Introducing direct payments and support planning

The practitioner and individual will build on the ‘what matters’ conversation to co-produce a care and support plan.

Some people may benefit from having access to an independent advocate to make a decision about what option is best for them.

Anwen is a wheelchair user who uses her direct payments to employ a PA to support her with getting washed and dressed and getting ready for work.

In the past, it was assumed her husband should provide this support.

Anwen is very clear she wants her husband to be her husband and not a carer. Although he can support her in an emergency, neither of them want him to have a PA or carer role.

The ‘what matters’ conversation lets Anwen voice these wishes and have them respected.

People who receive direct payments will agree with their local authority what services they will buy to meet their assessed support needs.

This should then be reviewed to see if the support package is working or if any changes are needed.

This review should be no more than six months after the initial assessment for children and no more than 12 months for adults.

People have a right to advocacy support to allow them to participate fully in the assessment process.

Over the last few years a number of innovative ways of using direct payments have been emerging. The goal is to understand what outcomes people want for themselves and their lives.

Direct payments offer the flexibility to provide care and support in a different way.

People can choose to have individual support but they may also be interested in joining up with people who have similar aspirations for activities and services they require.

Gorwellion Newydd offers re-ablement programmes to adults with acquired impairments and chronic illnesses.

Services include group sessions to increase confidence and emotional well-being and to develop positive personal and social relationships.

They also provide support to adjust to changed life circumstances, such as losing a close family member or spouse.

People accessing its services can become members of the co‑operative. This means they can also have their say about how Gorwellion Newydd’s activities and services should be provided.

People accessing the day centre use direct payments to purchase their services. It gives them control over the support they need to improve their lives. The activities help to maintain good physical and mental health.

The re-ablement programmes start with a format agreed with the individuals accessing the service, but are flexible in delivery in response to their skills and the desired outcomes.

In this example, a group of people with similar needs have been able to use their direct payments to purchase services that they can share.

They are able to take part in activities that improve well-being and enjoy the company of others at the same time.

This reduces loneliness and isolation and supports people to stay in good health for longer.

In addition, being part of a cooperative helps provide more voice and control over the services they receive.

Individuals need to receive the right support, from the right people, in the right place, at the right time.

Throughout the process of identifying well-being outcomes and assessing what care and support is needed, both the individual and the practitioner should have the information and support they require.

Local authorities offer resources to support practitioners and there may be internal shared knowledge to draw on for coming up with examples and new ideas for services.

Individuals should be given information before an assessment to provide time to think and talk through with family and friends.

Some individuals may have had bad experiences of previous interactions with professionals, for example many people find benefit assessments stressful.

Reassure people that the ‘what matters’ conversation is a positive and constructive discussion about how their well-being outcomes can be met.

Also, highlight the role of informal or formal advocacy support.

Trevor is a businessman and entrepreneur and couldn’t run his business without the highly tailored support from his PAs.

First of all, the practitioner must fully understand how to operate a 'what matters' conversation.

Direct payments must be offered early in the conversation and not seen as a last resort.

The practitioner should encourage the individual to explore and identify in as much detail as possible the strengths they have as individuals and in their existing social and community networks.

This support network may include unpaid carers, where those carers are willing or able to continue in that role.

The individual should then be encouraged to explore how they want to live their life and what barriers might prevent them from achieving their well-being outcomes.

The Welsh Government has identified eight elements to well-being in their Well-being statement for people who need care and support and carers who need support.

A conversation about people’s strengths and barriers may help identify solutions.

If nothing in these discussion provides a solution to any of the barriers that have been identified, then what’s left forms the basis for eligibility for support from the local authority.

Direct payments should be introduced as an option for arranging care and support that's most closely tailored to the requirements of each individual.

When the practitioner discusses direct payments as an option, they must make clear to the individual the support that's available to help them administer the payments.

The local authority must explore the options to support people who wish to use direct payments but who are concerned about, or unable to, managing the payments.

The Code for Part 4 of the Social Services and Well-being (Wales) Act, paragraph 150 stresses that the local authority must not refuse direct payments just because the individual can't manage them or is worried about managing them.

Direct payments are likely to be a new concept for many people. Once it is clear what their needs are and what activities or services would meet those needs, it's easier to explain how direct payments can help.

The ‘what matters’ conversation hands over more control to the individual to make their own choices about how they wish to live their life.

