Direct payments, personal budgets and, to a lesser extent, individual budgets are at the core of the government’s aim of personalising adult social care services around the needs of users. Through the Putting People First initiative, councils will be expected to significantly increase the number of people receiving direct payments and roll out a system of personal budgets for all users of adult social care, from 2008-11. In the long-term all users should have a personal budget from which to pay for their social care services, apart from in emergencies

The Department of Health is driving the Putting People First initiative, but scepticism remains among practitioners and social care leaders about the impact of personalisation on social workers’ roles, on levels of risk carried by service users and about whether councils will be adequately resourced to deliver reform

Direct Payments are cash payments given to service users in lieu of community care services they have been assessed as needing, and are intended to give users greater choice in their care. The payment must be sufficient to enable the service user to purchase services to meet their needs, and must be spent on services that users need.
Like commissioned care, they are means-tested so assume that, in many cases, people will contribute to the cost of their care.
Direct payments confer responsibilities on recipients to employ people or commission services for themselves. They take on all the responsibilities of an employer, such as payroll, meeting minimum wage and other legislative requirements and establishing contracts of employment.

Some of these services can be contracted out and many councils have commissioned support organisations to help service users handle these responsibilities

Personal Budgets are an allocation of funding given to users after an assessment which should be sufficient to meet their assessed needs. Users can either take their personal budget as a direct payment, or - while still choosing how their care needs are met and by whom - leave councils with the responsibility to commission the services. Or they can take have some combination of the two.
As a result, they provide a potentially good option for people who do not want to take on the responsibilities of a direct payment

Individual Budgets differ from personal budgets in covering a multitude of funding streams, besides adult social care: Supporting People, Disabled Facilities Grant, Independent Living Funds, Access to Work and community equipment services.
The government has only called for the roll-out of personal budgets - not individual budgets. The latter were piloted in 13 areas until the end of last year and an evaluation on the pilots is due out this summer
The Commission for Social Care Inspection said that of 661,000 older people receiving community services in March 2008, just 3% were receiving direct payments.
Relatively low take-up has been explained in two ways – the reluctance of local authorities to promote direct payments and bureaucratic barriers they place in the way of take-up; and reluctance on the part of service users to take them up due to the real or perceived burdens they bring.
On the latter point, the introduction of individual and personal budgets has been designed to reduce people’s reluctance to take control of their care by lowering the demands in terms of employing and managing people.

However, a 2004 report by the Commission for Social Care Inspection found many barriers originated from councils including:

• Lack of information for service users.
• Low staff awareness of direct payments and what they are trying to achieve.
• Patronising attitudes on the part of staff about the ability of people to manage a direct payment.
• Inadequate or patchy advocacy or support services for direct payment users.
• Unnecessary and bureaucratic paperwork.

There is no doubt councils are getting better on direct payments but the step change in take up demanded by government and independent living activists has not happened yet.

Cost

One potential reason for this is the cost of direct payments. A report by the Audit Commission in May 2006 found direct payments were a net cost for each of 10 councils studied.

While savings were made through service users taking responsibility from care managers for finding and administering care, the research found that these were more than offset by the costs of supporting users and providing training to staff.

It suggested that the only way councils could save money was by making the value of direct payments lower than the price of an equivalent level of commissioned care. However, in practice this may not penalise service users because they may be able to buy in services at a cheaper cost than councils by using smaller agencies or family and friends.

When councils commission providers they typically have to pay a premium to cover management and infrastructure costs.
However, research from the In Control programme has suggested that giving users control over their own care can save money overall.

Risk

Another key issue in the direct payments debate is around risk. Independent living activists have long argued that to have true independence, service users should be able to employ who they want to care for them.

Adult protection campaigners, while admitting the importance of independence, have argued that people employed as personal assistants should face the same employment checks as others to ensure users’ safety.

Currently there are no plans to force direct payment users to submit those who they employ to checks. The government resisted attempts to impose checks through the Safeguarding Vulnerable Groups Act 2006, which will create a vetting and barring scheme for people working with adults and children in October 2009.
The vetting and barring scheme will apply to England, Wales and Northern Ireland, but different arrangements apply in Scotland, under the Protection of Vulnerable Groups (Scotland) Act 2007. This specifies that councils have the right to withdraw a direct payment from a service user if they do not employ only staff who have undergone an enhanced disclosure check.

