Independent successes: Implementing direct payments · York Publishing Services Ltd 64 Hallfield Road Layerthorpe York YO31 7ZQ Tel: 01904 430033; Fax: 01904 430868; E-mail: orders@yps,ymn.co.uk

Independent successesImplementing direct payments

Carol Dawson

The Joseph Rowntree Foundation has supported this project as part of its programme ofresearch and innovative development projects, which it hopes will be of value to policymakers and practitioners. The facts presented and views expressed in this report are,however, those of the author and not necessarily those of the Foundation.

© Joseph Rowntree Foundation 2000

All rights reserved.

Published for the Joseph Rowntree Foundation by YPS

ISBN 1 84263 011 3

Prepared and printed by:York Publishing Services Ltd64 Hallfield RoadLayerthorpeYork YO31 7ZQTel: 01904 430033; Fax: 01904 430868; E-mail: orders@yps,ymn.co.uk

Contents

PageAcknowledgements iv

Executive summary v

Language used in the report viii

Glossary of abbreviations used in the report ix

1 The situation in Norfolk prior to direct payments 1

2 The project and project evaluation 4The national context 4Direct payments in Norfolk 4The operation of the pilot project 7The evaluation framework 11Key outcomes 13Training of employers and personal assistants 36Monies 37The views of the players about the scheme 46

3 Overview and evaluation by the monitor 51The working of the project 51Summary of the strengths and weaknesses of the scheme 55Future developments 55Closing remarks 56

Bibliography 57

Appendix 1: Direct payments questionnaire 60

Appendix 2: Competence checklist 63

Appendix 3: Maps 66

The author would like to thank the following.

• Laurie A’Court

• Bill Albert

• Suzanne Dunwoody

• Geoff Empson

• Marilyn Martin

• Alex McAnulty

• Ann McDonald

• Nick Miller

Acknowledgements

• Alex O’Neil

• Keith Roads

• Simon Palmer

• Members of the advisory group.

• All those who must remain anonymous butwho gave so generously of their time,thoughts and feelings as respondents to thisstudy.

• The Joseph Rowntree Foundation for thegrant to monitor the project and to producethe report.

iv

The Community Care (Direct Payments) Act1996 gave local authorities the power to makedirect payments to some individuals in lieu ofcommunity care services provided under theNational Health Service and Community CareAct 1990. Prior to this time, Social ServiceDepartments had been constrained from givingmonies directly to service users to enable themto purchase their own support. Many counties,including Norfolk, had developed a third-partyscheme, which acted as a broker for services fordisabled people who wished to employ theirown staff.

On 1 April 1998, a direct payments pilotproject, which adopted an innovative approach,was launched in Norfolk. It broke new groundin that the scheme applied to all adults aged18–64 who were assessed as eligible forspecified community care services (domiciliarysupport of more than five hours per week,respite care and associated transport). Itprovided three options available to peoplereceiving direct payments, which offereddiffering levels of support and involved thepartnership between an organisation of disabledpeople, an organisation for disabled people anda Social Services Department (SSD).

The Joseph Rowntree Foundation supportedthe pilot scheme by funding a researcher. Theresearch took the form of qualitative interviewswith disabled people who received directpayments, personal assistants employedthrough the pilot project, operational andsupport staff within the SSD, and players withinthe two support organisations. Questionnaireswere sent to all disabled employees and thedocumentation of the project was reviewed. Thereport, written to inform both disabled peopleand service providers, follows the process of

implementation, and draws conclusions andrecommendations for those wishing toimplement similar schemes.

Summary of findings

Below are the major findings from the project.Some are peculiar to schemes relating to directpayments whereas others are pertinent to allpartnerships between disabled people andSocial Service Departments.

1 Disabled people need to be involved in theintroduction of any scheme which impactson their lives including those related todirect payments. Failure to consult widelyand appropriately in the initial stages mayprove time-consuming in the long term andantagonise potential allies.

2 Disabled people should be full participantsin the initial discussions, and significantplayers in the implementation andoperation of any such scheme.

3 The introduction of direct payments iscomplex. Within a Social ServicesDepartment, it requires practical operationalchanges, a shift in approach to the conceptsof risk and control, and a challenge to theculture of direct service provision.

4 A direct payments scheme requires thecommitment of senior members of staffwithin the SSD in order to validate thescheme, and to make available the staff andresources to effect the necessary changes inculture and in practice.

5 The creation of a post, Direct PaymentsOfficer, at a managerial level within the SSD

Executive summary

v

Independent successes

dedicated to direct payments to oversee theintroduction of the scheme is helpful. Staffrequire training in the policies andprocedures relating to direct payments priorto the start of the scheme. Separateworkshops addressing issues of equalitywith disabled people may be useful.

6 A help line established within the SSD forstaff, operated by the designated DirectPayments Officer, provides an effective two-way communication system between thoseimplementing the scheme and those puttingit into practice.

7 Norfolk SSD entered into different servicecontracts with two support agencies. Onesupport agency, controlled and managed bydisabled people, would arguably be themost effective means of offering support.

8 The transfer from a third-party brokeragescheme is complex and can involve muchchange for disabled employers who mayneed to alter their support arrangements toconform to the policies and proceduresrelating to direct payments.

9 The numbers of people joining the schemewas initially slow as staff within the SocialServices Department and disabled peoplecame to understand the processes.

10 After two years, approximately 15 per centof those eligible for direct payments inNorfolk had chosen this form of serviceprovision. There were 75 people in receiptof direct payments.

11 The Norfolk scheme was open to all adultsaged 18–64, including people who receivedsupport from Social Service teams for

people with learning difficulties and usersof mental health services. Only three peoplewho did not receive their support fromteams working with people with physicalimpairments joined the scheme.

12 Most people became aware of directpayments through their social worker.Social workers need to begin from anassumption of competence rather thanincompetence when assessing willing andable.

13 Personal assistants were recruited throughadvertisement, informal networks and fromthe agencies that provided a service to theemployer before they joined the pilotproject. Most disabled employers had littledifficulty in finding staff. The schemebrought into the market some new personalassistants who might otherwise not haveentered this form of employment.

14 Children featured strongly in the project.Risk to children and vulnerable adults maybe reduced if personal assistants are askedto provide a certificate from the CriminalRecords Office (cost £10.00).

15 Norfolk has both rural and urban areas.There was little correlation betweenmeasures of rurality or population densityand the uptake of direct payments.

16 The financial monitoring of direct paymentsis best separated from the support functionand undertaken by the Social ServicesDepartment.

17 Direct payments are a cost-effective means ofservice delivery when compared with similarsupport costs from in-house service provision

vi

Executive summary

and agency support, although there are manyhidden costs within the SSD and otheragencies at the beginning of a scheme.

18 Only eight people left the direct paymentsscheme during the two years. Five had leftbecause of changes in their personalcircumstances and three had found itunsuitable. One failed to complete therequired financial monitoring forms andtwo were unable to manage theiremployees.

19 People who receive direct payments foundthat they had sufficient support inmanaging their monies and staff. Theysuggest that, although direct payments maycreate more work for them, the positivesoutweigh the negatives, which include:• employing whom they choose

• determining the hours of employment• determining the tasks they require the

personal assistant to undertake• the flexibility of the employment

relationship which allows them to varytheir routines and activities with moreease

• decrease of involvement withprofessional agencies.

Conclusion

A direct payment scheme that involves disabledpeople from its inception and throughout itsoperation can provide a very positivealternative to direct service provision, and onewhich empowers disabled people to live theirlives as they choose with no additional cost tothe Social Services Department.

vii

The use of language and terminology hasreflected ideological and practical differencesbetween the partners involved in the NorfolkDirect Payment Project, which are familiartensions at the interface between those whoreceive services from statutory bodies and thosewho receive direct payments.

People in receipt of services

The Norfolk Coalition of Disabled People usesthe term disabled people to refer to all thosewho are disabled by society. The Social ServicesDepartment (SSD) distinguishes betweendifferent groups of disabled people both withintheir policies and procedures, and also in thevery structure of service provision. In thisreport, the terms disabled people and disabledemployers will be used generically. Whenreferring to the different SSD provisions, thefollowing terms will be adopted: adult team(physical disability); adult team (mental health);adult team (sensory impairment); adult team(learning disability). Where necessary,distinctions will be made between disabledpeople by use of the following terms: people

who have physical impairments, mental healthservice users and people with learningdifficulties.

People in receipt of direct payments

Within the report, people in receipt of directpayments are referred to as disabled employerssince, unlike others in receipt of services, theydirectly employ their own staff.

Supporters/carers

Disabled people refer to people who provideassistance as supporters, whereas the SSDadopts the terms carers or home care assistants.Under the direct payments pilot project,employees of disabled employers were calledpersonal assistants.

Services provided

As above, the SSD refers to domiciliary andpersonal care whereas disabled people preferthe concept of domiciliary and personalsupport.

Language used in the report

viii

DSS Department of Social SecurityHAND a charity offering Help, Advice and Advocacy for Norfolk Disabled PeopleILF Independent Living FundILP Independent Living Project (part of HAND offering support to people who employed

their own personal assistants)JRF Joseph Rowntree FoundationNANSA Norfolk and Norwich Spastic Association (now renamed SCOPE)NCODP Norfolk Coalition of Disabled People (a registered charity which is a federation of

organisations of disabled people throughout Norfolk)SSD Social Services Department

Glossary of abbreviations used in the report

ix

1

The Independent Living Fund (ILF) wasestablished in 1988 to provide income fordisabled people to live independently in thecommunity. Between March and September1991, Ann Kestenbaum interviewed 123 clientsof the ILF and found that a quarter of thoseinterviewed had experienced difficulty inarranging support (Kestenbaum, 1992).

In Norfolk, 103 people were in receipt of ILFfunds. Social workers were increasingly askedfor advice on matters relating to employment,income tax, insurance, legislation, contracts andbookkeeping, which they felt ill equipped toprovide. There were also requests for support inrecruiting and interviewing personal assistants.People were in receipt of large sums of money –up to £700 a week to pay for 24-hour support(SSD funding via a third party, ILF monies andDSS benefits). Some were confused about theirfinancial positions. Personal assistants werefacilitating the financial affairs of theiremployers and there was evidence thatvulnerable people could be the victims of fraud.There was a growing recognition that theemployment of personal assistants requiredspecialist information and skills that must beeasily accessible to all potential employers.

A pilot scheme, which offered support to sixemployers, was initiated by social workers fromthe Norwich team, which supports people witha physical disability, and the Hamlet Centre; alocal charity controlled by disabled people. Thescheme ran for a year and proved verysuccessful. Employers felt more secure andsocial workers found that calls on their time byemployers were reduced. It became apparentthat many more people could employ their own

personal assistants through the support of sucha scheme. In 1992, there were 101,000 disabledpeople in Norfolk. It was estimated that inNorwich there were 12,600 disabled peopleliving in the community of whom 1,500 wereunder 65 and used some form of domiciliarysupport service.

Disabled people who were not eligible forfunding from the ILF but received financialassistance from Social Security or services fromthe local authority also sought to control theirown living arrangements and to choose theirsupporters. Since the division in 1948 betweenthe Department of (Health and) Social Security,dealing with financial benefits, and the SocialService Departments, providing services, thelatter had been constrained from giving moneydirectly to service users to pay for their support.However, a survey by RADAR showed that, of65 local authorities which responded, two-thirdswere then making payments directly orindirectly to disabled people. The device of aholding trust was often employed (RADAR,1990).

In Norfolk, disabled people, withprofessionals, sought the development of anindependent service that could enable anydisabled person to employ their own personalassistants. Under the provisions of the NationalHealth Service and Community Care Act 1990,the local authority could purchase a service thatfacilitated the employment of personalassistants by disabled people. The servicewould enable the Social Services Department tomeet its obligation of spending funds forcommunity care in the independent sector, andwould fill a gap in service provision between

1 The situation in Norfolk prior to direct

payments

2


private care agencies and the local authoritydomiciliary service. NANSA (now SCOPE)initially acted as a third party receiving SSDmoney on behalf of a disabled person. During1992, HAND, a voluntary organisation thataimed to provide help and advocacy for Norfolkdisabled people, undertook to develop a pilotproject. The SSD provided £4,000 to employ adevelopment worker. The pilot receivedpractical support from the Hamlet Centre(another organisation controlled by disabledpeople) in operating the payroll.

During 1993–94, Norfolk Social ServicesDepartment made a grant of £11,250 and JosephRowntree Foundation a grant of £12,003 to funda project development worker who wassupported by a liaison officer from the Norwichteam for people with a physical disability. Theservice, which became known as theIndependent Living Project (ILP), was formallylaunched on 4 October 1993. The inception ofthe project was recorded through funding fromthe Joseph Rowntree Foundation (FindingsSocial Care Research No. 61 and Dawson, 1995).

The ILP had thus arisen through acombination of factors:

• the need for disabled people to receivesupport and advice in employingpersonal assistants

• the changes in the arrangements of socialcare brought about by theimplementation of the National HealthService and Community Care Act 1990

• the requirement that Social ServiceDepartments must spend a proportion ofthe budget for community care in theindependent sector (this wassubsequently relaxed)

• the regulations governing theadministration of the Independent LivingFund.

The expressed aim of the ILP was: to offer aservice to disabled people who are under theage of 65 and who live independently or whoexpress a wish to do so.

The objectives were to:

• enable disabled people to liveindependently in the community

• provide advice, assistance, advocacy andsupport to enable people to employ theirown personal assistants

• make these services self-financing bycharging commission for services offered.

Two major issues determined the role of theproject and set the parameters for thecollaboration with the SSD: the assessment ofneed and the payment for services. The fundingfor disabled people to employ their ownassistants was obtained through a number ofroutes:

• the Independent Living (Extension) Fund

• the Independent Living (1993) Fund

• social security benefits

• independent means, e.g. private income,charitable grants.

Whilst the local authority was not legallyempowered to give a disabled person money topay for their own support, the SSD could paymoney for the social care of disabled people tothe ILP. The project thus acted as a broker forservices; it did not employ personal assistants.

In 1995, the ILP extended the service offered

3

The situation in Norfolk prior to direct payments

within 25 miles of Norwich to encompass thewhole of Norfolk. There were also additions tothe Board of Trustees of HAND (the ILP parentorganisation), some of whom were able-bodiedand some of whom were disabled. The ILP hada turnover in excess of £250,000 per year andthere were debates about whether the ILPshould remain within the remit of HAND orbecome a separate business with its ownconstitution. Conflicts about this and ideologicalissues arose between the trustees, between thetrustees and the staff, and within the staffgroup. In 1996, three trustees resigned, leavingfour disabled people as trustees. The projectworkers of the ILP did not have their contractsrenewed when they came to the end of theirterm and the manager of HAND resigned. A co-ordinator of the ILP was appointed and a fewmonths later a manager of HAND. Both were

appointed for skills in business management.The co-ordinator of the ILP had becomeinvolved with HAND as a volunteer; thenbecame an employee, before applying for andbeing offered the post.

In 1996, a political force, the NorfolkCoalition of Disabled People (NCODP), wasestablished in response to the debates about theDisability Discrimination Act and changes tosocial security benefits. The NCODP sought tobring together all organisations of disabledpeople across Norfolk as a campaigning forceand is described by the chairman as ‘a politicalorganisation with a constituency of all disabledpeople in Norfolk’. The chairman had brieflybeen a trustee of HAND during the period1995–96 and HAND became a foundingmember of the Coalition. The NCODP gainedcharitable status in 1997.

4

The national context

The Community Care (Direct Payments) Act1996 gave local authorities the power to makedirect payments to some individuals in lieu ofcommunity care services provided under theNational Health Service and Community CareAct 1990. Prior to this time, Social ServiceDepartments had been constrained from givingmonies directly to service users to enable themto purchase their own support. Many counties,as in the example of Norfolk above, haddeveloped a third-party scheme, which acted asa broker for services for disabled people whowished to employ their own staff. In July 1997,just under 50 per cent of all local authoritieswere operating some form of payment scheme,most of which were third-party schemes (Zarbet al., 1996). The Act gives local authorities thepower to make direct payments. It does not givethem a duty to do so. The research suggestedthat over 80 per cent of local authoritiesintended to carry through some form ofimplementation of direct payments. Amongstthese was Norfolk.

Direct payments in Norfolk

The consultation process

Local authorities are exhorted to consultrepresentatives of disabled people and otherinterested parties in considering whether orhow to use direct payments to help meet theneed of its local population (LAC (97) 11). Theconsultation that took place in Norfolk was notinitially a smooth process.

The drive towards a direct payments schemein Norfolk came from within the Social ServicesDepartment, as the newly formed NCODP wasnot proactive concerning the introduction of

direct payments. A team manager for socialworkers who serve people with physicaldisabilities in Norwich was charged with theresponsibility of researching and developingdirect payments in the SSD and released fromhis other duties for six months. He was the soleremaining person, from the SSD or the ILP, whohad been involved with the setting up of the ILPin 1993.

At this time, the ILP was supporting over 40people in the role of a broker across Norfolk.The third-party role had to change because thecriteria for payments under the Direct PaymentsAct differed from those adopted by the third-party scheme. The team manager from the SSD,under the newly created title of Direct PaymentsProject Officer (a temporary post), worked withthe new staff of HAND and the ILP. Togetherthey devised a scheme in which the ILP wouldundertake a key role with respect to directpayments in Norfolk. In June 1997, theycirculated a paper about the proposed scheme tostimulate discussion and consultation. A paperwas disseminated to groups of disabled peopleand an invitation was extended to attend apublic meeting to be held in a day centre forpeople with a physical impairment in Norwich.

At the consultation meeting, the chairman ofthe NCODP raised objections to the proposedmeans by which direct payments would beintroduced. The main bones of contention were:(a) that disabled people were given insufficienttime to work through and respond to theproposal; (b) that it was presented as a faitaccompli; and (c) that it only extended to peoplewith physical impairments. An extendedprocess of consultation was agreed. A groupjointly chaired by the Direct Payments ProjectOfficer and the chairman of the NCODP was

2 The project and project evaluation

5

The project and project evaluation

convened. The ILP was represented and otherparticipants representing people with learningdifficulties, physical impairments, physicalillness, mental health problems, sensoryimpairments and HIV/Aids were drawn fromorganisations throughout Norfolk.

