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Section 6: INFORMATION, SUPPORT AND TRAINING

137. Section 5 considered how direct payments can be used by users to become PA employers. Section 6 looks at users' information, support and training needs.

Example: The importance of local user support

'Having a direct payment gives me peace of mind. I feel as if I'm in control of my life.'

Mr McPherson is 71 years old, lives alone and is registered blind. He wasn't happy with having lots of different care workers come to his home, some of whom had no experience of working with blind people. His social worker suggested direct payments may suit his needs better and he was allocated 16 hours per week.

He met with the local support agency worker to discuss a detailed job description and look at recruitment options. The support agency advertised the post and helped him arrange interviews and generally supported him throughout the process due to his visual impairment.

Currently Mr McPherson employs 2 regular members of staff and has another 2 workers he can call on. One is for holiday cover and one is available to take him out on occasional evenings. His current staff have been working for him for the last 4 years. They have built up an excellent working relationship enabling him to stay independent in his own home. He is happy that his staff do things the way he wants them done.

Mr McPherson uses the support agency to provide a payroll service and a checking system unique to him to give him maximum control but with safety measures built in. He has been a representative on the local direct payments working group for several years, having a say in future developments both locally and nationally.

Users' input into local direct payments procedures

138. Under the Local Government in Scotland Act 2003, local authorities have a duty to involve service users in the development and planning of any services they provide, including when preparing their Community Care and Children's Services Plans. This should include representatives of people who receive or are likely to receive direct payments, their carers, the local support organisation, and service providers. Local support organisations should be involved on a local authority steering group overseeing the local implementation and operation of direct payments, and helping to provide training for local authority staff. In addition, local authorities are required to carry out their functions under the Local Government in Scotland Act 2003 in a manner which encourages equal opportunities, and, in particular, the observance of the equal opportunity requirements.

139. Service users need to be involved in the design and development of self-directed care policies and procedures locally as this assists in their design to suit individual needs. Care should be taken to include the views of people with different needs, people from minority ethnic backgrounds and people of different ages including older people aged 65 or over who are assessed as needing care services due to infirmity or age, people with learning disabilities or sensory impairments or people who are mental health services users who may not previously have been offered direct payments. The views of carers and of potential service providers will also be important.

140. Whatever form the consultation takes, it is important that people who have been consulted receive proper feedback about what has happened, and how their views have been taken into account. It is also important that the lines of communication remain open, so that the local authority remains responsive to users' views over time.

Information

141. Direct payments must be included in information about the full range of services that local authorities provide, including at pre-assessment and assessment stages. More detailed information about direct payments must be made available separately in formats that are accessible to people with different forms of disability and to people whose first language is not English. Working in partnership with a local support organisation will help ensure that information is presented in accessible formats.

142. Direct payments can be difficult to explain neatly in a couple of sentences, and prior knowledge cannot be assumed of either direct payments or the care services that they replace. All local direct payments information must give details of the direct payments support available to people locally and nationally, as in addition to direct payments, some people may have little real knowledge about their current council services, how they operate, who pays for the services or who controls the spending. For this reason, it is cost effective for local authorities to provide funding for users to access pre-assessment support with a local user-led support organisation. This is one of the expectations of local authorities following the Spending Review allocation for 2005 onwards (see paragraph 159 on pre-assessment work).

143. The Executive expects to see information about direct payments in local authority Community Care Plans, Children's Plans and Partnership in Practice agreements (PiPs). ²¹ PiPs set out how the local authority will help people with learning disabilities and people with autism spectrum disorder to access direct payments. Local area co-ordinators will get to know people with learning disabilities and their families in their local communities and help identify their needs and ensure they are met, including using direct payments.

144. Various booklets, fact sheets and other information about direct payments are available from UPDATE and other national and local organisations listed in Annex B.

Support

145. Research ²² shows that developing a support system is a prerequisite of successful direct payment provision. A well-run local support organisation also reduces the work of the local authority. Support organisations work in partnership with users, local authorities, voluntary organisations, service providers and advocacy services to offer information and sometimes even practical services for service users, such as pay rolling systems for PA employers. In terms of both cost and effectiveness, independent living support represents best value to invest in over the longer term as it produces better outcomes for both direct payments recipients and local authorities.

146. Local support can help local authorities continue the annual average projected increase of 50% in uptake of direct payments for self-directed care packages across Scotland. In particular, they may be able to assist with reaching socially excluded groups who with the right information and support, may be able to take over responsibility for their own care. Local and national disabled people's organisations are currently the biggest source of expertise on direct payments, as the independent living movement was developed by disabled people.

147. Their experience of flexible and creative responses to individuals' support needs is invaluable for supporting other under represented groups. But to enable them to do this, local organisations need reliable local authority funding to increase their capacity and develop their services for all users. With appropriate funding direct payments support organisations that are led by users may be able to help build expertise into new and developing support organisations for specific user groups, such as older people aged 65 and over, or for minority ethnic groups.

148. Local authorities should also consider whether it would be helpful for other people to have access to the local support service. For example, carers may need advice about how direct payments work, particularly if they are assisting someone with managing the payments. People who are self-funding their services may also welcome the advice of a support service.

