1 Innovative use of Carers Direct Payments: ideas from good practice Carers Direct Payments are most often monetary payments offered to carers who have been assessed by their local authority as eligible for social care services. The aim is to support them in their caring role. Direct Payments enable carers to buy services themselves to meet their own needs instead of having the local authority arrange social care services for them. Local authorities currently give Direct Payments at their discretion – they are not legally obliged to provide services to carers. The Government’s Care Bill aims to change this and give carers a legal right to services when they reach the eligibility threshold. Nonetheless, though some local authorities do not provide Carers Direct Payments, many local authorities have provided a Direct Payments service to carers since they were introduced with the Carers and Disabled Children Act 2000. In some localities, Direct Payments may also be provided to carers using NHS funding or from a pooled health and social care budget, applying different eligibility criteria. This report focuses on Carers Direct Payments for people who provide care to an adult. It aims to guide good practice and provide ideas for commissioners, carer’s leads and practitioners on facilitating the innovative use of regular and one-off Carers Direct Payments. By innovative, we mean using Direct Payments not simply to give carers a break from the person they care for, but to give them something with added value that makes extra difference to them personally as an individual, e.g. art classes, driving lessons, or assistance on holiday with the person they care for. The document draws upon a literature review, interviews and feedback from people involved in commissioning and delivering Carers Direct Payments, and feedback from carers. In theory, how innovative can Carers Direct Payments be? Department of Health (2009) Guidance on Direct Payments: for community care, services for carers and children’s services states that ‘Direct payments allow carers to purchase the services they are assessed as needing as carers to support them in their caring role and to maintain their own health and well-being.’ i There are few legal restrictions on what Carers Direct Payments may be used for: they may not be used for equipment or services that should be paid for by the Health Service, normal household bills, or (in most instances) services to meet the needs of the person the carer looks after. ii They may not be used to pay for personal care –the Department of Health (2010) Carers and Personalisation: improving outcomes best practice guidance, recommends that support for carers in the form of short breaks should be included in service users’ personal budgets. iii The 2009 Guidance clearly encourages innovative use of Carers Direct Payments, giving the following examples of their use: purchasing ‘flexible respite care’ - having a break from their caring role by using one-off Direct Payments to pay a personal assistant to come on holiday with them and the person they care for; purchasing a washing machine so they do not have to go out to the launderette; taking horse riding
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Innovative use of Carers Direct Payments: ideas from good practice
Carers Direct Payments are most often monetary payments offered to carers who have
been assessed by their local authority as eligible for social care services. The aim is to
support them in their caring role. Direct Payments enable carers to buy services
themselves to meet their own needs instead of having the local authority arrange
social care services for them. Local authorities currently give Direct Payments at their
discretion – they are not legally obliged to provide services to carers. The
Government’s Care Bill aims to change this and give carers a legal right to services
when they reach the eligibility threshold. Nonetheless, though some local authorities
do not provide Carers Direct Payments, many local authorities have provided a Direct
Payments service to carers since they were introduced with the Carers and Disabled
Children Act 2000. In some localities, Direct Payments may also be provided to
carers using NHS funding or from a pooled health and social care budget, applying
different eligibility criteria.
This report focuses on Carers Direct Payments for people who provide care to an
adult. It aims to guide good practice and provide ideas for commissioners, carer’s
leads and practitioners on facilitating the innovative use of regular and one-off Carers
Direct Payments. By innovative, we mean using Direct Payments not simply to give
carers a break from the person they care for, but to give them something with added
value that makes extra difference to them personally as an individual, e.g. art classes,
driving lessons, or assistance on holiday with the person they care for. The document
draws upon a literature review, interviews and feedback from people involved in
commissioning and delivering Carers Direct Payments, and feedback from carers.
In theory, how innovative can Carers Direct Payments be?
