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5. LOCAL AUTHORITY APPROACHES TO SDS

National Guidelines

5.1. The guidance issued by the Scottish Government in July 2007 identified a number of key interventions that local authorities could pursue in order to increase SDS take-up. This was statutory guidance, issued under Section 5(1) of the Social Work (Scotland) Act 1968 and it identified some specific tasks for local authorities to fund. These are:

• A local support service which, where possible, should be independent and user led
• Early involvement of individuals with the local support service to assist with self assessment and care planning
• Other essential training for individuals on SDS, and training of personal assistants ( PAs)
• All basic costs within a PA employer's package, where appropriate
• Designated SDS lead officers or teams within each local authority
• Training on SDS for care managers, finance managers and local authority directors
• Enhanced disclosures for PAs employed by individuals on SDS
• Legal support for PA employers where appropriate, eg. indemnity insurance
• Packages during PA employers' short stays in hospital, where appropriate
• Payments for SDS on a gross basis and to recover the individual's contribution later

5.2. Each of the three fieldwork sites has adopted a different way of implementing this guidance and this section of the report provides a brief outline of the measures that are in place in each. A more detailed explanation is also set out in the relevant appendices.

5.3. It is also worth noting that there are no national eligibility criteria for community care services and so, in all three sites local criteria are used to determine whether adult clients are eligible for a service, through SDS or otherwise. It is also the case, in all three sites, the way in which eligibility criteria are applied means that clients must have critical needs in order to qualify for community care services.

Uptake and Value of Direct Payments

5.4. Across Scotland in 2006/07, the latest year for which published data is available, a total of 2291 people received a direct payment. This equates to 4.5 per 10,000 population, although the average conceals a range between individual local authorities from 1.1 to 22.8. One of the fieldwork sites, Edinburgh, matches this average take-up rate and the other two both exceed it with Fife having a take-up rate of 8.6 and Scottish Borders, at 10.6, the highest of the Scottish mainland local authorities.

5.5. Table 5.1 below illustrates the scale of direct payments in the three fieldwork sites in 2006/07 compared with the Scottish average.

Table 5.1 The scale of Direct Payments in the 3 fieldwork sites

5.6. The growth in the total value of direct payments in each site and in Scotland as a whole is illustrated in the following chart. It should be noted that the figures cover direct payments only and that the slower relative growth in Edinburgh reflects the fact that they had already achieved a relatively high take up rate by 2001.

Figure 5.1 Indexed growth in value of direct payments 2001 to 2007

5.7. During this review, across the 3 sites, the most commonly cited barriers to increasing the level of DPs, were the difficulties associated with releasing funds from block contracted services and from building based community care provision.

Scottish Borders Council

5.8. The use of direct payments in the Borders has grown significantly in recent years and there is a clear commitment at the highest levels within the local authority to develop multiple funded packages of support as a core aspect of moves to develop more personalised services.

5.9. Lead responsibility for Direct Payments within Scottish Borders Council ( SBC) rests with a Social Work Policy Manager, as part of their wider policy remit. A dedicated budget is available which is used to fund the Direct Payments Agency ( DPA), Care Resource Team staff time, an ILF worker, DP training and senior management support time.

5.10. Social workers/care managers have a pivotal role in identifying potential SDS clients and starting the process of informing and involving clients in deciding whether it is the best solution for them. Individual social workers will have a varying amount of exposure to SDS clients during their career and interviewees in the Borders noted varying levels of knowledge and awareness amongst workers across the area.

5.11. A central Care Resource Team monitors the DP quarterly returns that are initially submitted by SDS clients to the DPA, and undertakes billing and financial assessments for residential and home care services, amongst other tasks. A finance manager and finance officer are involved in periodic reviews of DP spending levels.

5.12. In addition a dedicated ILF worker is based in the Welfare Benefits Section. This person's role is to promote and support take-up of ILF, following evidence from the DPA of significantly lower than average claims rates in the Borders. By promoting the take-up of ILF it is hoped to encourage recipients to consider taking on a DP as well, instead of continuing to receive a delivered service or a restricted level of service in their home.

5.13. Relevant local authority staff members are involved in individual case discussions with the DPA if any issues are identified by the Agency as requiring attention. In addition a Direct Payments Working Group meets on a 2 monthly basis to discuss relevant policy and operational issues. This group brings together all of the major stakeholders in the Borders, including representatives from unscheduled care and primary care health services.

5.14. Following assessment, local eligibility criteria are used to determine whether adult clients meet the criteria for a service to be provided. Currently, clients must have critical needs in order to qualify.

5.15. There is no waiting list for adults wishing to be considered for a DP but aspects of the services that they are assessed as requiring may be subject to a waiting list, as they would be for any other clients.

5.16. DPs for children are also based upon a needs assessment but applications are not subject to eligibility criteria and are therefore accepted from across the full spectrum of needs. DPs for children are funded from a fixed budget and there is a waiting list of children assessed as needing a DP, because the annual budget has been allocated.

5.17. Information on the total size of individual support packages is not collated centrally, but is instead held in individual client files within local social work offices. The absence of an up-to-date picture of overall SDS values appears to reflect a current focus locally upon DPs as the principal means of achieving independent living for clients, rather than the full range of funding streams available for clients.

5.18. As an independent voluntary body, the DPA operates under a contract with Scottish Borders Council. It advises and supports prospective SDS clients to make informed choices when they are considering setting up SDS, identifies and organises the necessary resources and negotiates with providers if necessary.