A working party consisting of a cross-sectionfrom these organisations proposed aninnovative approach to direct payments, whichbroke new ground in three main areas:

• the application of the scheme to alldisabled adults

• the implementation through apartnership between an organisation ofdisabled people (NCODP), anorganisation for disabled people (ILP)and a local authority Social ServicesDepartment

• the development of three options (withdiffering degrees of support offered bythe ILP and/or the NCODP) available topeople receiving direct payments.

The partners

The introduction of direct payments is complex.In Norfolk, there were three partners involvedin the direct payments scheme. All had theirown issues and agendas. This added to thecomplexity and brought both strengths andweaknesses to the pilot project. Every issue wasthoroughly debated which increased thecomplexity and time involved.

The ILP

The ILP, still a project within the organisationHAND and managed by the general manager ofHAND, consisted of a co-ordinator, two part-time project workers, one finance officer who

operated the payroll system for disabledemployers, and a part-time office administratorwho also worked for HAND. The ILP hadbecome self-financing by charging commissionfor services offered to disabled employers. Sincethe ILP would lose some clients as disabledemployers transferred from the third-partyscheme to direct payments, the SSD agreed tounderwrite the ILP to the sum of £78,000 (theamount it needed to remain viable). Under aseparate contract from the SSD, the ILP was tomonitor the financial returns of all peoplereceiving direct payments.

The NCODP

A joint-funding (Health and SSD) grant for threeyears was obtained for the post of a DirectPayments Co-ordinator employed by theNCODP. The post was for 25 hours per week.The Co-ordinator was managed by a committeeof representatives drawn from different groupsof disabled people throughout the county.

The role of the co-ordinator was to establishpeer groups in different locations. It wasenvisaged that the peer groups would comprisedisabled people with experience of, and skillsin, managing independent living. The groupswould support individual recipients and eachother on all aspects of independent living andbe responsive to local circumstances. It was alsoenvisaged that the Co-ordinator would offeradvice during the assessment process, inductpeople into the scheme, arrange training andprovide back-up support to the peer groups andsupport for those on the scheme.

Norfolk SSD

There was a commitment to direct paymentsfrom senior staff, such as the Director andDeputy Director (Adult Care) within Norfolk

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SSD. The Deputy Director confirmed his view inwriting that a direct payment scheme must be‘owned in principle and in practice by disabledpeople’. This was highly significant in the wayin which resources and systems were madeavailable to the project within the department.

Concurrent with the debates about directpayments, a restructuring of services was takingplace within Norfolk SSD. In 1993, the SSD hadarranged services to reflect the purchaser–provider split which was introduced in theNational Health Service and Community CareAct 1990. Social workers and occupationaltherapists, employed as care managers, werepurchasers of services and were organised infive districts across the county. Adults in receiptof services were allocated to teams workingpredominantly with one client group in a givengeographical area. There were teams workingwith people with physical impairments, peoplewith learning difficulties, people who use

mental health services and older people. Therewas one team across the county working withpeople who have sensory impairments. Teamsworking with children and families were alsoorganised by district but these had a differentmanagement structure. Each team had a teammanager.

Services for adults were restructured on 1April 1999. The changes in the districtboundaries and in management had little effecton data concerning direct payments. However,the uncertainties within the Department duringthe period before the restructuring wascompleted had an impact on the way in whichstaff were able to focus on an innovativescheme. The role of the Direct Payments Officerwithin the SSD was deemed by all threepartners to be crucial to the success of the pilotscheme. This temporary post, which wasinitially created in the SSD for six months, wasextended to the life of the project.

Direct PaymentsProject Officer

HAND NCODP

ILPNCODP

Co-ordinatorDirect Payments

Social Services Committee

Norfolk County Council

Social Services Department

Service Contract Service Contract

Figure 1 The partnership

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The operation of the pilot project

The Social Services Committee of NorfolkCounty Council accepted the proposal andagreed that direct payments should be offeredacross the county under an 18-month pilotscheme to commence on 1 April 1998.Monitoring of the pilot, also for an 18-monthperiod, which was funded by Joseph RowntreeFoundation, began formally on 1 July 1998.

The management of the project

The introduction of direct payments wasoverseen by a Project Board, an ImplementationGroup and a Consultation Group, each of whommet regularly. A Finance Panel was a lateraddition born of necessity (see Figure 2).

The Project Board

The Project Board consisted of SSD personnel;the Assistant Director (adult care), the Head ofFinance and Administration, the DirectPayments Project Officer, a Contract Officer and

other personnel as required. This was the finaldecision-making body with respect to thescheme, within the SSD. From hererecommendations were taken to the SocialServices Committee of Norfolk County Council.

The Implementation Group

The Implementation Group was responsible forthe practical day-to-day operation of the pilotscheme. It was alternately chaired by the SSDDirect Payments Project Officer and the NCODPChairman, and consisted of these two with theSSD Contracts Officer, the ILP Co-ordinator andthe NCODP Direct Payments Co-ordinator. If itwas decided that further discussions wererequired, the matters could be taken to theConsultation Group and finally to the ProjectBoard for ratification.

The Consultation Group

The Consultation Group was chaired alternatelyby the chair of the NCODP and the SSD DirectPayments Project Officer. It consisted of

Figure 2 The project management

Social Services Department

Directorate

ConsultationGroup

ImplementationGroup

Finance Panel

Project Board

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members of the Implementation Group,representatives from a range of groups ofdisabled people and some recipients of directpayments, since the function was to review howthe scheme was viewed by disabled people whocould be, or who were, in receipt of servicesincluding direct payments.

The Consultation Group seemed an effectivevehicle for debate in the early stages of theproject but attendance began to wane after thefirst few meetings. In order to consult with asmany employers as possible, the partnershiparranged an event at a local hotel to which allemployers were invited. The event lasted anafternoon and was chaired by the Chairman ofthe NCODP. There was a presentation about theprocesses of decision making within the schemeand then most of the time was given to opendiscussion in which people could voice theirconcerns or suggestions about the scheme to themembers of the Implementation Group. Thepartnership subsequently produced minutes ofthe meeting with an addendum in which thequestions raised by employers were addressed.This was highly effective in enabling people tofeel a part of the planning and organisation ofthe scheme rather than recipients of a service.However, the event also served to highlightdifferences between the employers. For, as willbe discussed later in this report, they were avery disparate group of people.

Finance Panel

The Finance Panel was born of necessity duringthe pilot scheme. It met monthly and consistedof the SSD Direct Payments Project Officer, theSSD Contracts Officer, the ILP Co-ordinator andthe ILP Project Administrator. The group waslater joined by the SSD Monitoring Officer. Thepurpose of this Panel was primarily to address

individual employers’ funding, employmentand monitoring issues. Writtenrecommendations were made about anynecessary action to be taken by either the ILP orthe SSD. The issues were then followed up atsubsequent meetings of the Panel in liaison withsocial workers or team managers if necessary. Ifany of the issues raised at the Finance Panelindicated the need for consultation on a widerbasis, they could be taken to theImplementation Group to decide whether or notrecommendations should be made to the ProjectBoard to modify policies or procedures of theproject.

Clearly, there was much commitment to thescheme from the SSD in terms of the personnelhours given in these panels and in carrying outthe work to support the pilot project. Indeed,there was a heavy commitment to the schemethroughout, from the Director and AssistantDirector (Adult Care) of Norfolk Social Services.

Support for SSD staff

From the outset, it was apparent that staffwithin the SSD would need support in gaininginformation about direct payments and inimplementing the systems within the pilotproject.

Training of staff

All community care assessors (social workersand occupational therapists) within the adultsector of Norfolk SSD (except those workingspecifically with older people aged 65 andabove) were offered training in direct paymentsprovided jointly by the Department, the ILP andthe NCODP. Five separate day-long events wereheld and the majority of staff were trainedincluding managers. The training consisted oftwo parts. The Chairman of the NCODP led the

9


first session in which he stressed the socialmodel of disability and made the links betweenthis model and direct payments both in Britainand Europe. The Project Officer from the SSDthen briefed staff on the options within thescheme; the Finance Officer from the SSD alsobriefed staff on the necessary paperwork; andthe Co-ordinators of the ILP and the NCODPmade their roles known. The days were veryfull. With hindsight, it might have been moreeffective had there been separate training aboutissues of equality and disability before thebriefing about direct payments. Staff who werechallenged by the session on the social modelcould have had longer to explore this issue andmore time could have been given to thequestions related to direct payments.

There was a clear divide, as shown by thequestions asked in the open sessions and in thecomments made during informal breaks on thetraining days, between those staff working inadult teams (physical disability) and thoseworking in others. The former were clearlyaware of many of the issues involved in directpayments and were able to draw on experiencesof the third-party scheme. Staff from otherteams had little sense of how things might workin practice. It might have been helpful to haveoffered some separate sessions for different staffgroups in which their specific concerns couldhave been addressed.

SSD help line

A help line for staff was established, advertisedand operated within the SSD by the DirectPayments Project Officer. All teams workingwith adults were leafleted twice about the helpline during the pilot project. By the end of June,three months into the scheme, there had been 15enquiries. In September 1999, 23 staff working

in adult teams responded to a questionnaire.Five of these were unaware that a help lineexisted. Two respondents were in adult teams(mental health) and two in adult teams (learningdisability). This suggests that they did not recallinformation coming to the teams about directpayments, possibly having dismissed it asirrelevant or because the information was notforwarded to them by their managers for similarreasons. Workers who used the help linereported finding it extremely useful. Assessorsorganise direct payments relatively rarelycompared with other services. They are not veryfamiliar with the minutiae and detail of settingup payments day by day and access toimmediate assistance or a response to aquestion, however minor, facilitated the wholeprocess. The Direct Payments Project Officer:

…. would strongly recommend it as a way ofcutting through some of the complexities

.... and also as a way of the SSD lead personkeeping an ear to the ground on issues.

The project

Eligibility for the scheme

The legislation only allows payments to beoffered to someone who has been assessed asneeding community care services, as delineatedunder the National Health Service andCommunity Care Act 1990. The decision to offerpayments therefore follows an assessment of anindividual’s needs. Initially, in order to beeligible for direct payments under the Norfolkscheme a person had to be:

• between 18 and 64 years old whenpayments commence

• disabled

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• assessed as ‘willing’ to receive payments

• assessed as ‘able’ to manage theirpayments and arrangements (withsupport if necessary)

• normally expected to need services for aperiod of at least 12 months

• willing to sign a Direct PaymentAgreement with the SSD which wasbinding on both parties

• willing to attend an orientation/information session before a final decisionwas made to make payments.

The legislation allows direct payments to be usedfor the purchase of any service that is defined as acommunity care service except permanentresidential care. Following the local consultationprocess, Norfolk Social Services Committee decidedthat payments could be used for:

• personal domiciliary assistance where theperson was assessed as needing fivehours’ assistance or more per week

• respite care where the amount of respitecould be assessed annually in advance

• transport for respite where this was anassessed need and where no otheralternative was available.

Direct payments could not be made for dayservices or equipment during the pilot project.

A disabled person could have a mix of directpayments and services, for example day serviceprovided by SSD, some personal assistance froma contracted domiciliary agency and a directpayment to purchase an additional element ofthe total service required.

Options for receiving direct payments

There were three options for direct payments.

1 Direct payments (self-management): suitable forpeople who wished to personally managetheir payments and arrangements.• SSD payments made directly into the

person’s bank account set up specificallyfor that purpose.

• Disabled person directly responsible forensuring all tasks relating to managingpayments and arrangements areundertaken.

• Disabled person is the employer of anypersonal assistants.

• Disabled person directly responsible forensuring receipts and financial returns aresent monthly to the ILP for charging andfinancial monitoring purposes.

• Disabled person may access NCODPtraining and peer support.

2 Direct payments (assisted management – other):suitable for people who wished to choosetheir own agent to assist them in managingtheir payments/arrangements.• SSD payments made directly into

disabled person’s/agent’s bank accountset up specifically for that purpose.

• Disabled person may delegate all or someof management tasks to agent.

• Disabled person is the employer of anypersonal assistant.

• Disabled person responsible for ensuringreceipts and financial returns are sentmonthly to the ILP for charging andfinancial monitoring purposes but thismay be one of the tasks delegated to theagent.

11



3 Direct payments (assisted management – ILP):suitable for people who sought a greater levelof assistance in managing their payments andarrangements, and where they preferred theILP to act as their agent. In practice, therewere two forms of assisted management. Inboth forms, the following applied.• Payments made to the ILP who acted as

the disabled person’s agent for payrollpurposes.

• Employer responsible for ensuring ILPreceives accurate information for payrollpurposes.

• Disabled person is the employer of anystaff, which includes managing staff andarranging cover for shifts.

• Disabled person is responsible forproviding ILP with receipts monthlyshowing expenditure.


In the first system, the ILP offered a fullfinancial management package in which theemployer submitted timesheets for the workundertaken by personal assistants and the ILPoperated the payroll, paid income tax and ranthe account. In the second system, the ILPoperated the payroll but the employer held themoney and paid the personal assistants directly.

Becoming an employer

A potential employer would first require anassessment of needs under the National HealthService and Community Care Act 1990. Thiswould be undertaken by a social worker or anoccupational therapist undertaking the role of

community care manager within SSD. If theperson was entitled to a service under the Actthey would then be offered a range ofalternatives including the option of directpayments. If they considered direct payments asan option, they were required to meet with theDirect Payments Co-ordinator of NCODP or theCo-ordinator of the ILP to discuss the scheme. Ifthey were willing to manage direct payments,and were also seen as able to manage them(with support if necessary), the social workerwould raise the required forms and the personwould enter into a contract with the SSD. If theywere to take the ‘self-management’ option, theywould be required to open a separate bankaccount, to complete timesheets for theiremployees and to return the monitoring formson a monthly basis. The person would recruittheir own personal assistants. If they were totake the ‘assisted management’ option, theywould be supported in whatever way theyrequired, for example in selecting personalassistants and in operating their payroll. Theemployer would send timesheets for their staffto ILP in order to raise the payment to thepersonal assistant. The social worker wouldsubsequently review the situation.

The evaluation framework

A researcher was funded by the JosephRowntree Foundation to monitor the project.The researcher had carried out the original workwith the ILP project (Dawson, 1995). Theresearch commenced three months after theinception of the direct payments schemealthough the monitor attended one of thetraining days for SSD staff in the spring of 1998.

The aim of the research was to:

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• monitor and record the events of the pilotproject

• highlight issues for policy and practice

• disseminate the findings both locally andnationally.

The main areas of interest were the:

• working of the partnership and theoperation of the scheme

• take-up of direct payments with respectto age, gender, locality and disability

• effectiveness of direct payments from theperspectives of the players in the arena.

Interviews

Three months after the start of the project,letters were sent to all recipients of directpayments requesting interviews with themonitor. There were 17 replies. By the end of theresearch, 23 people had offered interviews. Theresearcher also sought permission to speak totheir personal assistants. People wereinterviewed, some on more than one occasion,at intervals throughout the pilot. Interviewswere conducted using a tape recorder or hand-written notes during sessions, which lastedbetween one and two hours, usually conductedin the employers’ homes. Some interviews wereconducted with employers alone, some wereconducted with personal assistants on their ownand some were conducted jointly.

Interviews were also conducted withemployees of the SSD (including those closelyinvolved with the pilot and those in other partsof the Department) and with the partners. Thesewere repeated throughout the 18-month period.

Questionnaires

One year after the commencement of the pilotproject, questionnaires were sent to allemployers, and subsequently sent to newemployers as they joined the scheme (seeAppendix 1). In total, 36 questionnaires werereturned. A breakdown of the respondents bygender and by the numbers of those who werenew employers compared to those whopreviously used the ILP suggests that they werequite representative of those using the scheme.There was no reference to ethnicity in thequestionnaire as all recipients were whiteBritish. One woman, from Sri Lanka, became anemployer towards the very end of the project. Itwould be difficult to maintain her anonymity ifethnicity was introduced as a criterion ofcomparison. In the data within the report, someinformation is plus or minus 100 per cent sincesome questions were answered with tworesponses and others left blank.

Statistical data

Figures relating to the numbers eligible forservices and those in receipt of services weregained from the information and researchdepartment of Norfolk SSD. Data relating tomonitoring and numbers on the scheme wasoriginally supplied by the ILP and then by thefinancial monitor within the SSD.

Demographic data

Material was taken from the 1991 census,reports concerning sparsity and rurality fromthe Local Authority (Coldicott, 1998) and dataproduced by the information and researchsection of the SSD.

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Key outcomes

Uptake of direct payments during the first year

At the outset of the pilot project, it was agreedthat the scheme would be limited to 50 newdisabled employers in addition to those alreadyusing the indirect payment scheme run by theILP. However, fears that this figure would berestrictive proved to be unfounded. Numbers ofpeople wishing to join the scheme were verymuch lower than expected by some. As directpayments had been introduced as a pilotproject, there was a perceived need by membersof the Implementation Group to have numberslarge enough to fully explore different issuesrelated to direct payments.

Numbers on the third-party scheme at 31

March 1998

At 31 March 1998, when the direct paymentspilot project commenced, there were 48recipients of the third-party service provided bythe ILP: 16 men and 32 women all of whomwere assessed for services through the adultteams (physical disability) (see Figure 3 andAppendix 3, Map 1).

Awareness-raising campaign

HAND and NCODP began an extensiveawareness-raising campaign. Members of bothorganisations gave interviews on the local radioand in the local press. HAND printed leafletswhich were circulated widely, including to allGPs’ surgeries. The Direct Payment Co-ordinator of the NCODP visited many groupsof, and for, disabled people, including many forpeople with learning difficulties.

Transfer of people from the third-party scheme

During the first year, of the 48 disabled peopleserved by the ILP, 21 transferred to directpayments; eight were self-managing. Thetransfer of people from the third-party systemwas more complex than envisaged. A number ofdifficulties arose. Some people on the third-party scheme were employing relatives, whichis prohibited (unless no alternative) under theterms of the Act; some were paying personalassistants at rates above the allowance thenmade by the SSD under the direct paymentsproject; and some were receiving funding fromthe Independent Living Fund where the termsdiffered from those for direct payments. There

Figure 3 In receipt of services from ILP at 31 March 1998

60

50

40

30

20

10

0

Age groupings

TotalMaleFemale

Total56–6446–5536–4526–3518–25

14


was confusion about what personal assistancewas being purchased through monies fromdifferent sources. Some of the packages ofsupport were very complex and others did notcome within the scope of the Act.