Department of Health (2009) Guidance on Direct Payments: for community care,
services for carers and children’s services states that ‘Direct payments allow carers to
purchase the services they are assessed as needing as carers to support them in their
caring role and to maintain their own health and well-being.’i There are few legal
restrictions on what Carers Direct Payments may be used for: they may not be used
for equipment or services that should be paid for by the Health Service, normal
household bills, or (in most instances) services to meet the needs of the person the
carer looks after. ii
They may not be used to pay for personal care –the Department of
Health (2010) Carers and Personalisation: improving outcomes best practice
guidance, recommends that support for carers in the form of short breaks should be
included in service users’ personal budgets.iii
The 2009 Guidance clearly encourages innovative use of Carers Direct Payments,
giving the following examples of their use: purchasing ‘flexible respite care’ - having
a break from their caring role by using one-off Direct Payments to pay a personal
assistant to come on holiday with them and the person they care for; purchasing a
washing machine so they do not have to go out to the launderette; taking horse riding
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lessons to have a break and get some exercise; improving a path outside of the house
to the road to make it easier for someone in a wheelchair to get into a car to go out; and registering to do a charity trek.
The Department of Health Guidance states: ‘As a first principle, councils should aim
to leave choice in the hands of the individual, allowing people to address their own
needs as they consider best, while satisfying themselves that the agreed outcomes are
being achieved.’iv Councils may set reasonable conditions on the Direct Payments but
are asked in the Guidance to bear in mind that their purpose is to give people more
choice and control. The Guidance also states that councils should avoid setting up
disproportionately intensive monitoring processes.v Hence, in theory at least,
innovative use of Carers Direct Payments – use of Direct Payments for something
other than simply giving the service user and carer time away from one another - is
encouraged.
Are Carers Direct Payments being used innovatively? What benefit does innovative use of Direct Payment bring to carers?
Evidence suggests that giving carers the opportunity for a break can have a positive
impact on mental health: a 2001 study undertake in England found that 17% of carers
who had taken a break of more than a few hours suffered mental ill-health compared
to 36% of carers who did not have such a break since beginning their caring role.vi
There are pressing reasons for reducing carer stress. For example, carer stress is the
reason for admission to nursing or residential care in 38% of cases.vii
Research by the
Princess Royal Trust for Carers indicates that carers need time to carry out everyday
tasks and value short inexpensive holiday breaks to ‘recharge their batteries and
improve mental wellbeing.viii
The National Carers’ Strategy Demonstrator Sites
programme was an 18-month funded programme that started in 2009. As part of this
programme, 12 sites offered ‘breaks’ for carers. Some of the Carers Demonstrator
Sites included provision of short-term respite, sitting services or holidays and the
evaluation of the Sites indicated that breaks supported carers to continue caring and
prevented carer breakdown (and hence emergency admission to hospital or admission
to a care home) in some cases.ix
We can thus assume that using Direct Payments to
fund time away from the person cared-for could make a significant difference to
prevent carer stress and breakdown, but what difference does use of Direct Payments
in other ways make?
There is a great deal of published research on Direct Payments, but little specifically
on Direct Payments for carers of adults. Evidence on use of Carers Direct Payments is
included as part of the evaluation of the National Carers’ Strategy Demonstrator Sites
programme, however the evaluation does not clearly separate those which were given
as Direct Payments and those which are provided as services in its conclusions. There
is also a considerable amount of material published on Personal Budgets, including
many examples of innovative use, but examples tend to focus on Personal Budgets for
service users rather than carers. Hence in addition to undertaking a review of the
literature, we also we invited people who work with Carers Direct Payments to talk to
us about Direct Payments in their area, to discuss the impact of innovative Direct
Payments, the barriers, and what works for them in facilitating innovative use of
Carers Direct Payments. 12 people across eight localities – commissioners, managers
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and practitioners in voluntary sector organisations, local authorities and Clinical
Commissioning Groups (CCGs) - were interviewed. Several more people - carers and
people who work with carers - also reviewed or directly contributed feedback to this
document.
One-off Direct Payments
Carers Direct Payments may be a ‘one off’ payment, regular payments or payment of
a large sum in instalments, depending on the choice of the local authority. According
to a survey undertaken by ADASS, in 2011-12 just under half of the 51,191 carers in
receipt of a personal budget received their budget as a one-off Direct Payment.x Some
local authorities package Carers Direct Payments as ‘grants’. Some split them up with
different labels in order to apply different eligibility criteria or rules around what they
might be used for (e.g. ‘Short Break Grants’, and ‘Direct Payments’ being used for
anything else that may maintain the carers health and wellbeing).