"Direct payments has had a positive impact on our lives! I would not have been able to achieve this without the help and support I received and continue to receive from my local centre for inclusive living ( CIL). They have supported me through the whole process and assisted me in all aspects of employing a PA from drawing up the job description to the contract of employment. Thankfully my local CIL takes care of the payroll side of things so I do not have to worry about the financial side. I know that if I have any questions or problems they are happy to help and if I am unable to phone I can e-mail them and I get a speedy reply." (Disabled parent, Edinburgh)

Why independent and user-led support?

149. It is Scottish Executive policy to promote the use of independent user-led support organisations operating at arms length to local authorities ( i.e. governed and staffed mostly by service users). Research confirms that it is this arms' length relationship that ensures that users' needs are best represented, training is provided that is targeted to local users' needs, and essential practical experience is shared amongst peers. As the funder of the direct payment a local authority is not necessarily best placed to provide this.

150. The relationships between local authorities and support organisations rely on effective partnership working. Advice and support should be accessible, impartial, independent and wherever possible, provided by people with experience of using direct payments. Such peer support is about the hearing of other people's experiences, exchanging practical information and ideas, and sometimes trouble shooting over a longer period to ensure things work for an individual.

151. Research has shown that if the experience of independent support organisations is used to inform the design and delivery of support services, it leads to higher quality, more relevant and appropriate provision. Access to information and advocacy is a key element of independent living - this should come from an independent source. Of this, peer support is particularly important - it allows people to share experience and learn from one another. Direct payments are about empowering users so that it makes sense that users should get support and training from organisations that are user 'led' and not 'for' users. User-led organisations promote the concepts of independent living based on the social model of disability. Local authorities encouraging early contact of clients with a support organisation have found it a cost effective way of allowing people to explore independently whether direct payments best meet their individual needs.

152. There is much work to be done to further develop the support organisations and the services they can offer across Scotland, and to truly bring them into the mainstream of direct payments care provision. Facilitating the set up of an external support organisation can be difficult and time consuming and some local authorities have struggled to find local user-led organisations who have the capacity to provide direct payment support services and who wish to take on the responsibility of this role. This has contributed to slow take up of direct payments in some areas.

153. Active networks can help build up steering committees to sit within non user-led support organisations or to form management committees that will form new support organisations. Some national as well as local direct payments support offer training in managing committees and using organisational improvement frameworks such as 'Big Picture Facilitators'. For further information see the UPDATE website for Five Steps - A Guide to Providing Direct Payments Support Services (2002) published by Direct Payments Scotland and fact sheet The Role of the Support Organisation.

154. Several local authorities in Scotland have in-house support services, which form part of the independent living services of the social work department and so are visible to care managers and senior staff. This can mean that in house support encourages social work staff to consider direct payments more frequently, and can account for higher numbers in some authorities.

155. It is important that authorities do not allow the lack of a user led support organisation to prevent the increase in uptake of direct payments. Ensuring that service users have training, and are fully aware of their responsibilities before a direct payment commences, can limit the problems encountered around employment law. If local authorities set up in-house support, then in issues relating to employment, they can refer the service user to Citizen's Advice, ACAS, and SPAEN.

Mainstreaming local authority funding of support organisations

156. Those local authorities which do not presently fund local support will be expected to do so from 2006 under the terms of the direct payments grant allocated expenditure made by the Scottish Executive, and in order to fulfil their legislative duty to offer direct payments to eligible people. It is imperative that local authorities arrange for people to have access to local support particularly in the early stages. Funding of this support should be part of mainstream direct payments financing activity at local authority level and not simply something to be managed on a temporary or ad hoc basis. The level of investment a support system needs will partly depend on the type of service provided. It also needs to be proportionate to the expected number of people receiving direct payments - the more people that receive direct payments, the more support workers will be needed.

157. The funding of support organisations is one indicator being considered for assessing local authority performance under the Joint Performance Information and Assessment Framework ( JPIAF).

What kind of support and when?

158. Support organisations may be able to offer users support at four key stages in the journey to self-directed care:

Pre-assessment

159. Many support organisations do not yet have a remit for publicity or promotion of direct payments under the funding terms they have with their local authority. Local authorities have a duty to inform users of options for self-directed care and should see the funding of local support as key to this. Support organisations need an agreement with their local authority that they can accept self-referrals by people thinking about self-directed care. Support offered to a user before a local authority needs assessment may help clarify what an individual's needs are (self-assessment), what it may be practical to expect in terms of the level of care they may receive, and whether self-directed care may be worth further exploring to meet these needs.

160. Support organisations also have an important role in exploring how relatively small adjustments to a direct service from a local authority may meet some users' needs better than self-directed care.

Care Planning

161. After a care assessment, users need to make informed decisions about direct payments options to meet their assessed needs. They may need particular support and training when they first take on responsibility for managing their own services. They may need advice and help with contracting agency support, and those who are becoming PA employers for the first time may need access to someone with expertise in employment issues, or to a payroll service which will assist them with tax, National Insurance or other matters. Support services can also arrange essential training for PAs and local authority staff on self-directed care (see section 6).