Jane, who had employed her own personalassistants through the ILP almost since itsinception, describes why she was one of the lastto transfer to direct payments:

I had some girls already … on the DSS before …but since all this come to … I ain’t got anyone onthe DSS now – so now everything’s above board– they’re all legal now … before if they weren’tworking to give them a helping hand, you knowbut … so I had to say that that’s the situationnow.

Jane, like many others reported inKestenbaum’s study (1992), had recruitedfriends and neighbours in the grey marketeconomy. The monitoring and checks in thethird-party scheme were not as tight as those inthe direct payments pilot project and thesesituations took some time to resolve.

Clearly, the regulations surrounding thedirect payments scheme were tighter in law andin practice than had been the situation with thethird-party scheme. Individual exceptions weretaken to the Assistant Director within the SSDwho had to rule on a case-by-case basis. Therewas a need for unambiguous statements tosupport individual decisions so that theDepartment could demonstrate that theirdiscretion was applied without prejudice.

A dedicated social worker was appointed ona full-time basis on 28 September 1998 by theSSD for five months to help to speed up thetransfers, since all needed clarification about thenew scheme before they joined and some

needed a new assessment under the NationalHealth Service and Community Care Act 1990.It was believed that all would be transferred byMarch 1999. This was not to be the case. Theworker became unwell and had a period ofextended sick leave. Indeed, some transferswere not completed until almost the end of thepilot project, 18 months from the inception, andtwo situations still remained unresolved at thatpoint.

Numbers receiving direct payments at 31

December 1998

At 31 December 1998, nine months after thebeginning of the pilot project, 29 people – 11 ofwhom were self-managing – were receivingdirect payments. Eight people in receipt ofdirect payments were not previously involvedin the third-party scheme provided by the ILP.

Uptake of direct payments after a year

A full study was undertaken at 1 April 1999, ayear after the commencement of the pilotproject, to ascertain who was eligible for, andwho was taking up, direct payments using thedata held within Norfolk SSD. Data concerningthe uptake of direct payments had beenreceived to this point from the ILP. The studyinvolved a detailed examination of data collatedby the SSD information department at the endof the financial year. The data were not held inone system and had to be analysed manually, insome cases from different sources. The majordifficulty was that data are recorded by contractof service provision. If a disabled person receivesmore than one service, they will be recorded onmultiple occasions in the system, thus giving aninaccurate picture of the number of people whomight be eligible for a direct payment.

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Numbers of people eligible for direct payments

in Norfolk at 1 April 1999

The Act enabled local authorities to make cashpayments to some individuals aged 18–64 inlieu of community care services. Permanentresidential care is excluded. In Norfolk, peoplewho were assessed as needing domiciliaryassistance, and those who received regularrespite care or transport for respite care, wereconsidered eligible.

At 1 April 1999, there were 1,064 adults aged18–64 in receipt of domiciliary support inNorfolk. There were 334 men (31 per cent) and730 women (69 per cent). The data areincomplete concerning the ethnic origin ofpeople who use the services of Norfolk SSD.

If people living in residential homes andthose attending day services were included inthese figures, then the numbers would havedoubled. It is arguable that people in thesesituations should have been included in thepilot project as direct payments may have beenan alternative service provision. At the time ofwriting, Norfolk is assessing the implications ofmaking direct payments for the provision of dayservices.

The pilot project was initially available topeople aged between 18 and 64 in receipt ofmore than five hours per week domiciliarysupport. Across the county, there were 474people; 130 men and 344 women (see Appendix3, Map 2).

If the regulations had permitted directpayments to be extended to older people, thefigures for people who would have been eligibleunder the criteria adopted for the pilot project inNorfolk would be as shown in Table 1.

People using the scheme a year after its

commencement (31 March 1999)

At 31 March 1999, there were 43 people inreceipt of direct payments (see Figure 4); 27 ofthe 43 used the assisted management schemeoffered by the ILP and 16 managed their ownsupport.

There were 33 women of whom 12 self-managed and 21 had assisted management.

There were ten men of whom four self-managed and six had assisted management.

All were white British.

Figures at the end of the pilot and beyond

The numbers of people continued to risethroughout the pilot project as more peopletransferred from the third-party scheme andothers became new employers.

Uptake at the end of the pilot project

At 30 September 1999, at the end of the pilotproject, there were 58 people in receipt of directpayments (see Appendix 3, Map 7 and Figure 5);34 of the 58 used the assisted managementscheme offered by the ILP, one was assisted byanother organisation and 23 managed their ownsupport.

One person received services from the adultteam (mental health). Two people receivedservices from the adult team (learning

Table 1 People who would have been eligible for

direct payments if the age groups had been

extended

Age groups Total Men Women

65–74 829 252 57775–84 2,316 634 1,68285 and over 2,584 1,992 592Totals 5,729 2,878 2,851

16


disabilities). Fifty-five people received servicesfrom the adult team (physical disabilities).

One recipient was born in Sri Lanka. Allothers were of white British origin.

There were 39 women of whom 14 self-managed and nine had assisted management.There were 19 men of whom nine self-managedand ten had assisted management.

Beyond the period of the pilot

At the end of February 2000, there were 72people in receipt of direct payments and

another three joined in March. Therefore, twoyears after the commencement of the scheme inNorfolk, there were 75 people who had chosento receive their services through this means (seeTable 2). There were no new additions fromadult teams (mental health) or adult teams(learning disability). It is possible to identifyamongst the social workers in certain areas oneor two champions who more frequentlynominate people for direct payments than theircolleagues. In total, 36 people have become new

Figure 4 In receipt of direct payments at 31 March 1999

60

50

40

30

20

10

0

Age groupings

TotalMaleFemale

18–25 26–35 36–45 46–55 56–64 65+ Total

Figure 5 In receipt of direct payments at 30 September 1999

60

50

40

30

20

10

0

Age groupings

TotalMaleFemale

18–25 26–35 36–45 46–55 56–64 65+ Total

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employers; the others have transferred from thethird-party scheme. Two people are stillawaiting transfer.

Joining the Direct Payments Pilot project

Awareness of direct payments

Respondents were asked how they becameaware of direct payments in the questionnaire(see Figure 6).

It is significant that the majority of peoplewho were not on the third-party scheme prior tothe pilot project learnt of direct payments fromtheir social workers.

Many of those who used the third-partyscheme identified the source as the ILP. Severalwho did not previously use the ILP alsoidentified this as their source of awareness. It

may be that these people were in touch with theother services offered by HAND.

The publicity campaign launched byNCODP in the media apparently yielded nonew people directly. However, such a campaignserves to raise the profile of independent livingin general, and direct payments in particular,and the results of such a campaign may not beeasily measured or apparent, and might notshow results until some period of time haselapsed.

Choosing direct payments

People chose direct payments as their method ofservice provision for different reasons, althoughit was clear that all respondents saw directpayments as a means of gaining more controland choice in their daily living. Alison valuedbeing ‘able to choose my own staff, stay in myown home, be in control of my family’. Othersvalued being able to have ‘control of your ownstaff’. Meg sought a situation in which shecould ‘do what I like when I like’.

Some sought direct payments because theyadopted an ideological perspective in which the

Table 2 Summary of uptake of direct payments

Month Year Number

December 1998 29March 1999 43September 1999 58March 2000 75

Figure 6 Source of awareness of direct payments

14

12

10

8

6

4

2

0

Agencies

ILP prior to 1 April 1998New employers

MediaILP Friend Socialworker

Coalition Other

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central tenet held that disabled people shouldcontrol their own lives, and thus their ownsupport, with as little intervention from thestatutory services as possible. Alan wassaddened that he could not entirely lose the SSDinvolvement in his life even when in receipt ofdirect payments. A negative of receiving directpayments was that ‘I have to deal with the SSnetwork’. He wished that ‘they would just payme the money and let me get on with it’.

Other employers joined the pilot project tomaintain a way of life that they had chosen andthey viewed direct payments as a means toenable them to continue their existing supportpackage. For example John says:

I was paying £60 a week for help for almost ayear because I could not face an army of SScarers invading my home. I preferred to struggleon ... until I was completely on my knees andneeded but simply couldn’t afford any more helpthat I finally agreed to see a social worker.

He valued:

... being able to recruit staff that suit mypersonality, people I know I can trust and rely onabsolutely. Setting my own routine and timeschedule.

Others, however, seemed to have neither anideological commitment nor an establishedsupport package they wished to maintain butwere dissatisfied with their existing serviceprovision. For some, this was provided throughagencies contracted by the SSD or through theSSD in-house home care service.

A major source of contention was thechanging face of the personal assistants. Severalrecipients used the term ‘army’ to refer to thenumbers of staff sent to their homes:

I can employ one person rather than having anarmy of different people trooping in and out of myhouse. I can choose that person rather than justbeing told (or not being told!) who’s coming in.

Uncertainty about who might be comingwas a common theme from those who hadreceived support from SSD direct serviceprovision:

… when I had a home help from SS, I neverknew who was coming to my home, someweeks I could have a different lady every day. Itwas really worrying for us and our children.

A similar theme was expressed by those whohad received agency support. A benefit of directpayments was expressed by two recipients as:

… not having the worry of who’s coming in toyour home every day, wondering if you can trustthem.

… choice over who I have coming into my house,more control than agency care.

For some, the changes in personnel meanthaving to repeatedly explain their circumstancesand condition.

The whole thing is, I was so ill I couldn’t tell themwhat to do … I was so ill and they were makingme worse. I didn’t know whether I was coming orgoing.

Similarly Mary, from another part of thecounty, says:

I tire quickly so when one person coming inknows the routine of what needs to be done Idon’t have to keep explaining everything to them.Different people every day means I have to showsomeone every day where everything lives (e.g.

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hoover, airing cupboard) and how it works, howsome things need to be washed up carefully (e.g.non-stick saucepans, etc.).

Joyce sums up this notion when she saysthat direct payments lead to support which is:

… better because it’s consistent.

There was also a sense that the changes instaff meant that there was little opportunity toform relationships and so the disabled personwas viewed as a task to be done rather than aperson to be visited.

With SS home care I felt like they came in, ‘didme’ and then went off and ‘did’ someone elseand I was beholden to them. With DirectPayments I’m the boss and the employee has adifferent approach to me as I’m paying themrather than someone else sending them to help ahopeless person.

Another employer suggested that:

PAs [personal assistants paid through directpayments] are more interested in my particularneeds.

Many recipients of direct paymentscomplained of the inflexibility of both agencyand SSD service provision:

I can choose when I have help in and on whichdays rather than a social service home caremanager telling me when someone will becoming. We used to have the same time everyday which bound me to being at home at thattime every day.

Meg described having to ‘go to bed at 1800or earlier’ because of previous patterns ofsupport and having to go to bed with her

clothes on if she was to leave the home early inthe morning.

There was also a sense that the employeesfrom SSD and agencies had their own rules andmethods, which may not have been those of thedisabled person:

I feel more at ease asking an employee to dothings in a certain way … Some social serviceshome carers didn’t like being asked to do thingsin a particular way ... I can ask an employee to dothings other than the basic help, e.g. occasionallywashing a window if there are a few minutes leftat the end of a session. If I’d asked a SS homecarer to do that they would probably have told theHC manager and I would be afraid of losing someof my allocated hours of help. I would not haveasked an SS home carer to do anything like thateven though it would have been helpful to me.

The fear of withdrawal of hours fordeviation from an agreed care plan as voicedabove was common.

One employer summed up the benefits forhim of direct payments, which he felt were notavailable through agencies contracted by SSD orthrough the direct service provision of the SSD:

… the flexibility … hiring who you want to carefor you ... having a good working relationshiptogether, trust and routine.

Disabled employers chose direct paymentsas a means of service provision for a variety ofreasons although all sought more control overtheir own lives and lifestyles. Some chose itbecause of dissatisfaction with previous formsof service provision. It was outside the scope ofthis research to interview people who were notin receipt of direct payments to ask why theyhad not chosen that form of service provision.

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However, some demographical patterns beganto suggest that the choice about whether toreceive direct payments might not always havebeen made by the person in receipt of services.

The location of people choosing direct

payments

The population in Norfolk in 1991 was 745,613.A population count by parish was undertakenin 1996. Norfolk has three major centres:Norwich, King’s Lynn and Great Yarmouth.Each area has a distinct culture. Much of thecounty is also rural by most measures. During1998, the research department of the SSDundertook an analysis of the implications of therural dimension of service provision within thecounty. The location of disabled employers wasmapped against the previous measures ofrurality and sparsity. The figures in the studyare very small (there were 58 people at the timethe study was conducted) and may therefore beskewed for any number of reasons. As shownbelow, there appears to be some smallcorrelation between the uptake of directpayments and measures of rurality and sparsity,but this cannot fully account for the distributionof disabled employers throughout the county.

Sparsity and the uptake of direct payments

Map 4 in Appendix 3 shows a mapping ofwards by sparsity undertaken in 1996(Coldicott, 1998). Wards with 0.5 persons perhectare are considered sparsely populated whenfunding for services is calculated under thesocial services assessment exercise. There were230 wards, 50 of which were sparselypopulated.

A comparison of the sparsity mapping andthose in receipt of direct payments demonstratesthat 39 people who were eligible for direct

payments lived in 24 sparsely populated wards(8.2 per cent of the total eligible). No people insparsely populated wards used the ILP prior to1 April 1998. Two people in receipt of directpayments at 31 March 1999 lived in sparselypopulated wards (4.6 per cent of the total whoreceived direct payments at that time). Four inreceipt of direct payments at 30 September 1999lived in sparsely populated wards (6.9 per centof the total who receive direct payments). Thisshows that there is a small tendency for theuptake of direct payments to be lower insparsely populated areas.

Rurality and the uptake of direct payments

A mapping of the wards of Norfolk using ameasure of rurality devised by Haynes and Gale(1996) aimed to find indicators of socialdeprivation appropriate to rural areas(Coldicott, 1998) (see Appendix 3, Map 5). Largeurban wards are defined as those in continuousbuilt-up areas with populations greater than50,000 people. Small urban wards are defined asthose in continuous built-up areas withpopulations between 5,000 and 50,000 people.Near rural wards are defined as those within15km of a district general hospital. Far ruralwards are defined as those more than 15kmaway from a district general hospital.

A mapping of the uptake of direct paymentsagainst the census data of 1991 suggests thatthere is no apparent correlation between incomesupport levels and indicators of deprivation.However, the data relating to direct paymentsagainst the Haynes and Gale (1996) measures ofrurality are shown in Table 3.

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These figures suggest that issues of ruralityand sparsity might have some significance inthe uptake of direct payments. Over 60 per centof those in receipt of direct payments lived inlarge urban wards. The large urban wards inNorfolk include Norwich and its environs andGreat Yarmouth. However, 31 of the 35 peoplein receipt of direct payments who live in largeurban wards live within Norwich city. Therewere only two people in receipt of directpayments in Great Yarmouth, the other largeurban area. Clearly, this could not be explainedsolely in terms of rurality.

Norfolk SSD district boundaries and uptake of

direct payments

The SSD district boundaries are shown as at 1April 1999 in Appendix 3, Map 6. There were

great differences in the percentages of thosewho were eligible compared with those whotake up direct payments by SSD district (seeTable 4). These may begin to suggest that thereare other factors that are more significant in theuptake of direct payments than issues ofsparsity and rurality.

Eastern district includes the large urbanwards of Great Yarmouth and yet has a smallpercentage of people taking up direct paymentswhen compared with Norwich which has apercentage take up which is six times greater.

When the ILP was established in 1993, itoffered a service within a 25-mile radius ofNorwich. This was extended in 1995. Map 1 inAppendix 3 shows the distribution of people inreceipt of services from the ILP at the start of thepilot project. The Norwich district in SSD

Table 3 Data relating to direct payments against the Haynes and Gale (1996) measures of rurality

Total no. of people Total no. of people % of those eligibleeligible for direct taking up direct who take up direct

Ward classification payments payments payments

Large urban 172 35 20.35Small urban 161 14 8.7Near rural 59 3 5.08Far rural 82 6 7.31

Table 4 Uptake of direct payments by SSD district

No. eligible No. in receipt No. in receipt % of take up % of take upfor direct of direct of direct of those of thosepayments payments payments eligible at eligible at

District 31.3.99 31.3.99 30.9.99 31.3.99 30.9.99

Western 111 5 8 4 7.2Northern 124 4 7 3.2 5.6Southern 89 7 9 7.8 10.1Norwich 94 25 31 26.5 32.9Eastern 56 2 3 3.5 3.5Norfolk 474 43 58 9 12.23

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therefore has a longer history of payments madefor independent living than in some of theothers. However, Northern district also includeslarge urban wards in the environs of Norwich,which were covered by the early service of theILP and yet have a low overall percentage takeup. Southern district has no large urban wardsand yet has a percentage take-up which is twicethat of the Northern and Eastern districts. TheILP, the NCODP and the Project Officer DirectPayments SSD all have offices in Norwich. Someof the social workers in the Southern districtteam share a building with those in the Norwichdistrict. Although there is little direct contactbetween the teams, their information is readilyaccessible.

These data begin to suggest that the mostcrucial factor in determining whether or not aperson takes up direct payments is the approachof their care manager, most usually a socialworker. This is supported by the materialconcerning how people became aware of directpayments, which was discussed earlier.

One employer living in the Eastern districtjoined the pilot project quite late. She says that:

... It took me a long time to get onto the schemeand without the NCODP and [name of the DirectPayments Project Officer SSD] support I wouldhave given up.

As the Direct Payments Pilot projectprogressed, it became increasingly apparent thatthe single most significant factor in determiningwho became an employer through directpayments was the potential employer’s socialworker. This is explored further below.

Open to all?

The NCODP, in particular, argued that directpayments in Norfolk should be made available to

all people (18–64) who use community careservices. Norfolk SSD divides adult services byclient group. A year after the commencement ofthe scheme, one person with a worker in an adultteam (learning disability) received directpayments at the discretion of the assistant directorand one person with a worker in an adult team(mental health) was considering direct payments.As indicated above, Norfolk SSD divided teamsof assessors by the group of people to which theyoffered a service. The team to which a personrequiring an assessment of need was allocatedcould be somewhat arbitrary and could dependon the most severe or presenting issue at the timeof referral to the SSD. Where people had anumber of differing needs, this could lead tosome confusion. For example, it was possible forsomeone with a mental health problem to receivesupport from an adult team (physical disability) ifthey also had a physical impairment or vice versa.