Evidence suggests that many Carers Direct Payments have already been used in
creative ways. In 2010, as a one-off exercise, Hampshire County Council’s Adult
Services Department gave 826 carers a one-off Direct Payment of £200 to support
them in their caring role. Carers could spend the money however they felt would best
support themselves. The exercise was evaluated to find out how carers spent the
money and whether it made a difference to them in their caring role. 470 of the 826
carers choose to take part in the evaluation. The top two things that they spent the
money on were holidays and gardening. Other things that people spent it on included
equipment, leisure activities, utilities, driving lessons, education or a training course,
purchase of computers, car tax and MOT.
Less than 5% of respondents said that the money made no difference in supporting
them in their caring role. Over 95% said it made a difference and 45% said it made a
big difference. Feedback included:
‘The money has made a huge difference – I was able to pay for individual sessions at
the gym and have some ME time’
‘The money gave me the chance to go out for the day with my family and enjoy all the
things other families take for granted.”xi
Since 2004, Dudley Metropolitan Borough Council have been running a Carers Direct
Payment scheme, open to carers who cannot afford a break. In Dudley, Carers Direct
Payments are one-off payments of £300 available to give carers of adults a break’.
This is interpreted very widely - grants can be given for holidays, and short breaks
(with or without the cared for person), leisure activities and hobbies and equipment
for a hobby (including gardening), driving lessons etc. They may be used in
conjunction with support offered to a service user. For example, the Direct Payment
could be used to enable the carer to do something they would enjoy while the person
they care for has respite or sitting provision paid for out of their own budget.
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Dudley evaluated Direct Payments for a sample of their 450 Carers Direct Payment
recipients in November 2011. 47 of the carers who responded used their Direct
Payment for holidays and 22 for short breaks. 7 used them for day trips. Some people
in Dudley who used their Direct Payment to pay for a holiday or break away from the
person they care for found it difficult to get respite or alternative care for the person
they care for. Some experienced difficulty in reassuring the person they cared for that
they would be looked after in their absence. The presence of such barriers points
towards the importance of having flexibility in terms of options for carers to do
something else for rejuvenation if circumstances mean they cannot have a break from
the person they care for. An example from Hampshire illustrates the importance of
thinking outside the box:
“Trust is a major thing. We had a family where the carer didn’t want to leave her son
but she needed a break. They have gone away on holiday as a family. We gave her
money to pay her daughter to look after her brother on the holiday because that is
giving her a break and the reassurance that her son is looked after by a family
member. So they all have a family holiday together but she doesn’t deliver the care.
It’s about encouraging people to think outside the box rather than just putting
someone in residential care for a week.” Officer, Hampshire County Council
Eight of the Carers’ Strategy Demonstrator sites (Bath and NE Somerset, Bristol,
Derby, Lewisham, Liverpool, Nottinghamshire, Suffolk, and Sunderland) provided
one-off payments to help with or cover the cost of a holiday for the carer with or
without the person cared for. Carers and staff noted that funding holidays for both the
carer and person cared for enabled them to spend ‘quality time’ and made an
otherwise unaffordable break possible. Other sites offered breaks that were accessed
by the carer and person being cared for together (such as meals out with the person
cared for or with friends or family, as offered in the Sunderland, Bristol and Suffolk
sites). However, sometimes having ‘a break’ together can mean that carers do not
really get a break or indeed end up with more stress. Bearing this in mind, Cheshire
and Warrington Carers Centre try to build trust in respite services so that carers
became more able to feel that they can leave the person they care for with someone
else and have time away.
Bournemouth West Integrated Community Mental Health Team (CMHT) provide
one-off Direct Payments of approximately £300 to carers of people with severe and
enduring mental illness who are clients of the CMHT. Many carers use them for
breaks away or days out. Other uses have recently included horse riding lessons,
English lessons for a gentleman whose first language was Spanish, mobile phone
credit to enable a carer to maintain contact with the person they care for, and a
dressmaking course. An officer from the CHMT explained that even a one-off Direct
Payment can help prevent carer breakdown:
“One chap was really struggling to cope and we gave him a Direct Payment which
enabled him to go away. The person he cared for had to go to replacement care to
allow that to happen. I don’t think he would have been able to continue to provide the
support he was giving without having that break. Everybody has limits of what they
can deal with.” Officer, Bournemouth West Integrated CMHT
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Most carers who obtain Carers Direct Payments from Bournemouth Borough Council
also spend them on a holiday or short break. However, for some carers, having time
away with or without the person they care for is not an option because of frailty or
mental illness, and there may be a preference for very different things to enhance
wellbeing.
