workforce_strategy section heading

Considering Individual budgets within a domiciliary team (NToW15)

 

Lady being spoken to


Background
Changes in Government policy has led to major shifts in the way that domiciliary care services are commissioned, assessed, planned, delivered and monitored with the focus moving to a person-centred approach.

The Government aimed for all people that use care services to receive direct payments or individual budgets. The healthcare service provider C & S Care Services wanted to identify the implications of this policy from a range of perspectives and in particular from the perspective of a domiciliary care company.


Aims/Objectives
The aims of the project were to research the implications of the new direct payments and individualised budgets.

The objectives were to find out:

  • What involvement several domiciliary care agencies had in regards to individualised budgets and direct payments
  • What changes care providers may need to make to their services
  • Whether an influx of direct payment packages would cause problems for current working systems
  • Whether individuals who are in control of their budgets would continue to use a care provider
  • Whether a new type of worker would need to be identified to coordinate support to recipients of direct payments
  • Whether policies, procedures and training need to be changed to meet the Government's vision

What happened?
In order to assess the effects of individualised budgets and direct payments, interviews were held with:

  • People who are in receipt of direct payments and individualised budgets - both those who use a domiciliary care agency and those who arrange their own care
  • Local authority commissioners and contract managers
  • Organisations that support recipients of direct payments
  • Commissioning and contract managers from two local authorities
  • Domiciliary care providers
  • People within C & S Care Services
  • Personal Assistants (PAs) - both self-employed and ones working for an agency

 

Outcomes
Following the research, a report was produced. Some of the key findings from the report were:

  • The majority of care provided to recipients of direct payments required little change to the overall care package each week
  • The PAs recognised that their work needed to be flexible depending on the condition or activities required by each service user
  • One care agency felt that increasing the number of direct payment recipients would not pose problems, as they were already providing person-centred care packages. The remaining professionals could foresee problems - the main one being how to incorporate flexible care packages with direct payments into their existing systems with current levels of staff
  • The PAs recognised that with an increased workload, it may become difficult to manage the changing needs of people using services
  • One company already had revised policies in place
  • Some stakeholders were concerned about a range of issues, including the terms and conditions of employment for PAs, health and safety and other policy issues

 

Impact on workforce development and how you can use the learning
It was evident from this small project that a change in systems and ways of working for care providers was required. What was unclear was in what form and at what cost these changes would need to take place. Local authorities were aware of what the Government was proposing but were unsure how they would go about changing contracts for providers to reflect the outcome.