Direct payments for self directed care: draft policy and practice guidance

Introduction

Alzheimer Scotland is the leading specialist dementia charity in Scotland and works passionately to improve the lives of everyone affected by dementia.

• We run services in over sixty sites, providing practical help such as day care and drop-in centres, home support and carer support.
• We provide an extensive website (www.alzscot.org) and our freephone 24-hour Dementia Helpline (0808 808 3000) offers information and support and receives over 5000 calls per year.
• We publish leaflets, booklets, reports and a quarterly magazine keeping carers, people with dementia and professionals up to date.
• We lobby the Scottish Parliament and Westminster. Major achievements have been free personal care and the Adults with Incapacity (Scotland) Act 2000.

There are currently 64,000 people with dementia in Scotland, almost 2,000 of whom are under the age of 65. The number of people with dementia is predicted to rise in line with the ageing population.

General comments

Alzheimer Scotland welcomes the opportunity to comment on this consultation document and we have outlined our comments below.

A general point is that it is critical that these proposals are adequately funded so that recipients do not suffer delays in having their direct payment assessments fulfilled.

Comments on specific sections

1. To provide a designated direct payments officer within each local authority

This is a helpful proposal in order to ensure a basic level of service in every local authority area. It is important that any lead officer promotes direct payments as an option for all eligible client groups. We are particularly eager that direct payments are promoted as a flexible option for people with dementia and their carers to enable them to receive the care and support they need.

The guidance would appear to allow local authorities to adopt different practices in terms of what direct payments can be used for. For example “some local authorities allow direct payments to be used for a personal assistant to accompany a user on an independent break” (Paragraph 110). We are concerned that this will result in less flexibility in some local authority areas compared to other local authorities and that flexibility of this kind should be available on an equitable basis across Scotland.

A direct payment recipient holding direct payments for the care of his wife, who has dementia, informed us that he has been forced by the local authority into becoming an employer instead of his preferred option of purchasing services. Whilst choice is a theme of the guidance document it did not explicitly state that it is the recipient’s choice to decide if they wish to purchase services or become an employer. We believe that this point should be clearly stated in paragraph 47.

2. To fund direct payment support service which should ideally be independent and user led

Again this proposal would help ensure a basic level of service in every local authority area. Support services are important to help guide recipients through the direct payment process. It is particularly important that support services provide an adequate level of support to those who decide to become employers of personal assistants as well as to those who purchase services. It is also important that any support service is aware of and can respond to the particular needs of people with dementia and their carers.

We are concerned about the funding of these support services. It has been the experience of our Service Managers that there is currently little funding for direct payments. Adding additional responsibilities to local authorities without providing adequate funding will not improve services for potential direct payment recipients.

3. To fund pre-assessment work with potential users, to enable them to get the best from their assessment and care planning

(See response to 4)

4. To fund other essential training for direct payment recipients and training of personal assistants

It is important that training is funded so that recipients are provided with the information that will enable them to make informed choices and, where appropriate, to be responsible employers. It is also important that personal assistants are appropriately trained, and separate funding is key to ensuring that this the provision of training does not impact negatively on the amount of care which can be paid for.

5. To fund direct payments training for care managers, finance managers and local authority directors

This would be beneficial to help gain support from local authority staff for the policy.

It is important that social work departments promote direct payments as a possible option for those requiring care services. The experience of our Service Managers is that social work departments can be reluctant to offer direct payments, as there is little funding for them. It is also important that people with dementia and those holding power of attorney for a person with dementia are not overlooked by social work departments as potential recipients for direct payments.

6. To meet the cost of disclosure checks for direct payment recipients employing personal assistants

(See response to 8)

7. To fund employers indemnity for personal assistant employers

(See response to 8)

8. To fund direct payment packages during short stays in hospital

Our general point is that proposals 6, 7 and 8 would help to make direct payments viable for a greater number of people.

However, we do not believe that the guidance covers all the difficulties that employers of personal assistants may encounter. For example:

• Would an employer be liable for redundancy payments under employment law if the personal assistants services were no longer required? How would this be funded?

A carer operating direct payments informed us that he found a lack of support when problems arose. He was taken to an employment tribunal by a personal assistant, who received legal and financial support from a trade union. The direct payment recipient did not receive any support.

9. To recognise that long term best value should take account of individual quality of life and allow for exceptional circumstances

We support the idea that decisions should not be based solely on financial considerations. The quality of life of the individual should be a significant factor in determining the best type of care. It is essential that direct payments are adequately funded to make it possible for people to stay at home for longer.