The numbers of people in receipt ofdomiciliary support by social service teamswere as follows.

• People served by adult teams (physicaldisability): 831 in total; 250 men (30 percent) and 581 women (70 per cent).

• People served by adult teams (mentalhealth): 146 in total; 41 men (28 per cent)and 105 women (72 per cent).

• People served by adult teams (learningdisability): 87 in total; 43 men (49 percent) and 44 women (51 per cent).

The criteria established by the pilot projectmeant that the following were actually eligiblefor direct payments in Norfolk, i.e. people agedbetween 18 and 64 who were in receipt of morethan five hours per week domiciliary support.For all adults, this figure was 474; 130 men and344 women.

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• People served by adult teams (physicaldisability): 389 in total; 106 men and 283women.

• People served by adult teams (mentalhealth): 56 in total; ten men and 46women.

• People served by adult teams (learningdisability): 29 in total; 14 men and 15women.

Many people with learning difficulties andmental health service users receive servicesfrom SSD within day centres and residentialplacements. Day services within centres werenot included within the Norfolk DirectPayments Pilot Project and permanentresidential care is excluded by the governmentregulations concerning direct payments (LAC(97) 11). Direct payments were not offered as analternative to these forms of service provision.Hence, the figures for these two groups are low.Although the figures involved are very small, asa percentage of people eligible, the take-up ofdirect payments amongst people who usemental health services and people with learningdifficulties was lower than that of people with aphysical impairment.

Staff involved with the direct paymentsscheme within the SSD worked within adultteams (physical disability). The Projects OfficerDirect Payments was originally a team managerin the Norwich adult team (physical disability)and the worker seconded to the assessment role(to speed up the transfer of people from thethird-party scheme to the pilot project) wassited within the same team. The policy andprocedures manual relating to the pilot project,Operational Instruction No. 353 DirectPayments 28 May 1998, circulated from the

Assistant Director (Adult Care) wasambiguously worded when sent to DistrictManagers (Adult Care); Team Managers(Disability); District Managers (SupportServices); Development Officers (Adult Care);Project Officer Direct Payments; ContractOfficer and Contracts Manager. Significantly,Team Managers (Mental Health) and TeamManagers (Learning Disability) were not cited.

The framing of the pilot project wasdescribed by one senior staff member in thefield of mental health thus:

It is written from a physical disability perspective… the way it’s written and designed isdiscriminatory in a way.

As described earlier, all social work staffwithin the adult sector of Norfolk SSD (exceptthose working specifically with older peopleaged 65 and above) were offered training indirect payments. Staff within adult teams(physical disability) had knowledge of the ILPbut individuals purchasing their own supportwas a new concept for most staff working withpeople who use mental health services orpeople with learning difficulties. Staff had littleexperience locally or nationally to draw upon.Awareness of publications by such as Valuesinto Action concerning direct payments andpeople with learning difficulties was beginningto enter the arena towards the end of the pilotproject (Holman and Collins, 1997; Ryan andHolman, 1998a, 1998b).

A senior member of the Training and StaffDevelopment Team perceived direct paymentsto be ‘a physical disability thing really’.

There was some debate within SSD in theearly stages of the scheme, particularly withinadult teams (learning disabilities) and adult

24


teams (mental health), about the concepts of‘willing’ and ‘able’. There was an assumption bypeople within these teams that people served bythese teams would be unable to manage. Therestructuring within the SSD, changes in thedelivery of health services nationally andlocally, and the debates about the training,approval and reapproval of Approved SocialWorkers in the mental health arena absorbed theenergy of these teams and the topic of directpayments was marginalised.

At the end of the pilot project, the SSDProject Officer sent a questionnaire to staff. In areview dated 31 October 1999, he reported that30 staff had responded of whom six had set updirect payments. He concluded the following.

• Staff generally have a ‘broad brush stroke’awareness of the scheme with some staffwho have been involved in setting uppayments having an in-depthunderstanding.

• There are sometimes difficulties inassessing users’ willingness and ability tomanage payments.

• Staff are normally required to giveinformation to users about the range ofservices available. However, some staffare withholding information about directpayments where they consider the personwould not be able to manage. They makethe point that it is unreasonable to raiseexpectations only to dash them andresultant discussion can also take longerpotentially lengthening waiting listsunnecessarily.

• Staff working with people with mentalillness felt that there are very few

occasions where direct payments areappropriate for their clients because theyare usually too unwell to control theirarrangements.

• Staff working with people with learningdifficulties are beginning to think moreabout the appropriateness of directpayments.

These findings are being used to inform thedevelopment of staff training within the SSD.

The NCODP was heavily involved in thearena of disability politics. Althoughmembership of the coalition was drawn fromorganisations of different groups of people,including mental health service users andpeople with learning difficulties, the main thrustwas from people with a physical impairment.They were quite a disparate group of peoplewith varied agendas. A development worker inthe mental health field commented of peoplewho use mental health services:

I don’t think they see it as a natural coalition …The coalition doesn’t figure in my day to day work– doesn’t figure full stop. They are not involved inthe mental health field.

Whilst there were mental health serviceusers who attended the Consultation Group,and a person who represented mental healthservice users in the west of the county was onthe management committee of the DirectPayments Co-ordinator of the NCODP, therewas no lobby by people who used mental healthservices concerning the introduction of directpayments. There were no major debates withingroups involved with the Norfolk MentalHealth Care Trust, which was the largestprovider of mental health services in the county,

25


nor in the major independent voluntary andadvocacy organisations.

Members of the self-advocacy group forpeople with learning difficulties, Norfolk PeopleFirst, sat on the Consultation Group and weremore active in discussions about directpayments throughout the county. Groupsactively engaged in debates about directpayments, often with the involvement of, or atthe instigation of, the Direct Payments Co-ordinator of the NCODP. A slow but increasingpressure has grown for the provision of anadvocacy service to support people withlearning difficulties, with others, to engage withdirect payments. At the time of writing, fundinghas been agreed for an advocacy worker.

At the start of the project, the DirectPayments Co-ordinator of NCODP workedfrom his home. At one stage, there was asuggestion that he might spend some time at theoffice of the ILP since the two Co-ordinatorsworked closely together. The politics of thesituation, as discussed later, led to a change ofheart by the NCODP. He subsequently movedinto an office in an SSD day centre in Norwichwhich has traditionally served people withphysical impairments. This was a pragmaticsolution in many ways since there was space inan office that was accessible to the Co-ordinator.However, this also inadvertently reinforcednotions that direct payments were essentially anissue for people with physical impairments.

As indicated by the above-mentionedquestionnaire to staff, people working withinmental health teams felt the people with whomthey worked were too ill to manage directpayments. Workers within adult teams (learningdisability), while apparently more open to theidea, still had only two people within their

service on the scheme. However, some people inreceipt of direct payments who had socialworkers in adult teams (physical disability) alsohad major cognitive and mental healthproblems. Two had enduring powers ofattorney. There were people with neurologicaland degenerative conditions that lead tosignificant physical and mental healthproblems. Many complained of difficulties withmemory, concentration, processing informationand confusion; sometimes the result ofprescribed medication. Some were ascognitively challenged as those served by adultteams (mental health) and adult teams (learningdisabilities).

There seems evidence of an underlyingassumption that disabled people were ‘unableto manage’ in the latter two and an assumptionthat they were ‘able to manage’ in the former.Clearly, both assumptions carry risks. Somepeople who may have benefited from being inreceipt of direct payments were not offered thatopportunity; ‘some staff are withholdinginformation about direct payments where theyconsider the person would not be able tomanage’. Whilst recognising difficulties staffface in some situations, this raises wider issuesof equity of service provision for people withinthe county. Some people were beingdiscriminated against when being offeredservice options. Other people were in danger ofexploitation and poor support as they were notproperly able to manage the direct paymentsthat they received. A review of one situation bythe Direct Payments Project Officer resulted indirect payments being withdrawn from aseverely physically disabled young womanwhose condition affected her cognitiveprocesses and who, as a result, was not

26


sufficiently able to control her personalassistants. Social workers appear to be operatingas gatekeepers with respect to direct payments.

Fay comments about this thus:

I don’t think they [social workers] are quite asclued in as they could be about what it means tous … What is good for the spirit is good for thebody … I think sometimes that gets neglected …sometimes they are so busy looking after ourbodies – making sure we’re safe and secure andthat we’ve got food on our plates that they don’trealise that the spirit is being neglected …achieving something ... that’s important.

During the pilot project, Dawson andMcDonald (2000) drew up a checklist that mighthelp social workers to ensure that they areworking from an assumption of competence andgive more clarity to situations in which they judgethat a person is not ‘able’ (see Appendix 2).

Systems of support for disabled employers

At the start of the pilot, support mechanismswere established for disabled employers. Thescheme was constructed so that the NCODPwould support those who self-managedthrough the Co-ordinator and the operation ofpeer groups. The ILP was to manage the payrollfor those who wished it and offer practicalsupport to people on assisted management. Itwas apparent that some people gained most oftheir support concerning direct payments frominformal networks:

... My family was the greatest support network –plus friends and neighbours.

However, many did use formal sources ofsupport, although not quite as envisaged by theimplementation group at the outset.

Formal sources of support

The dichotomy between disabled people whoself-manage and those who use an assistedmanagement scheme, and the differences in theroles of the NCODP and the ILP, were notdistinct in practice. Fay, who self-manages, says:

I go through the paperwork and highlight thingsthat seem relevant to me ... knowing your ownback-up system … You pick up on things thatmight be useful to me … the fact that there issomeone on the end of the phone.

There was a continuum with some peoplerequiring more or less support. The amount ofsupport required by one individual also variedat different times. People who self-managedfrom time to time required support and adviceabout financial issues and legal matters relatingto employment. Throughout the project, theexpertise in these matters was perceived, bydisabled employers and members of thepartnership, to be located within the ILP. Forexample, when Fay had difficulties inestablishing her payroll and in sorting thefinancial issues, she went to the ILP for support.She explains:

Just because I use a remote control to turn mytelly over doesn’t mean I don’t turn it over myself.Just because I don’t paint the walls but I’vechosen the colour … It’s under my control ... itsounds obsessive sometimes … I go on and onabout having control ... I’ve made all the choices.

The ILP was thus offering support to peoplefor whom it did not receive a management fee.Early in the pilot, it was believed that this wasbecause people, particularly those who hadused the third-party scheme, were familiar withthe ILP as a support mechanism. This was not

27


borne out by the questionnaires completed bydisabled employers a year into the project (seeFigure 7).

The questionnaires indicated a high level ofunderstanding by disabled employers aboutprocesses and structures relating to directpayments. They were able to identify sources ofsupport or points of contact about a range ofissues; they were not constrained by a need toapproach only one source for support. Peoplewho were heavily involved in the NCODP,indeed who were personal friends of theNCODP Co-ordinator, and who also self-managed sought information and practicaladvice from the ILP. They sought emotional andideological support from the NCODP. Faypraises both the Co-ordinators of the NCODPand the staff of the ILP:

They are very generous with their time ... They doa brilliant job. They all do.

The differences in the roles between the ILPand the NCODP also became more blurred forpractical reasons. It was not possible for some of

the people wishing to receive direct payments toattend a formal briefing session. The DirectPayments Co-ordinator of NCODP and the Co-ordinator of the ILP have made home visits.There have been practical difficulties aboutaccess to private homes for the former who usesa wheelchair. However, he suggested that theILP Co-ordinator would accurately, and withoutbias, reflect the different options of support toanyone considering direct payments (seeFigures 8 and 9).

The contract between ILP and SSD was re-negotiated. SSD made a block grant to ILP toprovide a support service rather than ILPseeking commission from employers. This alsoserved to minimise the potential for competitionbetween the two organisations offering support.

Peer groups

At the outset of the pilot project, peer groupswere envisaged as a form of support andexpenses were available for those who wishedto attend. However, these were largelyunsuccessful although some members did

10

8

6

4

2

0

CoalitionILP

OtherUnspecified

Social workerCounty Hall

ChargesPaymentHoursFormsPayrollManagementRecruitSources of support

Figure 7 Sources of support for people who used ILP prior to 1 April 1998

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phone each other occasionally for support (seeFigure 10).

Although 11 respondents of thequestionnaires suggested that they belonged toa peer group, attendance at the meetings wasminimal. Disabled employers in receipt of directpayments were very widespread geographicallyand in a rural county such as Norfolk it is oftendifficult for people to meet. The groups ceased.This saddened the Direct Payments Co-ordinator of the NCODP who wanted:

… users to work together not just forthemselves.

Some found that they had only energy fortheir own situations:

I do not feel the need. I’m bedridden,housebound and too ill to bother with it.

Others may have wished to share theirexperiences and learn from others but practicalor emotional considerations inhibited their

Figure 8 Sources for support for self-managers

Figure 9 Sources of support for assisted managers

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OtherUnspecified


Recruit Management Payroll Forms Hours Payment Charges

Sources of support

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attendance. Physical resources were low forsome and many people expressed a sense oftiredness:

He [Co-ordinator for NCODP] keeps sending methings for these functions and I have to keepturning them down. I just feel whacked out. Sohe rang me up. He thinks I’m being nasty but I’mnot … I asked him if he knew what was going onhere so he said he didn’t have a clue ... so I toldhim … I just feel whacked out to come to dothings in the evening.

Some were concerned that too manydemands might be made of them and were ‘notsure how much time and energy I would haveavailable to give’.

Whilst some of the above indicated that theydid not want to spend their financial resourcesor use their personal assistant hours to support,or receive support from, the peer groups, therewas a suggestion that, had personal andmaterial resources been in abundance, theywould have been willing participants. Travelexpenses were available to ease the latter.Others, however, were clear that their reasons

for not wishing to become involved werefundamentally different. For example, Joy sawdirect payments as a means of her maintaining alifestyle which she had enjoyed beforebecoming very disabled by a degenerativecondition. She did not want to spend her timewith disabled people but, when her healthpermitted, she wished to go to the pub with hernon-disabled friends. Lesley voiced a similarview somewhat forcefully:

I’m not a male middle-class paraplegic. It has littleto do with chronic sick like myself.

These views highlight a very importantissue. The people who chose direct payments asa method of service provision differed greatlyfrom one another. Indeed, the only commonfactor was that they received domiciliaryservices from Norfolk SSD. Some had congenitalconditions, others acquired impairments. Somehad illnesses or conditions that weredegenerative; some did not. Their lifeexperiences differed enormously. There weredifferent sexual orientations. Some had been, orwere still, married. Some had children,

Figure 10 Sources of support for people who belong to peer groups

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8

7

6

5

4

3

2

1

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CoalitionILP

OtherUnspecified


Recruit Management Payroll Forms Hours Payment ChargesSources of support

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grandchildren and extended families. Somewere young and single. Some were employed,some had been employed and others had neverbeen in paid employment. Some had familieswho were wealthy whereas others were raisedin poorer circumstances. Their ages were aswide apart as the scheme allowed and bothsexes were represented. One person was from anon-white ethnic group. Some lived in ruralsettings, others lived in towns. Only a fewpeople on the direct payments scheme wouldhave socialised with each other outside of thiscontext.

Extended networks

Families were highly significant to many peoplein receipt of direct payments and to personalassistants. However, the views about familyinvolvement and support differed within andbetween the two groups.

Families of employers

Dawn, a young woman of 24, had recently leftthe parental home but lived close to her parentswho visited regularly. Dawn welcomed this. Ifshe had difficulty in paying her household billsor in matters of running a home, she felt pleasedto know that her parents would be able tosupport her. This type of contact seems littledifferent from many of the parent–childrelationships within the local estate whereDawn lives.

By contrast, other young employers hadlimited contact with their parents. Some hadparents who could be called on in an emergency.In reality, this support was seldom sought.Independence for many younger employersmeant moving away from their parents andbeing able to live alone without their parents’regular intervention in their lives.

Some older recipients of the service viewedfamily as a significant support mechanism andactively welcomed their involvement. One saysthat their:

… family was the greatest support network plusfriends and neighbours ... paid assistance is only asmall part of my support – more often than notit’s so stressful that it’s as much hard work for meas not having any assistance.

Alice lived on an estate similar to that ofDawn and had a large extended family in thevicinity. Her partner works away from homemost of the time, but her mother, father,daughter and niece all offer her support. She hasvisitors at least daily and also attends a dayservice twice a week.

Some older employers did not have parentsbut had children who were adult, and theirinvolvement and approval was important. Fayhad been in a difficult marriage and, following along period within the health services throughthe onset of a very disabling condition, had setup her own home and was now self-managingher direct payments. She says:

... one of my daughters has been gob smacked bywhat I have achieved over the last year ... she’sbeen very proud of what I have achieved and thathas been very nice too.

A number of employers had dependentchildren and this was significant when choosingpersonal assistants and determining their rolewithin the home. Employers were not‘dependent people’ but had other, often veryvulnerable, people such as children dependentupon them. Lesley says that in contrast to thesituation with agency care she can:

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… decide on some of the things I need doing …and don’t have someone bossing my family and Iaround and telling us what to do.

An important issue is raised here with respectto the welfare of children and of vulnerableadults. Employers are responsible not only forthemselves but also for others with whom theylive. Many were acutely aware of this.

Employers in receipt of direct paymentsviewed dependency and independence verydifferently from one another. Debates raised atthe consultation conference also highlighteddifference in this area. For some people,independence meant that the locus of decisionmaking should be within their own family;within a wider context of dependent and inter-dependent relationships. For othersindependence meant making decisions aloneand apart from their families.

Families of personal assistants

Children also featured heavily in the lives of thepersonal assistants. Many personal assistantswere women who had dependent children andwho were balancing the needs of children withpaid employment.

And Lisa said well … I know someone whowants work ‘cos she’s got children and so she’snow home when she leaves off – for her children... I’m easy … well I don’t mind children and ifthey’re stuck and they can bring the child ... I canstick the video on. I’ve got all the Walt Disney orthey can go in the garden and play ball on a daylike this … so I go flexi with them as well.

Personal assistants bringing children andgrandchildren to the home were not onlytolerated but also actively welcomed in somesituations. Kate, a disabled employer, has an

extended family that lives outside of Norfolk.Her prime personal assistant has an extendedfamily that lives locally and also cares for hergrandchildren. All visit Kate and this hascreated a new social network and in her words a‘second family’.