People hired by directly direct payment users will also not be covered by service regulation so will not be liable to assessment by CSCI or its successor body the Care Quality Commission.

The debate in the rest of the UK is unlikely to die in a hurry. At the Association of Directors of Adult Social Services spring seminar in April 2008, CSCI chief inspector Paul Snell warned that personalisation would create new safeguarding challenges and direct payment recipients would need to receive the same level of support as others receiving council-commissioned care.

A study by Skills for Care, published in June 2008, found that almost half of a sample of direct payment users did not carry out CRB checks when hiring personal assistants they did not know, while 46% failed to seek references.

At the same time, the General Social Care Council announced it would consult on whether personal assistants should be registered, along with domiciliary care staff, when the social care register is opened up to this group, which is expected in 2008.
This would provide the first element of regulation of personal assistants, though it is unclear as yet whether making it compulsory for service users to employ registered PA is on the agenda.

Views of social workers

A Community Care survey of 600 adult social workers, published in October 2008, found a lack of knowledge among practitioners about individual budgets and personal budgets, along with concerns about risk.

Only 17% felt well-informed about the concept of personal budgets and just over 20% felt the same about individual budgets.
Social workers also showed strong support for regulating care staff working for service users with direct payments or personal budgets, with over 90% backing compulsory Criminal Records Bureau checks, which are currently voluntary.

Expansion of personal/individual budgets

While individual budgets have traditionally been associated with the Department of Health, two other government departments have also moved into this territory.
In October 2008, the Department for Children, Schools and Families confirmed it would run pilots to provide individual budgets for disabled children and their families, from 2009-11. In November 2008, In Control called for disabled children to have access to individual budgets covering social care, health and education funding.
Meanwhile, the Department for Work and Pensions promised in December 2008 to legislate to give disabled people the right to control much of the funding spent on them by government.

This will be included in a Welfare Reform Bill due for publication in January 2009. It is unclear what the relationship is between the DWP’s “right to control” concept and individual budgets.

Key differences appear to be:-

• While individual budgets were focused on social care service users, the government said the “right to control” would be for all disabled people receiving relevant state funding.
• The evaluation of the individual budget pilots identified significant barriers to integrating funding streams, including legislative obstacles. The Welfare Reform Bill will aim to tackle these.
• It will enshrine choice and control over support funding as a right for service users.
• It may cover funding streams not covered by individual budgets, though not cash benefits.

Meanwhile, legislation on the health service in 2008-9 will enable people using health services to receive direct payments. This will enable the Department of Health to take forward plans to pilot personal budgets for people with long-term conditions.

Our employed staff and agency workers are fully skilled in providing 24 hour care to those who may experience the following frailties or illnesses:

•    Physical Disabilities
•    Palliative Care
•    Short–term memory loss
•    Mental Health Difficulties
•    Dementia-related conditions
•    Learning Difficulties
•    Intermediate (Short Term Intensive) Care conditions
•    Sensory/Dual Sensory Impairment needs

Or we offer support to those who may simply need companionship, help around the house or with some care and mobility assistance.

Live in care and holiday support services may be provided by either an employed social/health personal care assistant or the ‘Introduction’ of a self-employed social/health care worker enabling a best value approach for the service user so you may continue to live in your own home or travel, secure in the knowledge that assistance is available at anytime.  The key people we recommend will be equipped with the appropriate skills for your requirements.

How much will the service cost?

This is dependent on the agreed outcomes of the service. Our self-employed Live In ‘Introduction’ service normally begins at £497.00 per week for companionship duties; which includes the agreed social/health care worker salary (paid directly by you to the social care/support worker) and our administration fees.  You can negotiate a lower cost directly with the care worker.

What part of UK do the services cover?

To provide the best quality tailored care we restrict our service to London, Wiltshire, Bournemouth and Dorset, Bristol and Somerset, Plymouth, Devon and Cornwall; that is the South and South Western Counties.