“We have a case at the moment where the carer wanted to get a laptop. She has been
having difficulty getting out to go shopping so she will use the laptop to shop. Her
husband has dementia and she doesn’t feel comfortable leaving him to go to the
market or shops. There are other services she could use to enable her to get out, but
she decided she wanted a laptop to shop online. Also her daughter is moving abroad
and she will then be able to Skype with her daughter and the grandchildren by using
that. So it's a creative way of actually improving their quality of life.” Debbie Hyde,
Bournemouth Borough Council
Other uses of Direct Payments from Bournemouth Borough Council recently have
included choir membership, refresher driving lessons, college courses and gym
memberships.
In Bristol, one of the types of one-off Direct Payments currently available is aimed at
carers who are supporting people that do not use social services. The reason they
might not use social services might be because the person cared for refuses social care
services or because the cared-for person is not eligible for them. This means that
people with only low moderate needs, self-funders, people with mental health
problems and no social care need, and Continuing Health Care clients currently may
be able to access Direct Payments in Bristol, whereas in many places in the country
they would not be able to access this form of support. To give an example, one
Continuing Health Care client towards the end of life received a Direct Payment to
enable him to go to church once a week. The funding from these Direct Payments
mainly comes from the NHS through a pooled budget. A recent example shows how a
Direct Payment might be used to keep a carer in employment:
“We had a lady who works full time and was in moderate need and had a one-off
Direct Payment. She was able to rent a ‘Just checking’ system, which is new assistive
technology, so she could stay in work and know her mum is ok.” Debbie Charman,
Bristol City Council
Another example from Bristol shows how a Direct Payment may help people
maintain relationships that have been affected by caring responsibilities:
“There is an elderly couple and the wife has moderate dementia but no social care
need and the husband was struggling. We gave them money to go on a steam train
trip because that was what they always used to do together. It enabled them to revisit
the things they used to do together before she got ill.” Debbie Charman, Bristol City
Council
In 2011-2012, in addition to holidays and short breaks, Direct payments were used in
Dudley for karate lessons, to attend concerts, meals out, attend football matches, go to
speedway meets, evenings out, exercise classes, health treatments, gardening
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equipment, pampering and shopping, fishing tackle and a fishing licence, new TVs
and computers, amongst other things.
‘Paid for 12 month Gym membership. The gym is only 2miles from dad's home, so I
can go after I’ve washed, dressed and fed father. An excellent way to use the grant
money.’xii
The 2012-13 scheme is currently being evaluated and carers giving feedback are
pointing out how the Direct Payments have given them the opportunities,
opportunities they otherwise would no longer have, of being looked after themselves
(e.g. through pampering or by being waited on at a restaurant), doing things they used
to enjoy (e.g. playing darts and pool), having some social contact (e.g. by having a
day out and the chance to converse with other people there, or by having the chance to
visit family and friends), or realising an inexpensive dream that was previously denied
to them because their caring responsibilities meant they could not afford it.
“All my life I have been a steam enthusiast. I loved them as a child and have always
wanted to go on this trip going over the Ribble Valley Viaduct. Both my wife and I
care for our son for twenty-five years so this trip was impossible. He died and now I
am the main carer for my wife. With caring all our lives money is very scarce so the
trip was still impossible. The money you sent helped us to realise this dream... We had
a wonderful day and gave a silent thank you to your office as we passed over this
wonderful Ribble Valley Viaduct structure. Many many thanks for this opportunity
you gave to me and my wife. We will remember this trip forever.” Carer, Dudley
Respondents are also highlighting the benefits upon their health or how these things
can keep them going. Several are also mentioning Direct Payments as bringing
something into their lives that is guilt-free or lessens feelings of guilt.
“Last year I bought a puppy Yorkshire terrier. The allowance covered the price of the
dog and some injections for her and I was able to get a bed and a dog carrier.