Wendy, an employer in a more rural part ofthe county, has small children. She employed amother from the school attended by her ownchildren as a personal assistant. This providedsupport for her and company for her children asboth sets of children came to the home afterschool and would spend time together duringthe school holidays.

The husbands of personal assistants alsogave support to employers particularly withrespect to heavy work, building or decoratingtasks. There was a sense from some employersand from some personal assistants that therewas a mutual support, which could stretchbeyond the immediate employer–personalassistant relationship. Employers felt they werecontributing to the welfare and income of theirpersonal assistants in exchange for their supportin domiciliary tasks.

Personal assistants

Experience gained from the third-party schemeof the ILP suggested that people may needsupport in finding personal assistants. However,it had also shown that many people recruitedassistants through informal social networks(Dawson, 1995). Those moving to directpayments from the third-party scheme, for themost part, transferred with the same assistants.

Recruitment of personal assistants

Recruitment of personal assistants wasrepeatedly voiced as an area of potential

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concern by employers. Interestingly, those whohad had no difficulty in recruiting perceivedthat there may be a future difficulty in this areaif their present personal assistants were to leave.Some concerns were very clear. People whoemploy personal assistants do not have thepower to seek police references about theiremployees. Disabled employers may be open toabuse. As Emma who lives alone said:

I am not able to check on potential employees soI could be open to criminal abuse.

Others were concerned that vulnerableadults or children with whom they lived mightalso be victims of abuse. The latter raisedquestions about potential child protection issuesfor disabled parents, and the SSD children andfamily teams. Disabled parents, like any others,have responsibility for the welfare of theirchildren but there can be no assumption thatthey will not fulfil this role appropriately. Someemployers on the direct payments scheme inNorfolk asked their employee to provide theirown statement from the Criminal Records Officewhich cost approximately £10 to obtain.

Methods of recruitment varied (see Figures11 and 12).

There was little difference in the pattern ofstaff recruitment between those who are assistedin their management and those who managetheir own arrangements. The former groupemployed 36 staff and the latter 31. Friends andword of mouth were the second route comparedwith placing advertisements. Many personalassistants who were recruited throughadvertisements or word of mouth would nothave considered employment with the SSD orwith an agency. The terms of contracts of servicewere considered too restrictive in these formalsettings. Also many viewed their ‘work’ as arelationship with the employer and would notwish to work for more than one disabledperson.

Advertisement

Some employers who recruited through advertfound it quite difficult. One said:

I’m still looking for an assistant … it takes ages ...it’s so long winded.

Figure 11 Recruitment of staff by people with assisted management

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0No. of

employersNo. of

employeesFriend SSD Other

agencyResidential

carerOtherAdvert

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Fay placed an advertisement and had threerespondents. She describes the interviews:

The other two people were really unsuitable, theyweren’t flexible enough. One wasn’t flexibleenough timewise. She could only offer mebetween 10.00 and 12.00 each day. The otherone thought I would be a severely disabledperson ... more personal care … Whereas Kellywas actually more (a) flexible in her time andmore (b) flexible in what she was prepared tolearn for this ... what she was prepared to offer.

Kelly had never undertaken any work in thisfield before whereas the other two applicantshad, but Kelly was offered the job. ‘I know theyoffer training for people but I did a sessionbetween my daughter, Kelly and I’. Herdaughter had worked in professional supporttasks previously and ‘showed her how to do itall without her getting hurt’.

Alan found that some people did not comefor the interview despite having made anarrangement and another person actually didnot turn up for their first shift.

Exceptionally, employers had had very

unfortunate experiences with unsuitablepersonal assistants that they had recruitedthrough advert. One very physically disabledemployer laughs when telling the story of oneemployee who had arrived drunk for a shift andhe had arranged for a taxi to take them home.He now has two live-in personal assistants.

Another employer discovered he still had ahigh turnover of staff and found a negative ofdirect payments to be ‘having to recruit everysix/12 months’.

This highlights an issue about the sort ofperson employed. This person employed youngpeople who had similar approaches to life ashimself. However, the people available for workin this category were often students who movedat the end of their course.

Friends

Some people, like Jane, employed friends orfriends of friends in their local area.

And Lisa said well … I know someone whowants work ‘cos she’s got children and so she’snow home when she leaves off – for her children... if one can’t make it they phone the other one

Figure 12 Recruitment of staff by employers who self-manage

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0No. of

employersNo. of

employeesFriend SSD Other

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carerAdvert

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so we all work in … I interview them, I give thema month’s trial and see if they work in fine withme.

Jane has four women who come in on aregular pattern and two ‘floaters’. She affordsthem different status. Her main supportersreceive holiday pay but her relief staff do not.

As discussed below, many employers soughtstaff who lived in close proximity. This wasvalued by both parties. The personal assistantcould go home quickly if needed by their ownfamily, but was also on hand if there was anemergency at the home of the employer. Forexample, one employer had been able to call ona personal assistant at short notice when she fellout of bed.

Agencies

Both groups of people, those who receivedassisted management and those who self-managed, employed five personal assistantswho had worked for agencies from whom theemployers had previously received services (13per cent and 15 per cent of the personal

assistants employed on the scheme). Onoccasion, the personal assistant was stillemployed by the agency with respect to otherwork. Conflicts of interest arose infrequently butthese were issues which needed to beaddressed. There was discussion by someagencies of charging a fee if their staff were tosupport people privately when they had beenemployed by an agency to perform the sametasks. This did not happen during the pilotproject. SSD considered the in-house home careservice employment contracts with theiremployees very carefully and drew theiremployees’ attention to the terms of theircontracts. In some areas, SSD home care servicefound it difficult to recruit staff and there wasno agreement of consistent hours to be workedeach week. Some former SSD staff who becamepersonal assistants suggested that they hadfound this unsatisfactory.

Gender and age of personal assistants

All age groups of employers chose most peoplewithin the age range 30–50 (see Figure 13). Bothgenders employ more women (see Figure 14).

Figure 14 Gender of employees by gender of

employer

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0

PA <30PA 30–50PA >50

18–25 26–35 36–45 46–55 56–64Employer age groups

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employeesMale

employees

Femaleemployer

Maleemployer

Figure 13 Age of employees by age of employer

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This is consistent with the data from withinSSD, and national research, which also suggestthat the majority of staff in caring and supportroles are women. There is no difference betweenthe employment patterns of those self-managingand those with assisted management.

Travel to work by personal assistants

In a rural county like Norfolk, which has a verypoor public transport system, there was concernat the outset of the pilot project that some

people might find it difficult to recruit personalassistants. This fear seemed to be unfounded.Most people recruited assistants who lived veryclose to them. There is little difference betweenthe groups of assisted and self-managed groupswith respect to the mode and time of travel bytheir personal assistants (see Figures 15 and 16).There is a small difference in that more personalassistants with employers on assistedmanagement take ten rather than five minutesto make their journey.

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0Total 5 minutes 10 minutes 30 minutes 60 minutes Lives in

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No dataLives inBicyclePublic transportWalkCar

Figure 15 Mode and time of travel: assisted managers’ employees

Figure 16 Mode and time of travel: self-managers’ employees

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Management of personal assistants

The management of staff was an issue for someemployers. The ILP offered financial assistanceand support in recruiting personal assistants butthe daily management of staff was theresponsibility of the disabled person.Relationships between the employer andpersonal assistant could take many forms. Inone situation, a romantic entanglement causedsome embarrassment. Close proximity ofemployers and personal assistants wasparticularly pertinent when staff lived in orworked very many hours involving supportwith intimate personal needs. Paul explains thedifference thus:

… if you upset someone in the morning well ...they are still here … it’s different if you only havesomeone coming in for a couple of hours.

Whilst most situations worked very well forboth the employer and the personal assistant,there were some circumstances in whichemployers needed to assert their control overthe situation. Many were uncomfortable withthis aspect of the employer’s role but were ableto carry it out when required. As cited above,one employer dismissed a personal assistantwho was drunk on arrival at his home.

Not all employers were able to assumecontrol. In one instance when a young womanwas unable to assume the level of controldeemed necessary after much support, she leftthe pilot project.

In another scenario, the mother of anemployer intervened when she had to respondin an emergency as a personal assistant hadagain let the employer down. In this instance,the mother dismissed the personal assistantwho subsequently complained to an industrial

tribunal. The employer received support fromthe ILP in managing her affairs and the ILP wasnamed as a co-respondent in the hearing, whichhad major ramifications within the scheme.Legal advice was sought and the ILP waseventually deemed not to be an employer. Thiscontrasted with the findings of the tribunal inSouth Lanarkshire in which the Council wasregarded as an employer in a situation where apersonal assistant sought damages whenemployed through monies from theIndependent Living Fund (Hun, 1999). InNorfolk, a settlement was eventually agreedbetween the employer and the personalassistant.

However, in one situation, in March 2000, aperson had not transferred from the third-partyscheme to direct payments because of a debateabout the suitability of one of the personalassistants to be employed in that capacity.

Training of employers and personal

assistants

Training of employers and personal assistantswas seen to be an important issue at thebeginning of the pilot project and the NCODPwas contracted to provide training.

Training of employers

The Co-ordinator of NCODP wrote a manual foremployers explaining the operation of thescheme and outlining issues of employmentpractice. There were no formal training events.

Training of personal assistants

At the outset of the scheme, the ImplementationGroup also perceived a need for the training ofpersonal assistants. The nature of the training

37


and the topics to be covered were discussed bythe Implementation Group. The significantfactor was that disabled employers did not wanttheir staff to be trained without their beinginvolved. Some employers, like Fay above,wanted to train their staff themselves. Somepersonal assistants did not want to be trainedformally but to learn from their employer whatwas needed. It was agreed that employersshould decide for themselves how best to traintheir own personal assistants and money wasmade available for them to purchase training ifthey so chose.

Monies

Financial issues impacted on the pilot project ina number of ways. Disabled employers wererequired to open separate bank accountsthrough which to handle their direct payments.This became complex for some people as theyalso received funding from other sources, whichthey used to purchase support. There were alsoareas where it was difficult to ascertain whichwas an expense that should be met from thedirect payments fund and which from thedisabled employer’s own money. For example,Joan talks of the issues when her personalassistants take her out for the day.

… personal care isn’t all in my home. I’m notgoing to sit in all day if I can go out but that’s stillmy personal care isn’t it?

She pays the hours for her personal supportfrom her direct payments budget, her personalassistant’s mileage expenses from her mobilityallowance and lunch for her personal assistantfrom her own money.

Personal finances

Whilst the direct payments scheme hassafeguards concerning the spending of thepayments for personal care, there is no suchsafeguard around other monies. There wasconfusion on the part of some recipientsconcerning charges for services. Norfolk SSDhas a charging policy, which means that allpeople in receipt of community care services areassessed according to income for a chargetowards their services. Recipients of directpayments are not exempt from this. The IncomeSection of SSD was somewhat slow initially inissuing invoices for charges. Many employersfound this distressing as they were confrontedwith large bills which some had not beenexpecting. One employer voiced this negativeaspect of the scheme thus:

… not getting my bills regularly from County Hallfor weeks at a time. They write to me saying theyare at fault with the delay and then send me athreatening letter ... if I don’t pay immediately.

This situation was resolved to a large extentwhen the financial monitoring role wasassumed by the SSD and the departmentalprocedures were tightened between the systemconcerning direct payments and the IncomeSection.

Some disabled employers found themselvesin difficulties with respect to the payments ofhousehold bills, and were dependent oninformal carers and supports for this task.Dawn’s mother paid her bills. She hopes thather household bills will soon be paid by herpersonal assistants. She also feels that a newelectric wheelchair will aid her independentmobility and she may be able to maintain moreprivacy concerning her monies.

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Some people are finding themselves in debtor are turning to the ILP for support inmanaging general finances. Others manage alltheir own finances by post, Internet ortelephone. In exceptional situations, thisfunction has been wholly delegated to apersonal assistant. Even where an employer hasa number of staff, only one usually performsthis task. Clearly, it is an issue which employersneed to consider when recruiting staff. It is alsoan issue which social workers need to assesswhen drawing up the numbers of hoursallocated to people for direct payments. SSDcriteria allow for administrative tasks to beincluded in care plans.

Financial monitoring of the use of direct

payments

Monitoring of the ILP records was undertakenby the SSD Contracts Section and the DirectPayments Project Officer. It was identified thatthose who were using the ILP on the secondsystem (where the person makes their ownpayments although the ILP operates theirpayroll) were not subject to the same level ofmonitoring as those on the self-managementscheme, although they did pay their own staffdirectly. There were eight employers in thisgroup. They will be expected to follow themonitoring process for those on the self-management scheme in the future.

Monitoring the use of direct payments forpeople who chose either the ‘self-management’or ‘assisted management – (other)’ was initiallyundertaken by the ILP. On receipt of a copy ofthe contract from the assessor (the social workeror occasionally occupational therapist), the ILPcontacted the employer to explain the process,and to give him or her a schedule of dates by

which returns had to be made. On a four-weekly basis, the employer supplied the ILPwith paid invoices, and any other supportingevidence, detailing the service provided andmonies spent each week during the previousfour-week period. The employer was furtherrequired to send the ILP a copy of his or herdirect payments bank account statement once aquarter (i.e. every 13 weeks). The ILP checkedthe returns received from the employer (oragent) against the details on the contract and thecare plan previously supplied by the assessor.Once a quarter, they also checked paymentsagainst the bank statement. Details of theservices purchased by each employer were thensent to the Contracts Section at County Hall bythe ILP within two weeks of the end of eachfour-week accounting period. The informationwas entered on to the Contracts Database, witha copy being passed to Payments Section, tomake any relevant payments, and IncomeSection, which issued invoices for theemployer’s assessed contribution (charges forservice).

Early in the pilot project, it became apparentthat the monitoring of financial returns by theILP presented an additional complication in analready complex scheme. The very tight controlsand the copious paperwork were notsatisfactory for any party. Without exception,the monitoring process was identified, throughthe questionnaires and through the researchinterviews, by recipients of direct payments asthe least satisfactory part of the process. Onedisabled employer who manages her own directpayments felt very strongly that theinvolvement of a third party with respect to thisrole was an infringement of her privacy.Another suggested that it impinged on her

39


relationship with her personal assistant. Sheargued that there should be:

No requirement for timesheets – [it should] workon trust between both parties.

The monitoring role also compromised theindependent status of the ILP since they wereperceived to be ‘policing’ direct payments onbehalf of the SSD. The full monitoring role wassubsequently returned to the remit of the SSDand a post was established within thedepartment for that purpose.

Summary of financial arrangements within

the project

Domiciliary assistance rates

At the start of the pilot project in Norfolk, it wasagreed that for simplicity a standard hourly carerate would be paid to recipients for all hours ofsupport to be purchased no matter what time ofday or week they were to be used, i.e. nodifferential rates for weekends, anti-socialhours, etc. Instead, a slightly enhanced ratewould be paid which would allow directpayment recipients enough slack to be able topay differing rates if they so chose.

At 1 April 1998, based on the previousexperience of the ILP of running the third-partyscheme, an hourly support rate of £4.50 perhour purely for the payment of supporters wasagreed. To this figure, on-costs of 25 per centwere added in order to cover such as incometax, national insurance and holiday payments.This brought the overall hourly rate paid torecipients up to £5.63 per hour. At this stage,recipients were only allowed to use up to £4.50per hour to pay supporters as the on-costs werespecifically for other costs and they wererequired to keep the two parts separate.

After a year of the pilot scheme, these rateswere changed because of:

• a change in the employment marketwhich meant that recipients started toexperience difficulties recruitingsupporters at that rate

• recipients were starting to accumulatesignificant reserves in respect of unspenton-cost monies that were not required.

As from April 1999, it was decided to tie therates into the hourly rate paid to local authorityhome care assistants. It was also decided toreduce the percentage paid in respect of on-costsfrom 25 to 15.5 per cent. As from April 1999, therates paid were £4.98 per hour for support pluson-costs of 77p giving a revised hourly rate of£5.75. Recipients were also allowed morefreedom over the way in which they used theon-cost part of their payments. This seems to beworking better and financial monitoringindicates that people have sufficient money topurchase support-necessary on-costs.

The Norfolk scheme has to date had aminimum requirement of five hours per week asbeing the assessed need before anybody couldqualify for direct payments. This was originallyintroduced because of the cost effectiveness ofproviding direct payments and all the supportservices. As the scheme is becoming moreestablished, this will be reviewed.

Night sitting

At the start of the project, a figure of £40 pernight was agreed for the support costs whichthen had the 25 per cent on-costs added, givingan overall figure of £50 per night. As with thedomiciliary assistance rates, this was changed inApril 1999 and is now £44.27 per night support

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costs plus 15.5 per cent on-costs giving anoverall figure of £51.13 per night. These revisedfigures were arrived at by adding the samepercentage increase to the support element aswas added to the domiciliary support element.

Night sleeping

At the start of the project, a figure of £30 pernight was agreed for the support costs whichalso then had the 25 per cent on-costs added,giving an overall figure of £37.50 per night. Aswith the domiciliary assistance rates, this waschanged in April 1999 to £33.20 per night plus15.5 per cent on-costs, giving an overall figure of£38.35 per night. These revised figures werearrived at by adding the same percentageincrease to the support element as was added tothe domiciliary support element.

Live-in support

At the start of the project, a figure of £280 perweek was agreed for the support costs whichalso then had the 25 per cent on-costs added,giving an overall figure of £350 per week. Aswith the domiciliary assistance rates, this waschanged in April 1999 and is now £309.88 perweek plus 15.5 per cent on-costs, giving anoverall figure of £357.91 per week. These revisedfigures were arrived at by adding the samepercentage increase to the support element aswas added to the domiciliary support element.

Management fees

Under the Norfolk scheme, there were threeoptions, namely ‘self-management’, ‘assistedmanagement – ILP’, or ‘assisted management –other’. The differences between these optionsare explained elsewhere in this report. Thefinancial implications of each of these optionswere as follows.

Self-management

In addition to the rates paid to purchase thesupport required (as detailed above), peoplewho were self-managing were also paid astandard weekly amount (irrespective of theamount of support they were being paid for) of£7 per week in order to cover any costs incurredin administering their own payroll. Althoughthis was paid as a standard amount each week,recipients were allowed to use it as necessary,for example they may spend a block of £30 permonth. However, they could only use it forexpenses incurred in managing their directpayments and they had to account for itsexpenditure.