Direct payments can help people to have more say in meeting their care and support needs, for example in the services they receive. People can choose who provides the service, when, where and how this is provided.

Kate uses Direct Payments to purchase 24-hour daily care and support services provided by a dedicated team of personal assistants.

Previously, her parents organised the support but wanted to make sure these arrangements were more secure in case they became ill.

The Family First Co-operative was set up using direct payments and involves Kate, her family and the PAs. This arrangement gives Kate more control over her services than she had in the past.

The committee helps to organise the care, emergency cover, recruitment and training which improves the service and reduces pressure on Kate’s family.

Kate now has the services she chooses and greater voice and control. This also supports her personal development and has improved her well-being.

There is no national guide about what direct payments could be used for. Each local authority has their own guidance about the type of activities that can be funded.

The practitioner should share what the guidance says with the recipient during the conversation so they can identify other solutions if certain activities can’t be funded by direct payments.

However, the Code for Part 4 of the Social Services and Well-being (Wales) Act, paragraph 148 tells local authorities and the public that direct payments are intended to be used imaginatively, with the aim of supporting people in their choice of lifestyle:

"When discussing how needs might be met via direct payments, a local authority must be prepared to be open to new ideas and be as flexible as possible. People must be encouraged to explore innovative and creative ways to identify how they might most effectively achieve outcomes in a way that aligns with their personal preferences.”

It’s good practice to talk about direct payments from the start as one of the possible options for support.

Introducing the options early on will help both parties have a fuller and more meaningful conversation and avoid offering direct payments as a ‘last resort’.

This could include a conversation about how individuals can be empowered to feel in control of their direct payments and to use them in ways that suit their own personality and lifestyle.

Direct payments are suitable for a wide range of people who have been assessed as having an eligible care and support need, including but not limited to:

• adults of any age
• parents and carers aged 16 or over
• people with parental responsibility for a disabled child.

Sometimes a local authority may put safeguards in place to ensure that direct payments are being used for their agreed purpose.

Funding for interventions or support may need to be approved in a decision process by people who haven't met the individual whose needs are being assessed.

Some local authorities refer to the application for interventions or support a 'business case'.

A good business case normally explains not only what is necessary but why it’s necessary.

The business case should provide good context to the situation so it’s clear how the proposed intervention or support fits with support provided by family, friends, communities or other agencies.

Clearly stating the benefits of the suggested approach over the other options will also help to make a successful case.

Remember that if an individual isn't happy about a local authority's decision, they can make a complaint or ask for a reassessment.

John’s mobility has become restricted. As a consequence he is finding it increasingly difficult to leave his house.

His sense of loneliness and isolation is growing. His Social Worker, Gareth, explores with John how this could be overcome.

John explains that he always enjoyed the company of a dog when he was younger but he cannot look after one properly now as he could not take it for a walk.

He feels this is a shame as a relative has offered to give him a dog. Gareth suggests a dog walker could overcome this problem for John.

In this instance, the outcome is to reduce feelings of isolation and loneliness with a view to improving John’s sense of well-being and preventing the onset of depression.

The solution is a dog walker - not a solution Gareth would necessarily have considered had he not listened carefully to understand what matters to John.

This is at the heart of a good ‘what matters’ conversation.

It is important to tease out what really matters to the individual or carer, rather than make assumptions about what would make their life better.

In the example above, it would have been easy to jump to the conclusion that the best thing for John would be to arrange weekly trips to a day centre or enrolling him in a befriending service.

Of course, people’s needs tend to change over time. Assessments are not one-off events. They should be looked upon as an on-going process or series of events and conversations.

As needs change, so support plans need to change. People can require more, less or different support as time goes by.

What matters to people - video examples

Once the local authority approves direct payments, the recipient may become responsible for buying the services or equipment.

The core system is that local authorities will pay direct payments into an individual's dedicated bank account.

Direct payments recipients will need to keep good records of what they purchase and when.

It's good practice to discuss this with individuals to explore any possible process barriers to receiving direct payments.

It is useful to check with the individuals if they are familiar with how social services finance departments works.

The Code for Part 4 of the Social Services and Well-being Act (Wales) 2014 requires authorities to make direct payments reliably, routinely and on time. Paragraph 166 of the Code also says:

"Local authorities must ensure their financial monitoring arrangements for direct payments are proportionate. Reports which are completed by a direct payment recipient or their representative must be user friendly and not over burdensome."

Read more about this in Accessing support to be a direct payments employer.

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