Invitees

Cllr P White - Cabinet Member Adult Social Care Health and Wellbeing

Susan Cooper Corporate Director – Social Services and Wellbeing

Jacqueline Davies - Head of Adult Social Care,

Mark Wilkinson - Group Manager - Learning Disability

Judith Brooks - Group Manager - Business Support

Councillor D Sage left the meeting for the Direct Payments Item as he had earlier declared a prejudicial interest as he is in receipt of Direct Payments.  Councillor P Davies chaired the meeting for this item.

The Corporate Director Social Services and Wellbeing gave a report to Committee of the current situation with the provision of Direct Payments and the plans for the development of the use of Direct Payments in line with the implementation of the Social Services and Wellbeing (Wales) Act 2014

She explained that Direct Payments were cash payments made to a person who was eligible for care and support from social services, to enable them to arrange and pay for their own care and support.  Direct Payments were a different way of delivering social services responsibilities where there was an assessed eligible need.  The main purpose of Direct Payments were to give people:

• Flexibility over when their care was provided and the exact nature of the care. 
• Choice and control over who they have caring for them and the standards and quality of that care.

A Member asked what percentage of payments made were paid to employ personal assistants.  The Group Manager Learning Disability stated that payments were made monthly and that on average £14 an hour was paid to personal assistants however this could vary a lot depending on what providers were used.

A Member queried the process where service users had not fully utilised their payments.  The Group Manager, Learning Disability advised that payments were regularly monitored and instances where payments had not been used the Authority had reclaimed the amount and there had also been instances where the monthly payments had been reduced as a result.  He added that invoices were submitted by recipients of Direct Payments to detail how the funds had been spent.

Members queried how often payments were made and how robust the process was.  The Head of Adult Social Care stated that payments were made in advance on a monthly basis to enable service users to pay their employees in a timely manner.  She added that payments were reviewed regularly and adjustments made to payments where required.

A Member was concerned at the complications that came with the Direct Payments in that those in receipt of them would become an employer and questioned what support was available for them to manage the process.    The Head of Adult Social Care advised that when Direct Payments are taken up there is a lot of discussion with the recipient about their responsibilities as an employer and support and advice relating to banking and tax as well as their specific needs to determine the package of care they require.  She added the process is closely monitored and reviewed on an annual basis. 

A Member raised concerns regarding the funding for the contract of a service provider.  The Group Manager Learning Disability stated that the contract would be for three years with the option to extend and that the contract included £100k staffing costs.

Conclusions

The Committee noted the report, which provided Members with an update on the current situation with the provision of Direct Payments and the plans for the development of the use of Direct Payments in line with the implementation of the Social Services and Wellbeing (Wales) Act 2014.

Members asked how it was assessed where the Direct Payments were to be spent as in some instances visits to sporting events had been proposed.  The Head of Adult Social Care stated that there is a case management process in place for each person in receipt of Direct Payments and from that there are clear outcomes with clear responsibilities for Wellbeing.  She added that during the process they consult with the individual, their family members and their GPs to determine the best care package for their requirements whilst ensuring that they were promoting choice for the individual. 

Members asked what suitable safeguards were in place for people in receipt of Direct Payments that had a dependency on drugs or alcohol.  The Group Manager Learning Disability stated that they would not make cash payments to a person with a dependency on drugs or alcohol as this could potentially add to the problem.  He added that mechanisms were in place for monitoring the provision of payments.  

• Members asked what percentage on average of Direct Payments paid to individuals was used to employ a Carer. The Officer responded that most people employ a Personal Assistant at a payment of approximately £14 per hour.
• Members queried the process applied where an individual has not used all of their payment.  The Officer responded that the payments are monitored and that where payment has not been used or used inappropriately the payment may be reduced and that there have been instances where this has happened.
• Members queried how robust the monitoring of payments was, the Officer responded that this was carried out regularly and that a balance had to be struck between encouraging individuals to self-manage the payments and ensuring that checks are carried out appropriately.
• Members raised concerns regarding the funding, scope and length of contract for the commission of a service provider.  The Officer responded that the contract would be for three years initially with the option to extend and that the contract includes staffing costs.
• Members raised concerns regarding the competitiveness of the offer from BCBC compared to other providers.  The Officer responded that there is a need to raise awareness of the benefits and advantages of Direct Payments for individuals, for example via social workers, and that in future the service provider would be responsible for explaining this to potential clients.
• Members queried several of the new additions to the legislation and guidance and asked what the ‘suitable safeguards’ referred to in the requirement to enable individuals with a drug or alcohol dependency to request payments with suitable safeguards meant.  The Officer responded that an alternative to cash payments could be an option where there may be a potential for payments to be used inappropriately by an individual. 
• Members raised further queries regarding the apparent tension between prohibiting local authorities from stipulating how payments should be used and the requirement for ‘suitable safeguards’ in the case of people with drug or alcohol dependencies.  The Officer responded that mechanisms for monitoring needed to be in place to ensure that the Authority is carrying out the provision of payments as required by the Act.
• Members queried how assessments were carried out regarding the potentially large and diverse variety of activities may qualify for payment, for example where individuals have proposed activities such as visiting sports events or massage sessions.  The Officer responded that new methods of assessing and evaluating requests need to be developed.

• Members requested that this item be revisited in future and that reports include information on how the payment system is being monitored, how outcomes for individuals are being identified and monitored andthe type of activities being requested by individuals to enable them to achieve their personal outcomes.

Further information requested

• The Committee requests further information in the form of case studies to enable them to understand how the system works and how accessible the paper work and application forms are.  The request for case studies is as follows:

1.    A client with few needs - how their needs are assessed, the paperwork that has to be filled for direct payment, typical rate of payment, how the payment is paid and the outcomes for the client.

2.    A client with greater needs - how their needs are assessed, the paperwork that has to be filled for direct payment, typical rate of payment, how the payment is paid and the outcomes for the client.

3.    A client who has not used all of their payment and therefore has to reimburse, how this was discovered and if and how this has impacted on wellbeing outcomes for the client.

• The Committee requests further information on the criteria for a ‘suitable person’ when assessing applications for payments.