How do we select and train our staff and self-employed workers?

We have a full 5 day Interview and Induction Training week, obtaining and checking two written references, provision of an Enhanced Disclosure (CRB) checked against the PoVA and PoCA lists, further checks take place to ensure the candidate complies with all relevant employment regulations such as the Asylum and Immigration Act and Working Time Directive; and if working as self- employed we have firm confirmation of correct status. Training & Development certificates and records are kept up to date by the requirements of our organisation.

Our sister training organisation follows an extensive and comprehensive ‘Skills For Care’ common induction training and development programme for all employees and agency workers: which also encompasses the organisations beliefs such as service user respect, choice, dignity, privacy and the promotion of independence.

Over 70% of our care and support staff are at least NVQ Level 2/3 Health & Social are qualified.  Our rigorous selection  and training procedures are well known & documented within the organisations Policy manuals.

How does Sunshine Care support you?
Service users are provided with the organisations comprehensive ‘Complaints Guide’ on commencement of the service and are encouraged to speak to any member of administration staff regarding issues or concerns. We acknowledge that occasionally things may not go as planned. We encourage feedback from our service user’s regarding any issues.  We will act swiftly to correct anything that goes wrong, continuously learning from you and your feedback.

Following the successful introduction for self-employed live in care services the social/health care worker becomes an employee of the service user and not the organisation the service user would be responsible for the guidance, supervision and control of their own care and support staff .

Whilst the organisation promotes best outcomes and encourages best practice and compliance with policies and procedures at all times to its workforce; as a self-employed social/health care worker it is the service user and not the organisation who the worker must look to for direction control and supervision.  The organisation has developed comprehensive policies and procedures for the protection of the service user which can be requested at any time.

The social/health care worker should not be encouraged to have family or friends to visit them at a service user home without permission from the service user and their family.  We recognise that the relationship between service user and social/health care worker is an intimate one and should be built on trust and honesty.

For self-employed Live In introduction services the social/health care worker remains under the direction control and supervision of the service user at all times. The client is responsible for payment of wages to the self- employed social/health care worker and the appropriate agreed administration fees, four weeks in advance, to the organisation.

Sunshine Care, who pride themselves on having successfully provided in-house training for many years, will be launching their new E-Induction programme, which we hope will show the huge advantages of e-learning:

Convenience: Traditional offline training normally means employees need to collectively leave the workplace; this is not the case for e-learning.
Cost: E-learning is much more cost effective as learning can be done one candidate at a time.
Time: E-learning allows you to undertake your training whenever and wherever you want.

We will be joining a number of leading care organisations who have recognised these advantages and who have recently introduced e-learning into their training.
Sunshine Care will be gradually introducing more short Health & Safety and Social Care training courses into our e-portfolio.  These will be offered out to other local care agencies and care homes as part of the new range of services offered by their new sister organisation, Sunshine Care Training Ltd.

For more information on the act and how it may effect you please click here.

In November, the Government launched a consultation on the future of adult safeguarding in England, focusing on the protection of vulnerable adults within the care system.

The No Secrets guidance which is currently in place for local authorities, the police and the NHS to helps protect vulnerable adults will be addressed, as the government now wants to ensure it keeps up with changes in the social care system, with emphasis on choice, control and the changing forms of abuse.

The key issues the government will focus on include:

·    Whether there is now a need for legislation
·    The feasibility of a national database of recommendations from serious case reviews where abuse has occurred
·    What new measures are needed in the face of increased ‘personalisation’ of care with more people now being in charge of their own care instead of local authorities
·    What new measures are needed in the face of changing forms of abuse, such as financial abuse

Care Services Minister, Phil Hope said:

I am determined to improve safeguarding of vulnerable people. We need a greater focus on prevention, a greater emphasis on safeguarding in commissioning services and support, and greater empowerment of people to determine how they wish to be safeguarded. The No Secrets guidance must be updated to make sure everyone - individuals, police, care agencies, the NHS and local authorities prevent abuse, and also recognise it and stamp it out if it does occur.