Again after the first year, it was discoveredthat very few people were making much use ofthis money and as such it was just accumulatingin their accounts. Therefore, as from April 1999,it was agreed to stop paying this as a weeklyentitlement and instead to hold the moneycentrally and allow recipients to claim againstthis central pot of money as and when theyrequired it (up to an average of £7 per week).However, in practice, few people claim thisdespite being entitled to do so.

Assisted management – ILP

The ILP provides support, including a payrollservice to people who wish to receive directpayments but who want/require more supportwith managing their payments (i.e. the ILP actsas their agents). At the start of the pilot project,it was felt that the central government guidancewas indicating that each case had to be shownto be ‘no more expensive’ ( LAC (97) 11) thanproviding direct services so, with this in mind, itwas decided that the costs of the ILP needed tobe shown against individual users who chosethe ‘assisted management – ILP’ route.

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Again based on past experience and thenumber of cases choosing this route, it wasdecided to add a 17.5 per cent management feeto the payments made in respect of people onthis option. For example, a person in receipt often hours’ domiciliary support would have beenpaid £56.30 in respect of the support plus on-costs plus 17.5 per cent management fee of £9.85per week, giving a total of £66.15.This moneywas then paid to the ILP who kept the 17.5 percent towards their running costs and paid theremainder into the client account to administeron behalf of the user.

Again after the first year, this was changedas it was found to be administratively timeconsuming. As from April 1999, the ILP hasbeen funded via a service agreement for a blockof service. During 1999/2000, this cost £95,000for providing the service to between 50 and 60users (including the fee for the monitoring task).This has proved to be much easier both for thelocal authority and for the ILP.

Assisted management – other

This has been dealt with in the same way asself-managers (see above).

Funding the support organisations

Under the Norfolk scheme, there were twosupport organisations: ILP and the NCODP. Thefunding of the ILP has been explained above.The NCODP is funded via a service agreementand currently costs approx £21,000 per year. Atthe start of the pilot scheme, a joint funding bidwas approved which pays for this support forthe first three years of the scheme after whichthe local authority will assume responsibility.

Local authority support costs

In addition to the costs of the supportorganisations detailed above, the local authority

has had to invest a considerable amount of stafftime in the development and maintenance of thescheme. Originally, the pilot was set up withinput from a team manager for people with aphysical disability and a Contracts Officerworking within their existing posts. However, itsoon became clear that this was not practical soa full-time temporary post of Direct PaymentProject Officer was created to oversee thedevelopment of the scheme. This was at teammanager level.

After the first 18 months of the project, thefollowing became clear.

• There was a need for a permanent 0.5 full-time equivalent post of a Direct PaymentsProject Officer to maintain and continueto develop the project.

• There was a need to create a MonitoringOfficer Post in order to return thefunction to SDD. It has now been agreedthat these 1.5 full-time equivalent postswill be established and recruitment iscurrently under way. It is estimated thatthese posts will cost approximately£30,000 per year. It is hoped that, once theincumbents of these posts are in place,other staff who have been involved willbe able to be less involved.

In addition to the staff costs, the localauthority also spent approximately £1,000 ayear, from a budget of £2,000, on miscellaneouscosts such as venues for meetings andconsultations, and travel expenses foremployers to attend consultation meetings.

Contingency fund

It has been mentioned earlier that, right fromthe start of the pilot scheme, a contingency fund

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of £10,000 was set up in order to cover anyunforeseen expenses that a recipient might incurand which they could not cover from theirdirect payments. For example, if an employerexperienced a high turnover of supporters, theymight be incurring high recruitment costs whichthey could not meet from their payments. Insuch a case, they could make a claim against thecontingency fund. As from April 1999, this fundhas also been used for people claiming theirpayroll allowance. At present, the contingencyfund is held and administered by the ILP,although this is currently being reviewed andwill subsequently be resumed by the SSD.

This fund works as follows.

• At the start of the project, the ILP wasgiven £10,000 to hold and administer.

• At the end of each financial year (orearlier if needs be), the local authoritytops the fund back up to the £10,000ready for the new financial year.

During the first year of the scheme, therewas very little use made of the contingencyfund (probably less than £1,000). As a result ofsome of the other changes introduced as fromApril 1999 (detailed above), more use has beenmade of this during the second year. However,it is still likely to spend only half of the available£10,000. Despite the relatively small use of thisfund, it provides a very valuable safety net toemployers.

Training fund

At the start of the project, it was anticipated thatusers of the scheme might require training in anumber of aspects of direct payments, e.g.employment issues, etc. Therefore a trainingfund of £10,000 per year was established so that

users could ask for any training they felt theyneeded. This training fund is held andadministered by the NCODP.

This fund works the same as the contingencyfund. At the start of the project, the NCODP wasgiven £10,000 to hold and administer. At the endof each financial year (or earlier if necessary),the local authority tops the fund back up to the£10,000 ready for the new financial year.

During the first year of the scheme, verylittle use was made of this fund. However,during the second year, it appears thatapproximately half of the amount availablecould be used (although some of this will be onthe production of training materials rather thanon direct provision of training courses). Again,despite the relatively small use of this fund, itprovides employers with reassurance that theycan access training if they wish.

Summary of figures

As part of the ongoing monitoring of the costeffectiveness of the scheme, the figures shownin Table 5 were produced in respect of 1999/2000.

Cost effectiveness

Direct payments were introduced by centralgovernment with an expectation that localauthorities would be able to introduce thisalternative to direct service provision with noextra funding requirements (LAC (97) 11).Within the pilot project, the estimated costs ofdirect service provision for the same services arehigher than those for direct payments. If costeffectiveness is measured in these terms thendirect payments are a cost-effective means ofdelivering a service. However, such figures donot take into account hidden costs, such as time

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and resources spent within both the SSD andsupport agencies in establishing the differentsystems, nor do they offer a measure of thequality of service delivered and whether theservice may be delivered more cheaply orefficiently via other means.

Time and resources

As outlined above, the pilot was originally setup with input from a team manager (adult care)physical disability and a contracts officerworking within their existing posts. However, itsoon became clear that this was not sufficient soa full-time temporary post of Direct PaymentProject Officer was created to oversee thedevelopment of the scheme. This was at teammanager level. A social worker was alsoseconded to the project to conduct thereassessments necessary for the transfer fromthe third-party scheme. This was not reflected inthe costings.

Prior to the commencement, and during theearly stages, of the project, time was spentconsulting with all the managers in adultservices and there were discussions within team

Table 5 Cost of direct payments, 1999/2000

£

Costs of personal support/service delivery 574,867Support organisation – ILP 95,000Support organisation – NCODP 21,000Contingency fund 10,000Training fund 10,000SSD development/monitoring 30,000Project support costs 2,000Less underspend on contingency/training –7,000Total 735,867

Estimated costs of direct service provision (50% agency, 50% SSD in-house provision) for the samelevel of supportTotal 764,560

meetings of operational staff, within teams ofhome care managers, within seniormanagement teams (including directorate),within the research department, policy andplanning department, and finance department.All of the meetings would have involved thepreparation of papers and discussiondocuments. The resources that supported thesemeetings and the time of the staff involved werehidden costs within the SSD.

There was also time spent within thesupport agencies of a similar nature. The factthat there were two support agencies increasedthe time involved in meetings and negotiation.All was in duplicate; two service contracts withthe SSD, two venues, two sets of administrationand equipment costs.

The scheme devised by the partners wasextremely complex. The three optionsnecessitated different systems within SSD andthe support agencies. Initially, they alsorequired different systems of financialmonitoring. This was subsequently changedand all was monitored directly by SSD. The

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complex nature of the scheme led to someconfusion at the beginning of the project withinthe staff of SSD and with potential recipients ofdirect payments. A less complex scheme mayhave led to less discussion time and paperwork.

Another hidden cost involved social worktime. To establish a direct payment for anindividual employer required the systems to beset up and the processes to be engaged. Thesystems for payment and monitoring had to beestablished. This was another hidden cost.However, once direct payments wereestablished and personal assistants recruited,the involvement of social workers, and theirtime, was deemed to be less than might havebeen the case were the person in receipt of directservices or agency support.

When people are in receipt of a directservice, the costs of employing the home careassistants and their management are incurredby the SSD. Employees of the SSD invoke theinvolvement of the personnel department, thefinance section, policy staff and operational andadministrative managers. All employmentissues were dealt with by the disabledemployers themselves on the direct paymentsscheme, which has resulted in a saving in thisrespect within the SSD. These may be seen ashidden savings.

A survey by Zarb and Nadash (1994) of fourlocal authorities and 70 disabled people, whichconsidered detailed budget data including allidentifiable administration costs and overheadsinvolved, concluded that arrangements financedby direct or indirect payments (through a thirdparty) were on average 30 per cent cheaper thandirect service provision. The Norfolk pilotproject does not have detailed figures for theadministration and overhead costs. However, it

is clear that the majority of the hidden costs inthe Norfolk scheme were incurred inestablishing the scheme and in the early stagesof its operation. The hidden costs will decreaseas the scheme continues and the hidden savingswill increase.

Quality of service

There are many points at which quality mightbe measured in this project. All may be judgedby standards set by SSD, by criteria determinedby the agencies involved in the scheme, bycriteria established by external bodies, or bymeasures adopted by disabled employers. Therewas no agreement at the outset of the projectabout the means by which the quality of theservice would be measured and there was anongoing debate about what constituted a goodquality service. General notions, such that themoney would be spent on support, that peoplewould receive the support which they wereassessed as needing, and that people wouldreceive the support they needed in their role asemployer in a manner which was acceptableand accessible, and that the whole would bedecided by the members of the partnershipworking in harmony, guided the discussions butwere not defined in measurable outcomes.

The criteria used by different parts of theservice system to judge quality are not alwaysthe same and can be, in some circumstances, indirect conflict with one another. For example, ifthe conduct of personal assistants wasmeasured by the criteria within the SSD set forhome care assistants, the quality would havefallen very short of the stated standards incertain respects. As discussed above, somedisabled employers actively encouraged theirpersonal assistants to bring children, and in one

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case grandchildren, to their home. Yet, this isforbidden within direct service provision. TheEmployee Handbook (Home Care Assistants) statesthat ‘under no circumstances must you takeyour children to your place of work with you’(Norfolk Social Services Department, 1996, p. 6).

The decision about whether the service was‘good enough’ rested in five places during thepilot scheme: senior management within theSSD (and subsequently the social servicescommittee of the County Council); the reviewsystem for receipt of community care services;the personal assistants; an employment tribunal;and disabled employers. The role of the firstwas primarily to ensure that the scheme met thecriteria laid down by central government andthat the budgetary implications were sound.The financial monitoring system highlightedwhether the appropriate number of supporthours were being claimed and any discrepancieswere picked up. There was also a review ofservice every six months. The last two functionswere social work tasks but during the pilotproject these were often undertaken by theDirect Payments Officer to maintain aconsistency of service and because of thepressures on social workers. The review systemwas to be strengthened after the pilot projectwhen it would be continued by social workerswho may not be as familiar with directpayments as the officer.

During the scheme, there was concern thatpersonal assistants should receive a wage whichwas at least equal to that of staff employed insimilar roles within the SSD and that there shouldbe sufficient funding within the monies paid todisabled employers to take into account matterssuch as sickness and holiday pay. Equitableconditions of service were also sought and

recommended to employers. On the whole, thiswas in evidence during the pilot scheme and fewpersonal assistants left their employment.

The primary judges of the quality of theservice were the disabled employers. Employerswere actively involved in steering the directionof the pilot project in many ways. The NCODPDirect Payment Co-ordinator was himself adisabled employer in receipt of direct payments.The peer groups that he supported, theconsultation group and the conference forrecipients of direct payments were all means ofeliciting their views. Feedback from the worksupporting individuals undertaken by theNCODP Co-ordinator and the staff of the ILP,and the research from the JRF monitor, alsoinformed the Implementation Group of theviews of disabled employers.

As indicated above, employers chose theirown personal assistants and, withinemployment legislation, were able to determinethe conditions of service and role of the personalassistants. In some situations, the personalassistants were not able to perform as well asthe employer had wished but employersmaintained that, overall, when judged by theirown criteria, the support received throughdirect payments was better than that providedthrough direct service provision or throughcontracted agencies. Some employers hadactively chosen direct payments because thequality of service they had received previously,in terms of flexibility and responsiveness totheir need, was considered to be poor (seecomments earlier in this report). For someemployers, there were negatives in managingtheir budgets and staff but in a cost/benefitanalysis the benefits greatly outweighed thecosts. This is discussed in more detail below.

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A cheaper alternative?

Direct payments are a cheaper alternative thandirect service provision or contracted agencyservice and become cheaper still comparativelyover time. The present scheme could becomemore cost effective by using one support agencyrather than two. Savings would also be made ifless support were offered than at present butthis would mean that some people who havechosen the ‘assisted management’ option mayno longer feel able to manage. Others maycontinue but the risks of financial, physical andemotional harm would increase. A reduction inthe wages of personal assistants or theirconditions of service would be another, althoughequally undesirable, means of cutting costs.

It is difficult to envisage an alternativemeans of delivering a community care service,where there remains the requirement for anassessment of need by the SSD, which would becheaper than a direct payments scheme.

The views of the players about the scheme

Views of disabled employers

Disabled employers had positively chosendirect payments and, with very few exceptions,were pleased to have made that choice. Somesuggested that the time and pressures involvedin employing their own staff were weighty butworth the effort.

It’s more pressure – but then that’s life!

As highlighted above, some employersexperienced challenges with their personalassistants, particularly where there weremanagement issues. However, the ‘mistakes’that were made in some poor appointmentswere seen as mistakes that they had made for

themselves. One man went to bed in his clothesone night so that he did not have to call apersonal assistant out at 4.00 a.m. one morningwhen he was going to London. This was hischoice and he was pleased to have had theoption of making that choice. The sense of beingin control, making decisions and takingresponsibility for their own decisions washighly significant for some. One described thesense thus ‘I’m in control’. Another suggestedthat she had ‘total freedom in my day-to-daylife’.

Some disabled employers spoke directly of thepilot project. One maintained that ‘this schemereally works’. Another felt ‘really privileged to bea part of this scheme’. One employer was veryclear about what the scheme had meant to herand wrote on the bottom of her questionnaire:

It’s given me my life back, energy for my family,peace in the thought that there is some normalityonce again. I urge the SS committee to make thisscheme stay. If it wasn’t kept I wouldn’t just losemy carer, I’d lose a better way of life for ourfamily.

For most people who joined the pilot project,it was a positive experience as illustrated by theabove comments. Only eight people left thescheme, all for very different reasons. Five hadchosen the self-management option and threewere assisted.

• One man on the self-management optiondied.

• One man on the self-management optionwas admitted to a psychiatric hospital.

• One person who was managing their ownsupport was also paying full charges to

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the department and so it became morecost effective to buy her support privatelyrather than through the SSD.

• The personal assistant of one employerwho self-managed left and she chose towithdraw from SSD services completely.

• One man who managed his own supportrefused to submit monitoring forms andafter six months his direct payments weresuspended.

• One woman on the assisted managementoption experienced a marital break-upand moved into residentialaccommodation.

• One woman, in receipt of mental healthservices, experienced difficulty infulfilling her role as an employer andthere were concerns that her behaviourtowards her personal assistants, who shethreatened frequently with dismissal,would cause future difficulties for bothparties. The SSD now employs theassistants who continue to offer the samesupport to the woman as previously.

• One woman, with multiple sclerosis, wasunable to manage her staff even withsupport from the assisted managementoption since her mental capacity wasgreatly affected by her illness. Whilst theILP operated her payroll, it remained herresponsibility to manage her staff. On oneoccasion, she had arranged for twodifferent agencies to provide support andone personal assistant who she employedseparately to provide cover at the sametime. After discussions with the Direct

Payments Project Officer, it was decidedthat she would find it more appropriate toreturn to direct service provision.

Few people, therefore, left the schemebecause of difficulties in managing directpayments or because they did not like thescheme. In most of the situations, withdrawalwas due to a change in life circumstances.

For most people, the direct payments were apositive alternative to direct service provision orthat provided by agencies contracted by theSSD. The positives voiced include:

• employing whom they choose

• determining the hours of employment

• determining the tasks they require thepersonal assistant to undertake

• the flexibility of the employmentrelationship which allows them to varytheir routines and activities with moreease

• the level of support offered in their role asemployers

• decrease of involvement withprofessional agencies.

Areas of improvement which they identifiedwithin the scheme include:

• more training and awareness raising forsome social work staff

• the ability to use more flexibly the moniesin ‘care account’ (the account openedspecifically by the individual for thepurposes of direct payments)

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• the cumbersome paperwork related to thefinancial monitoring and the frequency ofthe forms

• the financial systems (particularly thoserelating to charges for services) at CountyHall.

The last three were addressed during thepilot project and improved in some part. Theseissues are still under review. This was valued bysome recipients, who felt that their voices werebeing heard and their concerns acted upon. Oneclaimed that ‘it’s brill to have input’. Thetraining and awareness raising of social workstaff was ongoing but needs furtherconsideration.

The personal assistants

Interviews with personal assistants were onlyconducted at the introduction of the employer.Therefore, a full range of views may not havebeen accessed during this research. However,those interviewed suggested that they preferredto work directly for a disabled employer ratherthan for an agency or SSD. Many did notperceive themselves to be ‘professional carers’but viewed their work as a relationship ofsupport between themselves and theiremployer. Often the support was mutual.

Many would not have been able to adhere tothe conditions of service within the SSD. Also,since the SSD could not guarantee regular hoursof work each week during the period of thepilot project, some personal assistants preferredto work in an arena where this could be moreeasily negotiated. Others preferred to keep theirworking hours under the requirements forIncome Tax and National Insurance, whichagain could be more easily negotiated with an

individual employer. Direct payments were seenas a positive factor in their lives as well as thelives of their employers.

