Agenda item

Report of the Deputy Chief Executive (People)

The Cabinet Member considered a report of the Deputy Chief Executive (People) regarding money management support and direct payment support services.

A corresponding private report which detailed confidential aspects of the proposals was also submitted to the meeting for consideration.

The underlying principle of self-directed support was the development of a culture supported by the tools that enable people to take greater control of their lives and the support they receive so that they can make decisions and manage their own care and support arrangements and manage risks. This put people at the centre of assessing their own needs and tailoring their own support.

Direct Payments enabled people to have control over spending their personal budgets and facilitated a greater degree of choice, than would otherwise be available, in how their support was delivered. This could be achieved through employing one or more personal assistants or through spending all or part of a personal budget with an agency who supply support workers to assist with meeting social care eligible needs.

People were able to access a range of support services to assist with the administration of direct payments.  Currently this support was almost exclusively provided through a single contract with an annual spend of approximately £250k. This current contract would expire on 31 March 2018.

The most recent peer challenge of Adult Social Care completed in 2016 recommended that options for Direct Payments support be considered especially in relation to choice of provision.  On reviewing the arrangements currently in place in Coventry was identified that, although only one provider was used, they offered a range of money management support options and this provided choice within one organisation.  This range included:

•  Direct Payment Support Service

•  Direct Payment Audit

•  Third Party Supported Accounts

•  Payroll Service

•  Promoting Financial Independence

•  Peer Group Support (quarterly)

•  Suitable Person

•  Appointeeship

•  Deputyship - (Through Application to the Court)

•  Individual Service Funds

•  Personal Assistant without employer liability

In setting a future direction for the arrangement of direct payment support services Coventry Adult Social Care sought comparable information and views from other authorities in the region, some of which was obtained through a recent regional workshop which formed a consensus view that offering a range of direct payment support organisations in itself produced no tangible benefits for people accessing these services and results in a potential dis-economy of scale.

Section 1.5 in the report noted that, as opposed to considering whether to engage more direct payment support organisations, work was undertaken to identify what further improvements and diversification of support could be obtained from continuing to contract with a single provider.  As a result of this work a number of improvements for future provision in the City had been identified. These included:

•  Further development of the Personal Assistants market with improved focus on growing the market place, access, recruitment and training. This would result in more Personal Assistants which would offer more options, innovation and greater choice locally. Personal Assistants would benefit from training, accreditation and support.

•  Development of a personal health budgets offer for the provision of continuing health care. These budgets could then be used flexibly and creatively to achieve a patient’s health and well-being outcomes.

•  A programme of promotional activities aimed at improving the take up of Direct Payments, Suitable Person Service, Individual Service Funds and Personal Health Budgets which would result in more people taking control over the care and support they received, more personalised services and improved outcomes

•  Sub regional commissioning as a solution for exceptional cases to be explored, such as a Personal Assistant (PA) service where a provider takes on the role of being the employer where someone lacks capacity. This would enable greater flexibility of care and support.

•  Change in contract terms and conditions to include sub-contracting which would allow Direct Payment customers to select a support provider of their own choice should they so choose

•  Customer satisfaction surveys to be developed further to capture feedback to enhance the operating model and improve the services that people access

This report sought approval for a new contract and service specification for 2 years including provision for subcontracting to alternative providers where the main provider was not the person’s preferred choice.  The opportunities of this preferred option were that costs could be contained, simplicity, offers choice, minimal back office costs, greater negotiation leverage, maximise operational headroom within financial envelope, supports the development of personal health budgets offer enabling continuity for citizens.  The risk was that operating through one main provider could limit choice as sub-contracting arrangements are only viable should organisations be willing and able to act as a sub-contractor

Alternatively the report explored Option 2, which was not recommended, to establish a framework to allow a range of providers in the market place that individuals could purchase from. The opportunities of this option were a greater choice of provider.  The risk was that this approach may increase costs overall as economies of scale would not be realised.  In addition, a greater range of providers in itself does not result in a greater degree of choice as support offers can be very similar between organisations.

The report also explored a third option , which was also not recommended which was to not contract for Direct Payment support and offer individuals a set amount of money within their personal budgets, which they could use to purchase a service from within the market place outside of contracted provision.  The opportunities were more choice and autonomy for service users.  The risks were a limited market and the ability to purchase an appropriate support service would be limited, thereby reducing the attractiveness of direct payments.  Risks associated with no contractual governance and the resulting lack of assurance as to standard of service would create further risks. 

The Cabinet Member for Adult Services and the Shadow Cabinet Member discussed with officers the options, the peer review and the process for service users.

RESOLVED that the Cabinet Member:

1)  Following the outcome of a review of the service and alternative Direct Payment Support arrangements, to support a series of improvements as described in section 1.5

2)  Approve a new contract and service specification for 2 years including provision for subcontracting to alternative providers where the main provider is not the person’s preferred choice.