5.19. The Agency's ongoing support to SDS clients comprises a payroll service for SDS clients to ensure that their PAs are paid the correct amount, on time, which the great majority of clients make use of, and advice and practical assistance relating to employment contracts, staff recruitment and related documentation concerning terms and conditions of service for employed PAs.

5.20. In addition the DPA is responsible for receiving and monitoring quarterly financial returns and bank statements from SDS clients and discussing with SBC appropriate actions or advice regarding specific issues relating to the use of funds. Clients are required to have separate bank accounts for DPs and other public funding streams.

5.21. The DPAs funding year on year is usually based upon the previous years plus an inflation uplift and does not reflect a pro rata allocation relating to the number of clients supported. Individual cases were said to present very different ongoing time demands upon staff after their package is initially set-up and as SDS numbers have risen, interviewees reported that resources were becoming ever more stretched.

5.22. Further information about SDS arrangements in Scottish Borders is contained in Annex Five.

City of Edinburgh Council

5.23. The creation of a central Funding Independence Team( FIT) has established a strong focus for SDS activity in Edinburgh which was held in high regard by clients. The extent and quality of the FIT's information regarding the overall funding situation across the City was felt to constitute a key tool in enabling it to understand and provide leadership to the development of SDS in the area.

5.24. The team is comprised of knowledgeable and experienced staff members who have worked in the field for many years and who, on the basis of evidence from this study, collectively and individually was reported to carry the respect of all key stakeholders in the area.

5.25. The team is perhaps most effective in promoting and supporting SDS clients, through its work negotiating with other funders to find solutions for individual clients. It is able to use the knowledge gained from this work to inform its approach to wider system issues and thereby further enhance the quality of the available support for clients.

5.26. The FIT also collects quarterly monitoring returns and bank statements from all SDS clients in order to demonstrate that funds are being spent on the commissioned service. The volume of this work dictates that it focuses upon ensuring general compliance with the relevant rules rather than highly detailed auditing of accounts.

5.27. Social workers are responsible for assessing people with care and support needs and, in so doing, for identifying those who may benefit from SDS.

5.28. New SDS applications are considered monthly by the local authority's senior management team where the local authority's care service eligibility criteria are used either to approve or reject cases. At present the local authority is only providing a service for clients who are considered to have critical needs. As a result although there is no waiting list for SDS applications, some of the services within an SDS package may not be immediately available and will therefore be subject to a waiting list.

5.29. A Complex Care Panel provides a forum for social work and health representatives to consider their respective contributions to individual packages and resolve any issues that emerge. It considers cases as part of the process of initial scoping and set-up in order to review ongoing arrangements that may need to be altered due to changes in a person's assessed needs.

5.30. The local SDS support service is provided by the Lothian Centre for Independent Living ( LCIL) along with independent living training and a disability information service. The LCIL is an independent, user led body which provides SDS support under a Service Level Agreement with the local authority. LCIL's ongoing support to clients involves helping them to access DPs, liaising with social work, PA recruitment, (including use of a dedicated telephone line), employment advice and supporting clients in handling relations with care agencies. It also provides a payroll service and prepares clients' Inland Revenue returns.

5.31. The Centre is finding that an increasing number of clients are on the margins of being able to manage SDS with support or falling within the remit of Adults with Incapacity legislation. These cases can present particular challenges to those involved in supporting access to SDS and over time, can require significant ongoing support from LCIL to sustain the SDS arrangements. As a result of the changing profile of clients and constrained funding LCIL is finding it increasingly difficult to offer an equitable service to all clients.

5.32. As the volume and complexity of the support service's work has increased and local authority funding has remained static it is reported to be increasingly difficult to maintain the quality of service, in particular telephone access to case workers was reported by clients as being less available than had previously been the case.

5.33. Further information about SDS arrangements in Edinburgh is contained in Annex Five.

Fife Council

5.34. There has been significant growth in the use of direct payments in Fife and there is a clear commitment to developing them further as a key component of the basket of community care services available.

5.35. Fife Council's Direct Payments Team is an in-house operation that provides support to SDS clients of all ages. The team has a critical role at various stages in the SDS process including raising awareness, training social workers, arranging packages, supporting clients and monitoring clients' expenditure returns.

5.36. Its ongoing support to clients includes operating a payroll service, referring them to third party agencies if necessary and attending service reviews.

5.37. Following an assessment of their needs by a social worker, relative to the local authority's eligibility criteria, a client's suitability for a direct payment will also be considered. If a client is approved for a care service, further discussions will be held involving the DP team and other services, to determine the most suitable service mix and arrangements.

5.38. Associated with the DP is a service agreement which incorporates the client's care plan. This explains how they can use their DP, the support they can expect from the DP team and what they have to do to ensure the package runs smoothly. A separate bank account for the DP/ ILF funds is a requirement and the DP team will help clients to set up such a bank account if necessary.

5.39. Many clients reported that the service offered by the DP team is invaluable to them. They are seen as helpful and approachable and make the task of being an employer much more straightforward. In particular, clients who described their memories as not being so good appreciate being reminded of the timing and amounts of the payments they have to make.

5.40. Access to direct payments for children and young people is slightly different in this area in that a Fife wide team which works with children with a disability has a budget for direct payments which is separate from their other budgets.

5.41. Further information about SDS arrangements in Fife is contained in Annex Five.

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