162. Some support services may also be able to help with drafting advertisements, job descriptions and contracts, provide rooms for interviews and assistance with interviewing, or act as an address for responses to advertisements. Additional enhanced support options may be externally based, for example, emergency back up, reliable payroll services, peer counselling, advocacy, outreach projects such as to rural users, or those from minority ethnic backgrounds.

Setting up the care package

163. Depending on individual circumstances and local funding options, a care package involving direct payments may take some time to put in place, particularly where service is achieved via a mixture of local authority services and self-directed care from local and central funding streams. Also, whilst experiencing council services over this period, some users may decide that direct payments are not for them or that small adjustments to a council services would meet their needs equally well or better.

Managing care

164. Support organisations play an essential role in helping people to manage direct payments for self-directed care once an initial package is in place, and in making adjustments to care delivery, during a learning curve of widely varying gradients for different individuals. It is best practice that local authorities provide access to a minimum of one day's external training for users as well as PAs they may decide to employ. Local authorities should also fund local pay rolling services as part of the direct payments care package. This practical support may enable a greater number of users to manage their own care.

Funding of essential direct payments training

165. Local authorities are expected to fund essential direct payments training for users and PAs under the terms of the direct payments grant allocated expenditure from 2006 onwards. To strongly encourage take-up of these training opportunities, local authorities should fund user training separately from the hourly direct payment rate, whether by ring-fencing funds per individual, or funding provided via the local support organisation (particularly for pre-assessment work). Direct payments recipients use tax payers' money and should have training obligations placed on them. Such training should be accompanied by a voluntary code of practice established for direct payments users through partnership working with peer-led support organisations.

166. Local authorities will need to fund the following essential training through local support organisations:

• Direct payments users: the philosophy of independent living and the expectations of support that arises from it for users
• Agency users' training that should include: how to shop around agencies; better control of agency care provision; how to set up effective contracts; use of agencies in respite and emergency cover situations; supervision of agency staff.
• Training for PA employers that should include: training on safe recruitment, employment, management and retention of PAs (for example health and safety and other employment law), including so-called soft skills which are essential to short and long term relationship building and retention of staff (for example being a good boss, supporting, supervising and developing your staff). Other useful training might be undertaken as part of supporting care management in the first and subsequent years, such as: disability equality training; assertiveness skills; building self-esteem; managing conflict; self-advocacy.
• PA training that should include: the philosophy of independent living and the expectations of caring that arises from it for users and PAs; first aid; moving and assisting; training for any continuing health care needs such as certain aspects of diabetes and epilepsy.
• Once essential PA training is complete, it is for users to provide further training of their PAs according to their personal needs. This is part of establishing expectations for employer and employee of working arrangement and building the working relationship.
• Training for those who carry out local authority care assessments, care management and finance staff involved in the monitoring of direct payments. Training should include elements such as the: philosophy of independent living and the expectations of caring that arises from it, importance of income maximisation, Independent Living Fund, Supporting People grant and other funding sources which may be available to purchase care and support in the home, in the community, in education or in the workplace.

National support for direct payments

167. In addition to help available locally, some national bodies have an important role to play in supporting users. Some of the larger independent living support organisations such as Lothian Centre for Integrated Living, Glasgow Centre for Inclusive Living and the Scottish Personal Assistant Employer's Network ( SPAEN) have well established training programmes which can be purchased throughout Scotland for users, PAs and local authority staff. Such organisations are crucial in capacity building the network of local support organisations so that they can deliver quality and consistency in the training available locally. They are also there to provide information and services. Independent living options are about choice, and there should be a choice of sources and types of information available for users to take account of individuals' as well as different user groups' needs.

168. For example, the centres for integrated living may be able to provide a range of services that include an independent, impartial advice and information service, independent living advocacy, peer support and counselling, disability equality training, housing information, employment and training support services, accessible meeting and conference facilities, assessment of community care services, outreach skills, campaign, policy and local development work. This is in addition to direct payments services such as training, help recruiting PAs, and pay rolling services. See Annex E for contact details.

169. SPAEN is a national support organisation offering advice, support, advocacy and training on the practicalities of PA employment procedures including all aspects of safe recruitment, the drafting and issuing of terms and conditions of employment, and the day to day personnel management of employees. Their coaching and development programme explores real life scenarios and the expectations that PA employers and their staff have of each other. Underpinning SPAEN's services is an employers' indemnity scheme that gives employers' insurance liability and access to a comprehensive system of personnel and employment law advice. SPAEN is also a registered body for vetting enhanced disclosure checks (see Annex D for contact details).

170. Other organisations and projects offer targeted help for different user groups. For example, at present approximately one third of direct payments recipients are aged 65 and over. To reach even greater numbers of older people, the Scottish Helpline for Older People ( SHOP²³) is a consortium of key organisations working to improve information on direct payments for older people. The Scottish Consortium for Learning Disability ( SCLD²⁴) has produced a guide on receiving direct payments for people with learning disabilities. Social workers and GPs should be able to approach their professional organisations for referrals elsewhere and ACAS and others have a training role targeting various client groups and professional bodies. See Annex E for contact details.

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