The partnership

There were three partners in the Norfolkscheme: Norfolk SSD, NCODP and the ILP(whose parent organisation was HAND). At thestart of the pilot project, both HAND andNCODP were controlled by disabled people. Allthree partners held different ideologies and haddifferent aims. Whilst all the members of thepartnership had a shared commitment todisabled people receiving payments, all also hadtheir own agendas, expectations andconstraints. Within the SSD, the additionaldrivers were the need to transfer service usersfrom a third-party scheme to one whichconformed with the requirements of the newlegislation governing direct payments, toprovide a service which was in keeping withprofessional standards, and to do this with noadditional funds. The ILP also shared the needto transfer people to direct payments but, sinceit derived its income by the commission itcharged on services offered under the third-party scheme, there was a need to securefunding. The parent organisation continued tofocus upon the need for advocacy for disabledpeople. The NCODP sought more control fordisabled people in whatever arena. Where aimswere shared, there were differences about howthey might be realised. This was to becomehighly problematic. The final proposal was bornof compromise and represented an attempt tobring together, and placate, differentperspectives. As a result, the pilot project wasvery complex and demanded constantdiscussion and clarification. These discussions

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pulled the members of the partnership together.The work surrounding direct payments wasseen as a vehicle through which workingrelationships were being established betweenthe members, and one that was highly valued,for all involved.

The ILP had been given almost totalautonomy by the manager and trustees ofHAND and only the Co-ordinator of the ILPwas present in the Implementation Groupwhich was attended by at least two members ofthe SSD, the Chairman of NCODP and theDirect Payments Co-ordinator employed byNCODP. Similarly, the Consultation Group waschaired alternately by the Chair of NCODP andthe Direct Payments Project Officer from SSD.The Co-ordinator of the ILP was a participant inthe group.

Six months after the inception of the pilotproject, when it became apparent thatemployers were not discriminating betweentheir use of the ILP and NCODP, concern on thepart of the latter led to the co-ordinator of directpayments for NCODP having an office withinthe SSD day service rather than with the ILPwhich had been previously discussed. Despitethis, both co-ordinators worked very closelytogether. As the partnership debated andbecame more aligned in their thinking, the ILPbecame increasingly estranged from its parentorganisation, HAND.

Tensions within HAND, which had existedsince 1996, grew. Disputes emerged about theallocation of resources within the organisation.A crisis was provoked when the ILP was cited inthe case of the disabled employer being broughtbefore an Industrial Tribunal accused of unfairdismissal. The Co-ordinator sought guidancefrom his manager and Trustees and requested

legal advice. Differences in perspectives andapproach became magnified by clashes ofpersonality. The Chairman of HAND, also anemployee of the SSD, was coincidentally at thesame time deemed in breach of SSD policyabout employees operating as Trustees inorganisations with which the SSD hascontractual arrangements. He was required toresign. Another Trustee, who was also amember of NCODP and a recipient of directpayments resigned. Two more Trustees were co-opted onto the board and the organisationcontinued to function.

The four staff of the ILP felt increasinglyestranged from their parent organisation andsought management from disabled people whohad an understanding of the issues of directpayments. They approached the NCODP with arequest that they might be managed by thecommittee that managed the Co-ordinator ofDirect Payments for the NCODP. NCODPagreed. However, the manager of HAND, withthe Trustees, refused the requested transfer. TheSSD contract for the ILP was due for renewal atthe end of the financial year. After taking legaladvice, the SSD renewed the ILP contract for sixmonths whilst a resolution to the problem wasdetermined by going out to tender.

All members of the partnership agree that,although the differences between the threepartners produced a creative tension during theearly stages of the scheme, more progress mighthave been made if there had been only onesupport/voluntary agency involved. Bothsupport organisations had agendas which,whilst related to direct payments, were notspecifically about independent living. HAND,the parent organisation of the ILP, wasconcerned primarily with advocacy for disabled

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people and had great expertise in the welfarerights arena. The NCODP, whilst having a sub-committee specifically to manage the DirectPayments Co-ordinator, was primarily anorganisation established to campaign for changein the opportunities and access to rights fordisabled people. Although both had employeesworking exclusively in the field of directpayments, and had interests in the issues ofindependent living and the empowerment ofdisabled people, this was not the prime focus ofeither organisation.

The pilot project had served to meet the aimsof all of the parties at the outset and haddelivered a service that had enabled disabledpeople to employ their own personal assistantswith the level of support they required. By theircriteria, the scheme had been successful.

The County Council

Within the SSD, the pilot scheme was alsodeemed to be a success by the Project Board. Itwas brought into the mainstream of socialservice provision after a decision by NorfolkCounty Council on 5 December 1999. This wasthree months later than originally expectedbecause of restructuring within the localauthority. The request raised by theImplementation Group, and approved by theProject Board, for two permanent posts to becreated within the SSD, a Monitoring Officerand a part-time Project Officer, was granted.

The NCODP and the ILP were involved inthe recruitment for these posts and wereinvolved in the interview process. The posts willbe taken up as soon as is practicable in the newfinancial year.

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The working of the project

The Community Care (Direct Payments) Act1996 empowered local authorities to givemonies directly to service users for the firsttime. Previously, Norfolk like many countieshad established a third-party scheme that actedas a broker for services. The drive for theimplementation of the direct payments pilotproject came initially from within the SSDbecause of the need to transfer 48 service usersfrom the third-party scheme to conform to theprovisions of the Act. Disabled people were notactively engaged in the initial debates about theestablishment of a direct payment scheme,which necessitated a further period ofconsultation. The consultation was verysuccessful and disabled people became involvedin each stage of the process of planning and inthe operation of the scheme. There was a spiritof co-operation and of active participation.Disabled people were not passive recipients of ascheme devised and managed by serviceproviders. They came to understand theconstraints imposed upon and within the SSDand sought to work within these, and staffwithin the SSD came to a greater understandingof issues pertinent to disabled people. Theworking in partnership, of itself, was a learningexperience for all; one which may be built uponin the future both within the arena of directpayments and beyond.

The introduction of direct payments isundoubtedly complex. In Norfolk, there werethree partners involved in the pilot projectwhich added to the complexity. Every issue wasthoroughly debated, which increased the timeinvolved, and many decisions were the result of

compromise. Unfortunately, only the DirectPayments Officer from the SSD had beeninvolved in the establishment of the third-partyscheme in 1993. Some of the issues that wereconsidered during that period were debated andrehearsed again. Whilst this was necessary forthe establishment of the partnership and thepilot project, there was less time to address evenmore innovative ideas.

Unfortunately, the introduction of directpayments coincided with major changes withinservice provision in Norfolk. A reorganisationwithin the adult services in the SSD absorbedmuch attention and energy of staff in this arena.Services for people with learning disabilitiesand mental health problems were undergoingrapid change. The relocation of people from alocal learning disability hospital occupied muchdebate in this field. Nationally driven changesin mental health services, outlined in theNational Service Framework, created a climateof uncertainty and fundamental restructuring ofservices on an inter-agency basis across thecounty. A decision had also been reached thatthe department required more social workers tobe approved to operate under the Mental HealthAct 1983. Twelve social workers wereundertaking the training and a further 12 wereoperating as mentors. It had further been agreedthat workers already approved would berequired to maintain evidence files, which wasperceived as an additional, and stressful, task.Workers in the teams serving people withmental health problems were extremelystretched. The introduction of Primary CareGroups also involved much debate and energywithin the department. Undoubtedly, these

3 Overview and evaluation by the

monitor

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factors conspired against the development ofthe direct payments scheme.

Against such a backdrop, the commitment ofsenior members of staff and the creation of apost within the SSD dedicated to directpayments to oversee the introduction of thescheme was highly significant. Time andresources were given to the scheme by peoplewithin the finance section, contracts departmentand research department of the SSD. Staffwithin these units had little experience ofworking with disabled people at the outset butthe changes in approach have been manifest. Achampion of direct payments, who wascommitted to the empowerment of disabledpeople and who had skills in establishing newprojects, was a huge asset.

The partnership in the Norfolk schemeinvolved two agencies which had differingagendas and which, to some extent, werepotential competitors. Initially, the ILP continuedto be funded by receiving commission for those towhom a support service was offered. If employersmoved from the third-party scheme to managetheir own direct payments, the ILP would losemoney, although the SSD had underwritten theILP so that the income would not fall below theamount it needed to remain viable. There was atension in the scheme since the ILP wouldbenefit from creating dependency which wascontrary to the spirit of direct payments and thepilot project, although there was no evidence ofthe workers of the ILP engaging in practices ofthis kind. The role of the ILP was furthercompromised by the contract for the monitoringof the financial returns. The ILP in effect becamea policing arm of the SSD. This was notwelcomed by disabled employers because of theadded paperwork necessary for the

involvement of a third party and also because ofissues of confidentiality. It quickly becameuntenable and this function was resumed by theSSD. The statutory monitoring and the supportactivities are quite distinct and are best locatedin different agencies.

The NCODP was also under some pressureto demonstrate that its services were required asthe funding for the post of the Direct PaymentsCo-ordinator rested upon its success. Thisconcern of the NCODP led to the maintenanceof the three distinct options for recipients ofdirect payments. The NCODP wished to beidentified with the self-management option. Thedichotomy between the two agencies and theservice offered was little in evidence in practiceand employers sought the support they neededfrom whoever and wherever they felt was mostappropriate to a particular need at a given time.The partners moved closer, in both method ofworking and in philosophy, during the pilotproject and a mutual trust was establishedbetween the workers in the field. There wascollaboration rather than competition but theexistence of two organisations meant thatnegotiations and co-ordination were more timeconsuming than might otherwise have been thecase. One organisation with the sole interest ofsupporting people in receipt of direct payments,controlled and managed by disabled people,would produce the most desirable and mostcost-effective outcome for all. Employers wouldhave one point of contact where they couldaccess a range of support depending on theirsituation at any given time; the SSD would haveone organisation with which to negotiatecontracts and service agreements, and therewould be no duplication of such as venue andequipment costs.

53

Overview and evaluation by the monitor

The take-up of direct payments was initiallyslower than anticipated as staff within the SSDand disabled people came to understand theprocesses. The delay in transfer and the lack ofnew employers joining the scheme caused someearly concern, as the partners were keen todemonstrate the viability of the scheme. Therewas also a desire that sufficient people wouldcome forward so that any flaws in the processescould be identified and rectified during the pilotperiod. It is a measure of the trust and strengthwhich developed between the partners and theboards overseeing the project within the SSDthat, when a personal assistant took hersituation to an industrial tribunal, the event wasregarded as one of the inevitable, althoughunwelcome, consequences of people employingtheir own staff and the risks inherent in thatscenario. There was confidence that the schemewas sound and that this situation presented achallenge to be addressed and not a threat. Thedivorcing of the ILP from its parent organisationHAND became apparent at this point as themanager of HAND, who had not engaged in theprocess of the partnership and had not takenpart in the debates, did not share the view of thepartners.

Throughout the pilot project, it was apparentthat the introduction of direct paymentsinvolved a change of culture within the SSD.Prior to the implementation of the NationalHealth Service and Community Care Act 1990,both assessment and provider functions werewithin the SSD. From 1993, the functions hadbeen separated. Norfolk had embraced thepurchaser–provider split powerfully. There wasstill some culture of direct service provision butnow manifested in the control of serviceprovided through service contracts and

inspections of contracted agencies. Directpayments were welcomed by some staff,particularly those who had experience ofworking with the third-party scheme, but forothers within the SSD it represented a shift inwhich they, as individual workers, or thedepartment as a whole, would be enablingdisabled people to take greater risks. Asdiscussed above, those heavily involved in thepilot scheme, including a member of directoratewho chaired the Project Board, moved towardsa position of accepting more risk as the projectprogressed. The monitoring and management ofthe monies were relaxed somewhat. Greaterflexibility about the spending of the money wasgiven and this enabled some employers to takegreater responsibility for their lives and also totake greater risks, both emotionally andphysically.

Social workers, as the assessors for servicesunder the National Health Service andCommunity Care Act 1990, remained thegatekeepers to direct payments. It is concerningthat some chose not to discuss this option withclients, particularly as the majority of disabledemployers became aware of direct paymentsthrough their social workers.

The ILP was established within Norwich, thelargest urban area within the county, andsubsequently offered a service across the wholecounty. The direct payments scheme hadrecipients living all over Norfolk although themajority lived in Norwich and its environs.Proportionally far more of those eligible fordirect payments who lived in Norwich actuallyreceived direct payments. This had little to dowith notions of rurality and sparsity ofpopulation and much to do with the culture ofthe staff within the SSD in other areas. The

54


above raise issues of equity of service provision,which the SSD will need to address within itstraining plan and operational policies.

The Norfolk Direct Payments Pilot Projectwas open to all adults aged 16–64 who receiveddomiciliary support for more than five hours aweek, a regular respite service and whoincurred transport costs related to their respite.It did not include attendance at a day centre.Whilst some people served by adult teams(physical disability) receive a day service, manypeople with mental health or learningdisabilities receive their support through dayservices. Over 800 people throughout the countyeach day attend day centres for people with alearning disability. Direct payments were notoffered as an alternative means of serviceprovision for people who were living inresidential accommodation, and some peoplewith mental health problems and more withlearning difficulties live in residential settings inthe county. Only two people who did notreceive their support from adult teams (physicaldisability) joined the scheme. As highlightedabove, teams in the other arenas were largelypreoccupied with other significant changes intheir services and some workers dismissed theconcept of direct payments on the basis thattheir clients were not ‘willing’ and ‘able’. TheDirect Payments Project Officer in SSD haddiscussed direct payments with social workersfrom these other teams and they had alsoattended the training sessions. The NCODPDirect Payments Co-ordinator had spoken tomany groups representing people with learningdifficulties and the NCODP had soughtrepresentation from mental health service userson the Consultation Group. Yet, despite this, thepilot project was largely unsuccessful in

engaging in debates about the implementationof direct payments within the mental health orlearning difficulty arenas either within orwithout the SSD.

Seventy-five disabled people used thescheme. Most were highly pleased with theopportunity it afforded, few had criticisms andeven fewer left. By this measure alone it may bedeemed successful. However, the interviewswith employers during the pilot projectindicated a much higher level of dissatisfactionwith services directly provided by SSD homecare service or agencies contracted by the SSDthan had been the case in the research whichmonitored the establishment of the ILP duringthe period 1993–94 (Dawson, 1995). This isconcerning. The research did not set out toassess whether the expectations of service usershad increased during this period or whether thequality of the service being provided haddecreased. However, anecdotal stories from therespondents suggest the latter. Perhaps the take-up of direct payments would not have been sohigh if people had received a direct servicewhich was more flexible and responsive to theirindividual requirements.

There was no typical direct paymentsrecipient. The ages, the gender, the sexualorientation, the family structure, their incomeand employment, and their family backgrounddiffered enormously. In some scenarios,disabled employers sought to gainindependence from statutory services andcontracted agencies. Some sought independencefrom their families (in particular from theirparents) whilst others wanted to maintain themutual dependence of family members uponone another. There was a sense from someemployers and from some personal assistants

55

Overview and evaluation by the monitor

that there was a mutual support, which couldstretch beyond the immediate employer–personal assistant relationship. Employers feltthey were contributing to the welfare andincome of their personal assistants in exchangefor their support in domiciliary tasks. One wasnot dependent on the other but rather there wasan interdependence.

Summary of the strengths and weaknesses

in the scheme

The strengths in the scheme have included:

• the working together of disabled peopleand professionals in partnership

• the willingness of each player to take onnew ideas, to compromise and to movetowards a common goal

• the learning to resolve differences and toacknowledge strengths

• the responsiveness to the voices of peopleusing the scheme

• effectiveness in conforming to therequirements and guidelines of centralgovernment

• effectiveness in enabling 75 disabledpeople to employ their own personalassistants

• the range of support options and theperceived quality of the support offeredto disabled employers

• the perceived benefits from theperspectives of disabled employers

• the mutual reciprocity between serviceusers and personal assistants

• the commitment of senior staff, thecreation of a post specific to directpayments and the operation of thetelephone help line for staff

• a relaxation of formal checks and balancesas trust grew between disabled employersand the SSD and the willingness withinthe SSD to take more risks.

The scheme was not so effective in:

• reaching out equitably to all who wereeligible across the county

• engaging with the debates within mentalhealth and learning difficulty arenas andaccessing direct payments for people withmental health problems and learningdifficulties

• resolving the tensions within one of thesupport agencies

• changing the culture of service provisionby offering an alternative provision forthose in day or residential services.

Future developments

The partners involved in the pilot project havenot ceased the development of the scheme andmany of the issues that arose are now beingpursued. The post of an advocacy worker isbeing created to empower people with learningdifficulties and mental health service users toaccess direct payments.

Other means could be explored of openingup choice to people with more profoundlearning difficulties or mental incapacities.During the pilot project, two people were notable to manage their payments and the SSD

56


subsequently employed their personal assistantsto continue to provide the support sought bythe disabled person. In a similar vein, the SSDmight explore entering into service agreementswith a support agency or trust which couldbecome the employer of personal assistants whowere chosen or preferred by a disabled personand thus offer those who are not ‘willing’ and‘able’ to receive direct payments a greaterdegree of choice about the person who providestheir support.

A working party is researching theimplications of introducing direct payments inlieu of some day service provision. The nextstage would be to consider the implications ofoffering direct payments in lieu of residentialservices.

The NCODP is establishing stronger linksacross the county with the aim of raisingawareness of direct payments. There will alsoneed to be more awareness raising and trainingfor some staff within the SSD.

Work, which has already begun, also needsto be undertaken within the SSD with respect toissues of ethnicity and recording of ethnicorigin.

The specification for a tender for the supportoffered to those in receipt of direct payments isbeing drawn up. It is hoped that this willresolve the tensions within HAND and ILP, andalso reduce the complexity in the arrangementsfor support.

Direct payments are soon to be offered toolder people in the county and, drawing on theexperience of the pilot project, the consultationprocess between the SSD and all the interestedparties has begun.

Closing remarks

The whole story of the Norfolk Direct PaymentsPilot Project is one of a moving kaleidoscopebetween dependence, independence and inter-dependence; within and between theorganisations involved in the partnership;between the scheme and disabled employers;and the disabled employers and their personalassistants. The project is continuing to move andto change, and there is a sense of optimism andchallenge. It is a scheme that has broughtfundamental questions of equity into thedebating arena and has raised the quality of lifefor many disabled people and their families.

