Direct payments for informal carers

Why was this example implemented?

Caring can have an adverse effect on carers’ health, with carers’ providing more than 20 hours of care per week at the greatest risk of ill health (Fletcher, 2006; Pickard 2004; Hirst, 2004). This is significant as around 6.8 million adults in Britain are carers, of which 3.8 are the main support for the person they care for and approximately three quarters care for older people (Pickard, 2004). Informal carers are an indispensible link between the needs of older people and the availability of formal services which can be insufficient. Thus more flexible support for carers in the community is needed to ensure that they can continue in their caring role.

England has benefitted from strong and articulate organisations representing the interests of carers; these organisations have consistently lobbied Parliament to make sure that carers’ needs are appropriately recognised. The 1995 Carers (Recognition and Services) Act gave carers the right to an assessment of their needs if they provided or intended to provide substantial and regular care (Fletcher, 2006). The Community Care (Direct Payments) Act 1996 allowed local authorities to give payments directly to users to meet their care needs. However, initial implementation of the act did not extend to older people or carers. The use of direct payments was evaluated and revised after implementation and in 1999 the Government launched their National Strategy for Carers which set out what service providers should do for carers (Keeley and Clarke). In the same year the Carers and Disabled Children Bill gave local authorities the power to give direct payments to carers to assist them in their caring role. The Carers (Equal Opportunities) Act 2004 amends the two previous Acts for carers and has three aims: ensure carers are informed of their rights to have an assessment, ensure that work, learning and leisure are considered as part of the assessment of needs, and give local authorities the right to enlist the help of housing, health and education authorities to provide support to carers (Fletcher, 2006). The way that payments are means tested and managed remains the same as in the original bill of 1996.

Description

As set out in the acts for carers, local authorities have a statutory duty to assess the needs of carers (including their aspirations for leisure, employment and training). If carers are assessed by the social worker as in need of assistance from social services, they must be offered a direct payment in lieu of directly managed services. However, the carer must show that they are able to manage the direct payment, with assistance if need be, and the payment must be at least as cost effective as directly managed services. Direct payment users must set up a separate bank account for the payment to be paid into and must keep a diary or use bank statements to show the local authority how the payment is being used every six months.

The direct payment can be used to purchase services or equipment to help carers in their caring role. It can also be used to help them maintain their health and well-being, such as for leisure activities. The most common form of local authority provision for carers is to enable them to have a break; a cash direct payment or personal budget for a carer allows the carer to make the arrangement that best suits her/him and the person needing support. For example, a direct payment might fund a regular weekly outing or services from a paid carer to provide care at home so the informal carer can have a break. People caring for a spouse might choose to spend the direct payment on a holiday for both of them to enjoy together. Direct payments for carers cannot be used to purchase services for the person whom the carer is supporting (who may receive a direct payment in their own right). The aim of direct payments is to increase the choice and independence afforded to carers to meet their needs flexibly and creatively so that they can continue caring.

Though carers can use direct payments as they need, it is expected that carers will mainly use the payment to take a break from caring responsibilities. The Government is making £400 million available through the NHS over the next four years to support carer breaks (DH, 2010).

The use of direct payments is ongoing and their implementation has recently evolved to be more flexible for carers. Direct payments now form one option available to carers under a new personal budget scheme that allows the money to be held and managed by the carer or the council, or a combination of both.

What are/were the effects?

During the initial implementation there was a low uptake of direct payments among carers; 957 payments were made in 2003 in England (Fletcher, 2006). As a response to this low uptake, direct payments have now been made a quality indicator of performance for social services in order to increase the number of payments being made. This has resulted in a dramatic increase in the number of carers taking direct payments, increasing from 7,350 in 2007/2008 to 21,014 in 2008/2009 (CQC, 2009). Contributing to a low uptake of direct payments may be that many carers may not consider themselves to be carers and therefore would not seek an assessment of their needs which is a prerequisite for a direct payment. Thus helping those who support older people to identify themselves as carers has been made a priority by the Government in the next stage of the Carers Strategy (HM Government, 2010).

There is very little evidence of the impact that direct payments have on carers of older people; most research has been into the impact on parent carers of disabled children. What evidence there is tends to be anecdotal and not rigorously evaluated. However, the majority of carers find that direct payments offer them greater flexibility to lead more normal lives (Carers UK, 2008).

What are the strengths and limitations?

Strengths

• Direct payments can provide carers with respite from caring activities in ways that are acceptable to both the carer and the supported person.
• Carers can receive an assessment of their needs even if the older person refuses to have a needs assessment. They can receive a direct payment even if the person they care for is not receiving support from social services.

Weaknesses

• Though direct payments may offer greater flexibility, they can be difficult to manage as money spent must be accounted for. However, social services can assist carers by helping them arrange bookkeepers to help manage their funds.
• As direct payments are linked to a council’s quality rating, this may mean that people are pushed into having direct payments when they may not be suitable. There is little evidence on impact that is specific to direct payments received by informal carers for their own use.

Opportunities

• Direct payments for carers can help ensure that they continue caring and could potentially help carers to return to the labour market as their caring burden is lessened. This is an expected impact, but is not yet substantially proven.

Threats

• The process for setting up a direct payment can be slow; 1 in 4 carers of one survey reported that it took longer than a year to set up (Carers UK, 2008). This lengthy process could create added stress for carers who are already strained.
• Not all carers wish to manage a direct payment, which is why in some cases social services will help manage the budget. Direct payments will not be suitable for all carers and pushing carers into direct payments may mean that they are inappropriately allocated and could result in carers giving up the direct payment.

Credits

Author: Laura Holdsworth, Centre for Health Services Studies, University of Kent
Reviewer 1: Georg Ruppe
Reviewer 2: Thomas Emilsson
Verified by:

External Links and References

• Care Quality Commission (2009) Performance judgements for adult social services: An overview of the performance of councils in England. London: Care Quality Commission.
• Carers UK. (2008) Choice or Chore? Carers’ experiences of direct payments. London: Carers UK.
• Dawson C. (2000) Independent successes: Implementing direct payments. York: Joseph Rowntree Foundation.
• DH, 2010. ‘Personal budgets for all and more breaks for carers’ 
• Fletcher M. (2006) ‘Carers and direct payments’, in Developments in Direct Payments, J. Leece and J. Bornat (eds), Bristol: Policy Press, pp. 171-185.
• Glasby J and Littlechild R. (2002) Social work and direct payments. Bristol: Policy Press.
• HM Government. (2010) Recognised, valued and supported: Next steps for the Carers Strategy. 
• Hirst, M. (2004) Health inequalities and informal care: End of project report. York: Social Policy Research Unit.
• Keeley B and Clarke M. (no date) Carers Speak Out Project: Report on findings and recommendations. London: Princess Royal Trust.
• Pickard L. (2004) The effectiveness and cost-effectiveness of support and services to informal carers of older people. London: Audit Commission.