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Cash for home care
Tony Lynes writes about the new system of Direct Payments

A fundamental change is taking place in the
provision of home care for older people. Home helps employed directly by the Council have already been replaced by care workers employed by agencies under Council contracts. What is now happening is that people assessed as in need of home care are offered "direct payments". Instead of having a care worker supplied by Social Services, they are paid an amount which, in the Council's view, is enough to enable them to make their own arrangements.

Direct payments have been available for some years to younger people in need of community care. They were extended to older people in 2003. The new system, Southwark Council claims, will provide more choice, continuity, reliability and flexibility. You can decide who you want looking after you; you are more likely to be able to ensure that the same person comes each week; and you can agree with them when and how they will provide the service.

The actual amount of the payments depends on a means test. Just as people receiving home care services arranged by the Council are expected to meet part of the cost if they can afford to do so, those getting direct payments may also have to contribute to the cost of employing a helper. If you get the full amount, it should enable you to pay the worker the amount they would get by working for a private agency.

Many people will welcome the opportunity to take more control over their domestic arrangements, but others will prefer not to have the worry and responsibility involved. So it's important to stress that, at least for the present, nobody is obliged to accept direct payments. The Health & Social Care Act 2001 says that direct payments can be made only with the person's consent and no-one should be put under undue pressure to consent.

For those who decide to take the cash, there are strict rules to ensure that it is not mis-spent. The money has to be paid into a separate bank account and can only be used for the intended purpose. Bank statements and time-sheets have to be submitted to the Council regularly, as well as an audited account at the end of the financial year!

There are also rules about who you can employ as a helper. The booklet issued by Southwark Council, Living independently by using Direct Payments, says: "You cannot use direct payments to employ your partner or close relative unless there are exceptional circumstances." What the government regulations say, however, is that unless it is the only way of meeting your needs satisfactorily (which may well be the case), you can't use the money to pay your wife or husband,or a daughter, son, brother or sister who is living with you - but you can employ a daughter, son, sister or brother who is not living with you, and you can employ a niece, nephew or grandchild, whether living with you or not. So there's actually much more scope for employing relatives than the Council's literature implies. This could be very good news for many people now caring for elderly relatives without any payment.

There are safeguards for the person receiving care too. Anyone getting direct payments will have a support worker, employed by an agency at the Council's expense, to help with finding a suitable care worker, opening a bank account, dealing with the paperwork involved in being an employer, and making contingency plans for holiday periods and other breaks. The support worker will be expected to keep in regular contact and ensure that the arrangement is working satisfactorily.
There are also arrangements for people who can't manage direct payments themselves to appoint someone they know and trust to act on their behalf.

Are direct payments a good idea? It's easy to assume that anything that gives people more choice and more control must be a good thing, but the proof of the pudding is in the eating. Will standards really improve when the Council is no longer directly responsible for the service provided? Will the recipients be able to cope with the red tape involved? And will there be adequate protection for older people at risk of exploitation by those more interested in grabbing the cash than in doing the work?

For the present, we can only give direct payments a cautious welcome, in the hope that the answer to all these questions will be "Yes".