Because my husband suffers from depression and goes to a day centre twice a week, I
find myself very lonely. I have kept dogs before and thought she would be a kind of
company for me. It also gives me distraction from my circumstances and gets me out
for a walk each day. She is lovely company and a loyal little friend… the toll of caring
for someone often sucks the life out of you, leaving you unable to plan or arrange
anything for yourself/ so to receive something for yourself to use for yourself is like a
breath of fresh air to me and there is no guilty feeling of using house money just for
yourself. I am eternally grateful for this help.” Carer, Dudleyxiii
Over half of the Carers’ Strategy Demonstrator Sites (Bath and NE Somerset, Bristol,
Lewisham, Liverpool, Suffolk, Sunderland and Torbay) provided a Direct Payment
for the purchase of equipment or domestic goods that would enable the carer to do
something unconnected to their caring role (e.g. a computer for social networking
with friends and family, online shopping and leisure, or a bike). Staff in the Sites
noted that this enabled carers to choose something that met their individual needs (i.e.
rather than just choosing an existing service they could choose something
personalized to them). They felt that this can be a relatively cost-effective way of
meeting carers needs. Carers said this made new hobbies or leisure activities a
possibility for them. They appreciated the flexibility and choice that this option gave
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them.xiv
Carer Direct Payment Awards given by Telford and Wrekin Council usually range
from £100-£500, although higher amounts may be awarded. Money from the NHS in
a pooled budget is used to top up the Direct Payment Award budget if that pot runs
out. Direct Payments are most commonly used for breaks and relaxation therapies,
laptop computers, gym memberships and driving lessons, but some uses are more
unusual. The following example illustrates the importance of listening to the carer
about what will make a real difference to them and considering giving the go ahead
on something you would not usually give approval for.
“One social worker was working with a couple and they didn’t go out much. She went
out to do a bit of shopping but that was it. They didn’t socialize much at all. Her
partner was housebound. The social worker talked to them. They talked and talked
and she said ‘what I really would love is.. I sit her looking at this carpet day in and
day out and I’m ashamed to invite the neighbours in.’ This carpet was literally
threadbare. The social worker came back to me and said ‘what do you think?’ And I
said ‘well, if you can demonstrate that it will improve her wellbeing and quality of life
then I would go for it.’ And we did and I think the whole thing cost about £850. When
the social worker went back again and the lady had had neighbours in. She felt every
morning when she came down it was fresher, it looked lovely, it lifted her mood. It
tipped the balance of her wellbeing. For that particular carer, it was very relevant to
enhance that person’s quality of life.” Jill Tiernan, Telford and Wrekin Council
Other diverse examples of things Telford and Wrekin have given Direct Payments for
include sofas, flying lessons, French lessons, college courses, motorbike repairs to get
the carer back on the road, and hobby equipment.
Eight of the Carers’ Demonstrator Sites (Bath and NE Somerset, Bristol, Derby,
Lewisham, Liverpool, Suffolk, Sunderland and Torbay) gave one-off Direct Payments
for activities or courses to improve carers’ wellbeing. These were used in various
ways including alternative therapies, gym memberships, stress management courses
and pampering sessions, sometimes in conjunction with alternative care such as
sitting services. Carers said that therapies and gym memberships improved their
fitness and wellbeing. They said that using Direct Payments in this way promoted
relaxation and reduced their stress as well as facilitating weight loss. They also said it
increased their confidence and self esteem as well as providing an enjoyable
experience. Staff also noted that it reduced stress amongst carers, brought confidence,
gave carers a chance to relax and helped carers make positive lifestyle changes to
improve their health and wellbeing. xv
Cheshire and Warrington Carers Centre manage the Carers Personal Budget Project,
which currently funded by the Primary Care Trust. A multiagency panel, consisting of
staff from the Carers Centre, local authority and the CCG meet twice a month to make
decisions on awarding money for Personal Budgets. The money is most often
received as a Direct Payment of up to £500, which can be given in one lump or in
smaller chunks over a period of up to six months, depending on the request of the
carer and their circumstances. Some of the things carers have recently spent their
Direct Payment on include ballroom and Bollywood dancing, microlight lessons,
driving lessons, photography courses and weightwatchers.
