that particular carer would be able to withdraw a limited amount of money each week to pay expenses.

It was a good outcome. Very positive and all credit to the bank and the banking staff. Mrs X had a fine time out and about as well! But you see, on the database, well, I couldn’t even log that afternoon as a ‘piece of work’.

And the rapid turnover of carers means that it’s not always to have a regular worker with one person. I wonder how much thought was given to the older population when the changes to the benefits system was made.

PIN numbers will be easy to understand for people who have grown up with them - but the amount of homes I’ve visited that have numbers written on calendars or in wallets, is just, well, I’d say it’s the case more often than not.

I’m not sure what the answer is, the Giro system wasn’t perfect, but at least it allowed some kind of access. In any case, sometimes things that can seem like a wonderful idea until you consider the implications across the board.