Below are extracts taken from an article written by Mithran Samuel on CommunityCare.co.uk:

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.

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