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“We had someone who had microlight lessons. He was probably in his late 60s and
caring for his adult daughter and that's what he used to do when he was younger
before he had all of this responsibility. So it's the only time he had felt free. He’s up in
the air and nobody could get hold of him if they tried…
One lady joined Weightwatchers. The Direct Payment paid for her enrolment, the
books. She lost over two stone. She says she can fly up the stairs now. Its helped her
in her caring role as well but its making friends, having regular breaks, having
something else to focus on.” Steph Garner, Cheshire and Warrington Carers Centre
Regular Direct Payments
We do not have published evidence on what carers of adults currently spend regular
Direct Payments on across the UK. However, anecdotal evidence suggests that many
spend them on existing social care providers and services, using care agencies for
sitting/ ‘home based-respite’ or PA services so that either the person cared for or the
carer themselves can get out of the home. In other words, people are fitting into
existing ‘off the peg’ provider services. This is not ‘wrong’ or a problem: we know
that such services are very important to many carers and can help with emotional
wellbeing, reducing strain and giving peace of mind.xvi
Nonetheless there are strong reasons why local authorities should also consider how
they might better facilitate the more creative ways carers might use regular Direct
Payments to support them in their caring role and maintain their health and well-
being. One is that ‘alternative care’, such as use of sitting services and PAs, is not
acceptable to some. Feedback from carers in the National Carers’ Strategy
Demonstrator Sites indicated that those care for are sometimes reluctant to go
somewhere without their carer and it can be difficult or undesirable for carers to leave
the person they care for with someone else.
‘I got a greenhouse from the carers’ centre... It has helped me at a lot, but I don’t
know anything about breaks - I wouldn’t leave my husband with anyone. I would
rather be with him 24/7 and my son.’xvii
Another reason is that research shows that carers often have to give up things and put
their own lives on hold when they start caring for someone. The Survey of Carers in
Households found that in 2009-10, around two in five carers (42 per cent) said their
personal relationships, social life or leisure time had been affected because of the
assistance they provided. Those who had been affected in this way were asked an
unprompted question to establish the effects of caring. The most common effects were
having less time for leisure activities (69 per cent), being too tired to go out (32 per
cent), being unable to go on holiday (23 per cent) and the effect upon their own health
(20 per cent).
When asked about spending time doing social or leisure activities specifically, 25 per
cent of carers said they had less time with friends and 20 per cent had less time for
pastimes or hobbies because of their caring responsibilities.xviii
Recent research
undertaken by Carers UK between 2010 and 2011 has shown that 78% of carers have
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cut back on holidays and 74% have cut back on leisure activities as a result of
caring.xix
Carers UK’s State of Caring 2013 survey found that 74% of carers have cut
back on seeing friends and family in 2013.xx
Commissioned support services for carers do not always help mitigate this impact on
carers’ lives:
“I’ve found that not everyone wants to go to carers support groups for carers of
people with a particular condition. They don’t really want it rubbed in their face all
the time that they are a carer and this is the most they can expect in life. They don’t
always want any bit of leisure time that you can give them to be about caring.” Alison
Myers-Ward, Hampshire County Council.
‘Making it real for carers’, co produced by carers, tell us carers want to see in
practice:
“The space to be someone other than a carer.
Time to pursue my own hobbies and interests without worrying about the cared for
person.”xxi
If people are allowed to use them innovatively, Direct Payments can meet these
needs.
“There is often confusion [amongst practitioners) around what is a ‘carers service’.
It has to be something beneficial to the carer. Many people do carers assessments and
identify day services for the service user as a need for the carer as they think it will
give the carer a break. I say, that's ok, that can go in the support plan and personal
budget of the service user, but what does the carer get? What is specifically for them?
They may well only be able to use that time to try to catch up with the basic daily
things they are behind on, the housework, not do something that will really benefit
their wellbeing. Also, the clients may refuse services and the carers still need help
and are entitled to the assessments – they need something that is specifically for them.