As we age, some of us find it difficult to cope with domestic responsibilities and our own personal care needs. Our service is designed to provide care in our customers own homes on a one-to-one basis.

Our team of highly trained and experienced specialist staff provide care for people who may be physically frail or housebound, in the comfort of their own home, whilst maintaining their dignity.

We employ loving and compassionate staff who have a genuine interest in the mental, emotional and physical well being of those they look after.  Our committed staff enable us to provide a community care service of such high quality that we are seen as the first choice provider by many social workers, district nurses, doctors and care managers.  We endeavour to provide that little bit extra to enhance the lives of the vulnerable and elderly who are finding it difficult to cope on their own.

All our staff are police-checked, regularly supervised, well-supported and trained to an exceptionally high standard.  Delivering a consistent quality service is our priority and we ensure this high standard by careful recruitment of the best care support staff we can attract and the ongoing monitoring of their performance throughout their employment.

Sunshine Care provides care for a variety of people, each with their own specific care needs, and so match your requirements with the skill sets and personalities of our care support staff.

A Service User Care Assessment and Care Plan is produced through consultation with each client to ensure we gather accurate information about care needs, wishes, preferences and personal goals.

There may be many reasons why you are looking at care options. You may be looking for a friend, family member or yourself. You may find that a little support is needed with those tasks that are becoming more difficult, or because of restricted mobility through an accident or illness. It may be that your needs aren’t just for personal care, you may need a companion and a housekeeper too.  Whatever your needs may be, Sunshine Care can help, please call us on 0845 2600670

Direct Payments are an alternative way of providing social care services to those people who need support to live independently in the community. Following an assessment of needs and an agreement that eligible needs will be met, South Hams Social Services will give people the choice of having social care services arranged for them or trying a Direct Payment.

Basically, a Direct Payment gives individuals requiring social care support the opportunity to arrange and pay for it themselves. Being able to arrange and control services to meet eligible needs means people can organise their lives flexibly on a day-to-day basis. It also means that people have a bigger choice in how to meet their eligible needs.

Where can I go for help
Contact for Devon
Care Direct: 0845 1551 007
www.devon.gov.uk/

Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapattis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.

The symptoms of hypoglycaemia can include:

•    headache,
•    mental confusion (which may include aggressive behaviour),
•    slurred speech,
•    abnormal behaviour,
•    loss of memory,
•    numbness,
•    double vision, and
•    Temporary paralysis and seizures (fits).

If you are hypoglycaemic, you may also experience trembling, faintness and palpitations, and excessive sweating. Sometimes, behaviour can be irrational, and disorderly, and may be mistaken for drunkenness.

Where can I get advice?
www.diabetes.org.uk 
www.bda.uk.com (British Diabetes Society)
Tel 0121 200 8080
Fax 0121 200 8081

I am sure that many of us will welcome the opportunity to help vulnerable neighbours to avoid some of this winter’s dangers.  Without causing alarm, we would like to increase awareness of the symptoms of hypothermia, and we feel that it is important to encourage older people to claim their full range of benefits, and to spend their winter fuel allowance wisely so that they increase their spending on keeping their homes warm.

Hypothermia is caused when the body’s core temperature falls below 35ºC.  The signs and symptoms can be:

•    Shivering at first, muscle stiffness as the body gets colder.
•    Skin cold to touch and pale in colour.
•    Confusion and low response levels, which can lead to unconsciousness.

Generally it is best to wear several layers of thin clothing under a warm jumper as body insulation.  Prepare a warm flask of soup or hot beverage and keep this handy to raise body temperature during cold snaps.  Try to move around and exercise as much as possible.  Keep your phone or piper alarm close to hand.  Change any wet clothing as soon as possible.  Fit draught-proofing to help seal gaps around windows and doors.  Further information about easy exercises you can do while sitting down that will help you to stay warm and mobile is available from the Age Concern Information Line, on 0800 00 99 66.

Other useful Telephone Numbers are:
Warm Front Scheme  0800 072 0151 – for grants to make homes warmer.
Winter Fuel Payment – 08459 15 15 15 for people aged 60 and over.