Respite alone might slow the point at which crisis is reached but some innovative use
of Carers Direct Payments means the situation of carers can actually improve, e.g.
relationships. For example, give them back the things they have had to give up, the
things that people who aren’t carers have, such as the chance to learn new skills,
resume a hobby and the chance to be looked after or pampered themselves. Its fine to
put a need for respite on the form and in the service user’s resource allocation but
you also need to consider what can be put in place to actively improve the carers life,
not only give them a bit of time to tread water rather than drown.” Officer Hampshire
County Council
Only three of the eight organisations we spoke to provided regular Carers Direct
Payments. In Hampshire, regular Direct Payments may be given to eligible carers if it
is agreed at assessment that they will provide what carers need to support them in
their caring role. One-off Direct Payments for specific items or courses may
accompany regular Direct Payments - the frequency and amount is determined by the
carers assessment. An example from Hampshire shows that Direct Payments can
make a difference in carers’ aspirations as well as their wellbeing:
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“We have a carer who has had reiki training. We arranged a Direct Payment for her
because she wanted a break from her caring responsibilities. We said ‘how can we
make a difference for you?’ and she said, “Well I’ve always wanted to do reiki
course. I’ve never had time to do it.” We said ‘well how can we help you?’ and the
carer said “well I can’t afford it.” So we said ok. The service user, her partner, can
be left on his own. So the carer did this course and she practiced on her partner and I
think it helped their relationship. So he benefitted from her class as well. She did the
introductory year. Then she did another year as well to go on further. Her aim was
then that she might eventually be able to get a little bit of money by doing reiki, which
is brilliant. So it gave her a break and it gave her something to work towards for the
future and I think her wellbeing improved dramatically.” Officer, Hampshire County
Council
Bristol City Council has a similar arrangement to Hampshire with regards to regular
Direct Payments for carers. Carers in Bristol who are assessed to be in ‘critical’,
‘substantial’ or ‘exceptional’ need and are supporting people eligible for social
services can get a set amount as a Direct Payment per week, with the amount
determined by the carer’s level of need. Substantial need equates to £45 per week,
which is the value equivalent to a three hours sitting service. Critical need would
attract £60 per week, which is the value equivalent to four hours’ sitting service.
Carers and practitioners in Bristol are encouraged to think of things other than using a
sitting service if that is not what they need. For example, they might spend the money
on a gardener so they do not have the additional worry of being unable to keep the
garden up together as a result of their caring duties. In Devon, regular Direct
Payments are sometimes are used for facilitating specific hobbies, e.g. art classes, but
most carers choose to use them to buy domestic support, such as help with ironing
and cleaning.
At the Carers Demonstrator sites that offered regular or ‘one-off’ or payments to help
with the costs of support with practical activities in the home such as gardening,
cleaning, shopping and home repairs (Bristol, Lewisham and Suffolk), staff
commented that such practical help in everyday life was a priority for some carers
rather than having a break from caring. They said it makes carers lives easier and
reduces stress. There was a perception amongst carers that support to improve or
maintain their home environment has a positive impact and reduces stress and
anxiety.xxii
Ideas on what can help facilitate innovative use of Carers Direct Payments
Raising awareness of, and improving access to, carers DPs in the community
Recent research undertaken by SPRU on local authority practice relating to carers
involvement in personalisation (main findings due summer 2013) has found that
carers often decline the offer of their own assessment because they cannot see its
purpose having contributed to the service user assessment. This means people are
likely to be missing out on Carers Direct Payments they may be entitled to. As
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support in the form of short breaks is often technically under the control of the service
user, carers do not have equal control to the person they care for. The study suggests
that if carers do not take up the offer of a separate assessment, the carer’s needs
should be fully assessed during the service user assessment and documented
sufficiently for any additional carers’ funding to be allocated separately to them to
meet their needs as carers.xxiii
In Hampshire, the officer responsible for Carers Direct Payments attends service user
and carers forums, BME groups and user-led organisations’ meetings to tell them
about Direct Payments and other services available to carers, and raise awareness of
what a carers service is to combat the commonly-held assumption that it equates to
day services for the person cared for or respite in a care home.
“The community needs to be educated as to what a carers service is. Carers don’t
realise it is for them. They never think about themselves.” Officer, Hampshire County
Council
One suggestion was that carers should be notified as a matter of course that Direct
Payments might be available to them.
People told us that carers are often reticent with regards to taking up something for
themselves that is free, so some may require a deal of reassurance about Direct