57

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60

Please tick or circle one answer per question:

1 Are you male/female?

2 Are you aged 18–25; 26–35; 36–45; 46–55; 56–64?

3 Approximately how long have you been receiving direct payments?one year;six months;three months;less than three months

4 When did you first hear about direct payments?two years ago;eighteen months ago;a year ago;six months ago

5 How did you learn of direct payments? Through:a friend;media;the ILP;a social worker;the Coalition of Disabled People;other (please specify)

6 Did you employ personal assistants through the ILP prior to April 1998?Yes/No

7 How do you manage your direct payments?self-manage (i.e. do it yourself or with your personal assistant);through the ILP;with the support of another agency (please specify)

8 If you self-manage did you use another agency previously? If yes was thisthe ILP;another agency (please specify)

9 How many personal assistants do you employ? Please circle: 1; 2; 3; 4; 5; More

Appendix 1: Direct payments questionnaire

61

Appendix 1

Please tick one option on questions 10–16 for each personal assistant

10 Is your personal assistant? Male Female

11 How old is your personal assistant? under 30; 30–50;over 50

12 How did you recruit your personal assistant?They were a personal friend previouslyThey provided your support previously as a home carer from

the Social Services DepartmentThey provided your support previously as a home carer from

another agencyThey were your supporter in residential careYou advertised and recruited through interview

13 How does your personal assistant travel to you?On footIn a carOn a bicyclePublic transport

14 How long does it take them?Five mins;Ten mins;Half an hour;More than half an hour

15 What tasks do you employ your personal assistants to undertake?ShoppingPaying the household billsHouseworkPersonal carePreparation of meals

16 On average how many hours a week does the personal assistant work?3 hours or less7 hours (i.e. about a day or a night)2 days3 days or more

62


17 If you needed support about any of the following please indicate who you would contact byusing this number scheme:(1. Coalition, e.g. Keith Roads or peer group; 2. ILP; 3. Social worker; 4. Social Services Staff at

County Hall; 5. Other – please specify)

Recruiting staffManaging staffPaying staff and running the payrollMonitoring forms for direct paymentsNeeding more hours of personal assistancePaying your household billsCharges made for your services by Social

Services Department

18 Are you a member of a direct payments peer group?Yes/No

If yes: Why?If no: Why not?

19 What are the positives for you in receiving direct payments?

20 What are the negatives for you in receiving direct payments?

21 Are there any changes you can identify that would make the scheme better?

22 Is there anything else I should know?

Many, many thanks for your time.

I would be willing to speak with you further in an interview:

Name

Address

Phone number

Most convenient time for me is:

63

Devised by Carol Dawson and Ann McDonald(first appeared in Practice, Vol. 12, No. 2, 2000,pp. 5–20).

Before you say that someone is unable to

make this decision ask yourself the

following questions

1 What is the significance of the life history

of the person on this decision?

• life story/social history• recent past• present context• future aspirations

2 What is known about the person’s ability

to communicate?

• known issues arising from:

cognitive difficulties:– in receiving data– in processing data– in responding– attention spanhearing losssight lossphysical disabilities

3 Has the information been presented in

different formats?

• spoken work giving consideration to:

structure of the conversation:– introduce the topic at the beginning to

orient the person– provide an overview of the topic or

issue– finally fill in the detailsentence construction:– short and simple– one topic

Appendix 2: Competence checklist

sentence content:– statements in the active voice are

easier understood than the passiveappropriate vocabulary:– possibly simplified– use of circumlocation to talk round a

word that is forgotten or not knownvolumepitch

• written word using:

capital/lower casesize of scripttype or handwritten scriptBraillemoon

• augmentative systems of

communication:

communication boardselectronic systems

• signed communication systems:

BSLMakatonHand on handCued speechDeaf-blind manualBlock

• pictorial representations:

photographsdrawingssymbols

• objects of reference

• experiential/situational learning

• video material

• audio material

4 Is the person able to make a decision?

• history of decision making

• make decisions about other issues of a

similar level

64


• hold two ideas simultaneously

• effective memory

– immediate– short term– long term– semantic– episodic

• concentration span

• have a preference

• understand consequences

• maintain internal consistency

• the emotional content of the decision

• techniques for facilitating decision-

making have been tried

– decision trees– small choices used to build skills– group discussions

5 What is the significance of this particular

decision?

• the legal status of the decision to be

made

• the legal powers and responsibilities

with respect to the decision

• the risk in the situation

– the likelihood of a negative outcomefor the person/worker

– the seriousness of a negative outcomefor the person/worker

6 What were the circumstances of the

decision making?

• not involved with another task

• attention fully secured before the task

was started

• the information was given on several

occasions

• the information was given in different

settings

• the information was given by different

people

• free from distractions such as:

– other events happeningsimultaneously

– sounds– smells– tastes– colour– light– comfort (continence/pain)

• the time of day most helpful to the

person taking into account such as:

– medication– tiredness– hunger– stress levels– pain

• the relation of the timing of the decision

to:

long-term factors:– significant life events– major life crises– transitionsshort-term factors:– meal times– meetings with other people– changes of venue– significant activities

• the significance of the venue for the

person:

– stressful– exciting– relaxing

7 Who was involved in the decision-making

process?

• the worker was able to interview the

person without support

65

Appendix 2

• the worker interviewed the person

alone

• the support with which the person is

most comfortable

• those who communicate most

effectively with the person

• someone who has no vested interest in

the outcome of the decision

• more than one other person has been

involved

• the power issues in the relationships

have been considered

• issues relating to the age, gender, race

and disability of all parties have been

considered

8 How quickly was a decision required?

• the person was given sufficient time to

make a decision

• the decision was made over a period of

time

• the opportunity was presented on more

than one occasion

• the opportunity to try different

alternatives over a period was given

Only when the above questions can all beanswered and it is established that a person isunable to make this decision at a particular timeask …

Who is the most relevant person or persons tomake a substitute decision?

66

Map 1 People receiving a service from the ILP at 31 March 1998

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67

Appendix 3

Map 2 People eligible for direct payments at 31 March 1999

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68


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aman

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bham

and

Cobh

am

St A

ndre

ws

St A

ndre

ws

St A

ndre

ws

Mag

dale

n Ea

stM

agda

len

East

Mag

dale

n Ea

st

Mag

dale

n W

est

Mag

dale

n W

est

Mag

dale

n W

est

Gor

lest

onG

orle

ston

Gor

lest

on

Lynn

Cen

tral

Lynn

Cen

tral

Lynn

Cen

tral

St M

arga

rets

St M

arga

rets

St M

arga

rets

Lynn

Nor

thLy

nn N

orth

Lynn

Nor

th

Chas

eCh

ase

Chas

e

Lynn

Lynn

Lynn

Sout

h W

est

Sout

h W

est

Sout

h W

est

Gay

woo

d N

orth

Gay

woo

d N

orth

Gay

woo

d N

orth

Gay

woo

d Ce

ntra

lG

ayw

ood

Cent

ral

Gay

woo

d Ce

ntra

l

Gay

woo

d So

uth

Gay

woo

d So

uth

Gay

woo

d So

uth


wst

on W

est

Spro

wst

on W

est

Spro

wst

on W

est

Sprowston Cen

tral

Sprowston Cen

tral

Sprowston Cen

tral

Spro

wst

onSp

row

ston

Spro

wst

onEa

stEa

stEa

st

Spro

wst

onSp

row

ston

Spro

wst

onSo

uth

Sout

hSo

uth

Crom

eCr

ome

Crom

eTh

orpe

Thor

peTh

orpe

Nor

thea

stN

orth

east

Nor

thea

st

Thor

pe S

outh

Thor

pe S

outh

Thor

pe S

outh

Man

crof

tM

ancr

oft

Man

crof

t

Mile

Mile

Mile

Cros

sCr

oss

Cros

s

Thor

pe N

orth

wes

tTh

orpe

Nor

thw

est

Thor

pe N

orth

wes

t

Mou

seho

ldM

ouse

hold

Mou

seho

ld

Thor

pe H

amle

tTh

orpe

Ham

let

Thor

pe H

amle

t

Lake

nham

Lake

nham

Lake

nham

St S

teph

enSt

Ste

phen

St S

teph

en


Eato

nEa

ton

Eato

n

Uni

vers

ityU

nive

rsity

Uni

vers

ity

Nel

son

Nel

son

Nel

son

Hend

erso

nHe

nder

son

Hend

erso

nBo

wth

orpe

Bow

thor

peBo

wth

orpe

Heigha

m

Heigha

m

Heigha

m

Helle

sdon

Nor

thHe

llesd

on N

orth

Helle

sdon

Nor

th

Helle

sdon

Sou

thea

stHe

llesd

on S

outh

east

Helle

sdon

Sou

thea

st

Helle

sdon

Wes

tHe

llesd

on W

est

Helle

sdon

Wes

t

New

Cos

tess

eyN

ew C

oste

ssey

New

Cos

tess

ey

Catto

n G

rove

Catto

n G

rove

Catto

n G

rove

Cosl

any

Cosl

any

Cosl

any

69

Appendix 3

Map 4 Sparsely populated wards

GR

EA

T Y

AR

MO

UT

H

KIN

G’S

LY

NN

NO

RW

ICH

AR

EA

Sp

arse

ly p

op

ula

ted

war

ds

010

20

Kilo

met

res

War

d b

ou

nd

ary

Dis

tric

t b

ou

nd

ary

Wal

sing

ham

Wal

sing

ham

Wal

sing

ham

Wel

lsW

ells

Wel

lsBu

rnha

mBu

rnha

mBu

rnha

m

Crea

keCr

eake

Crea

ke

Nor

th C

oast

Nor

th C

oast

Nor

th C

oast

Dock

ing

Dock

ing

Dock

ing

Hunstanton

Hunstanton

Hunstanton

Heacham

Heacham

Heacham

Snet

tisha

mSn

ettis

ham

Snet

tisha

m

Ders

ingh

amDe

rsin

gham

Ders

ingh

am Valle

y Hi

llVa

lley

Hill

Valle

y Hi

ll

Rudh

amRu

dham

Rudh

am

The

The

The

Woo

tons

Woo

tons

Woo

tons

Grim

ston

Grim

ston

Grim

ston

Gay

ton

Gay

ton

Gay

ton

Spel

low

field

sSp

ello

wfie

lds

Spel

low

field

s Clen

ch-

Clen

ch-

Clen

ch-

war

ton

war

ton

war

ton

Wes

tW

est

Wes

tW

inch

Win

chW

inch

The

The

The

Wal

pole

sW

alpo

les

Wal

pole

s

Wes

tW

est

Wes

tW

allo

nW

allo

nW

allo

nSt

Law

renc

eSt

Law

renc

eSt

Law

renc

e

Mer

she

Land

eM

ersh

e La

nde

Mer

she

Land

e

Emne

thEm

neth

Emne

th


Wat

lingt

onW

atlin

gton

Wat

lingt

on

Dow

nham

Dow

nham

Dow

nham

Mar

ket

Mar

ket

Mar

ket

Airfi

eld

Airfi

eld

Airfi

eld

Mid

dlet

onM

iddl

eton

Mid

dlet

on

Upw

ell,

Out

wel

lU

pwel

l, O

utw

ell

Upw

ell,

Out

wel

lan

d De

lph

and

Delp

han

d De

lph

Denv

erDe

nver

Denv

er

Ten

Mile

Ten

Mile

Ten

Mile

Wis

sey

Wis

sey

Wis

sey De

nton

Dent

onDe

nton

Coni

fer

Coni

fer

Coni

fer

Mid

-For

est

Mid

-For

est

Mid

-For

est

Nar

Val

ley

Nar

Val

ley

Nar

Val

ley

Prio

ryPr

iory

Prio

ry

Swaf

fham

Swaf

fham

Swaf

fham

Wis

sey

Wis

sey

Wis

sey

Nec

ton

Nec

ton

Nec

ton

Sprin

gval

eSp

ringv

ale

Sprin

gval

e

Herm

itage

Herm

itage

Herm

itage

Laun

ditc

hLa

undi

tch

Laun

ditc

h

Hagg

ard

Hagg

ard

Hagg

ard

de To

nide

Toni

de To

ni

Ship

wor

thSh

ipw

orth

Ship

wor

th

Toftw

ood

Toftw

ood

Toftw

ood

Tow

nTo

wn

Tow

n

St W

ithbu

rge

St W

ithbu

rge

St W

ithbu

rge

Nea

ther

dN

eath

erd

Nea

ther

d

Mat

tisha

llM

attis

hall

Mat

tisha

ll

Upp

erU

pper

Upp

erYo

reYo

reYo

re

Two

Rive

rsTw

o Ri

vers

Two

Rive

rs

Swan

ton

Swan

ton

Swan

ton

Mor

ley

Mor

ley

Mor

ley

Beet

ley

and

Beet

ley

and

Beet

ley

and

Gre

ssen

hall

Gre

ssen

hall

Gre

ssen

hall

Eyns

ford

Eyns

ford

Eyns

ford

Wod

ehou

seW

odeh

ouse

Wod

ehou

se

Kidn

erKi

dner

Kidn

er

Gre

atG

reat

Gre

atW

itchi

ngha

mW

itchi

ngha

mW

itchi

ngha

m

Upp

er W

ensu

mU

pper

Wen

sum

Upp

er W

ensu

m

Fulm

odes

ton

Fulm

odes

ton

Fulm

odes

ton

Astle

yAs

tley

Astle

y

Foul

sham

Foul

sham

Foul

sham

Reep

ham

Reep

ham

Reep

ham

Wen

sum

Wen

sum

Wen

sum

Valle

yVa

lley

Valle

y

Tave

rner

Tave

rner

Tave

rner

The

The

The

Rayn

ham

sRa

ynha

ms

Rayn

ham

s

Lancas

ter

Lancas

ter

Lancas

ter

Four

Sto

wes

Four

Sto

wes

Four

Sto

wes

Blak

eney

Blak

eney

Blak

eney

Cley

Cley

Cley

Gla

ven

Gla

ven

Gla

ven

Bodh

amBo

dham

Bodh

am

Sher

ingh

amSh

erin

gham

Sher

ingh

am

The

The

The

Runt

ons

Runt

ons

Runt

onsCr

omer

Crom

erCr

omer

Chau

cer

Chau

cer

Chau

cer

Corp

usty

Corp

usty

Corp

usty

Suffi

eld

Park

Suffi

eld

Park

Suffi

eld

Park

Roug

hton

Roug

hton

Roug

hton

Ove

rstra

ndO

vers

trand

Ove

rstra

nd

Mun

desl

eyM

unde

sley

Mun

desl

ey

Past

onac

res

Past

onac

res

Past

onac

res

Bact

onBa

cton

Bact

onN

orth

Nor

thN

orth

Wal

sham

Wal

sham

Wal

sham

Wes

tW

est

Wes

tEa

stEa

stEa

st

Erpi

ngha

mEr

ping

ham

Erpi

ngha

m

Ayls

ham

Ayls

ham

Ayls

ham

Scot

tow

Scot

tow

Scot

tow

Buxt

onBu

xton

Buxt

on


Happ

isbu

rgh

Happ

isbu

rgh

Happ

isbu

rgh

Stal

ham

Stal

ham

Stal

ham

Catfi

eld

Catfi

eld

Catfi

eld

Hick

ling

Hick

ling

Hick

ling

Nea

tishe

adN

eatis

head

Nea

tishe

ad

Hors

efen

Hors

efen

Hors

efen

Mar

tham

Mar

tham

Mar

tham

Win

terto

nW

inte

rton

Win

terto

n&

Som

erto

n&

Som

erto

n&

Som

erto

n

Hem

sby

Hem

sby

Hem

sby

Orm

esby

Orm

esby

Orm

esby

Rolle

sby

Rolle

sby

Rolle

sby

Sout

h W

alsh

amSo

uth

Wal

sham

Sout

h W

alsh

am

Horn

ing

Horn

ing

Horn

ing

Hove

ton

Hove

ton

Hove

ton

Fleg

gbur

ghFl

eggb

urgh

Fleg

gbur

gh

Acle

Acle

Acle

Cais

ter

Cais

ter

Cais

ter

Nor

thN

orth

Nor

th

Cais

ter

Cais

ter

Cais

ter

Sout

hSo

uth

Sout

h

Brad

wel

lBr

adw

ell

Brad

wel

lN

orth

Nor

thN

orth

Brad

wel

l Sou

thBr

adw

ell S

outh

Brad

wel

l Sou

than

d Ho

pton

and

Hopt

onan

d Ho

pton

Lothingland

Lothingland

Lothingland

Free

thor

peFr

eeth

orpe

Free

thor

pe

Reed

ham

Reed

ham

Reed

ham

Clav

erin

gCl

aver

ing

Clav

erin

g Mar

shla

ndM

arsh

land

Mar

shla

nd

Abbe

yfie

ldAb

beyf

ield

Abbe

yfie

ld

Chet

Chet

Chet

Wav

eney

Wav

eney

Wav

eney

Dich

ingh

amDi

chin

gham

Dich

ingh

am


cham

pBe

auch

amp

Beau

cham

p

Broa

dsBr

oads

Broa

dsCr

own

Poin

tCr

own

Poin

tCr

own

Poin

t


Burlingham

Burlingham

Burlingham

Blof

ield

Blof

ield

Blof

ield

Brun

dall

Brun

dall

Brun

dall

Plum

stea

dPl

umst

ead

Plum

stea

d

Rack

heat

hRa

ckhe

ath

Rack

heat

h


Colti

shal

lCo

ltish

all

Colti

shal

l

Hain

ford

Hain

ford

Hain

ford



ixsw

orth

Spix

swor

thSp

ixsw

orth

Drayton

Drayton

Drayton

Taverham

Taverham

Taverham

Hevi

ngha

mHe

ving

ham

Hevi

ngha

mCa

wst

onCa

wst

onCa

wst

on

Old

Old

Old

Cost

esse

yCo

stes

sey

Cost

esse

y

Crin

glef

ord

Crin

glef

ord

Crin

glef

ord

& C

olne

y&

Col

ney

& C

olne

y Beck

hith

eBe

ckhi

the

Beck

hith

e


Nor

th-

Nor

th-

Nor

th-

Fiel

dsFi

elds

Fiel

ds

Abbe

yAb

bey

Abbe

y

Tow

nTo

wn

Tow

n

Hum

bley

ard

Hum

bley

ard

Hum

bley

ard

Mer

gate

Mer

gate

Mer

gate Sm

ockm

illSm

ockm

illSm

ockm

ill

Fore

how

Fore

how

Fore

how

Hing

ham

Hing

ham

Hing

ham

All S

aint

sAl

l Sai

nts

All S

aint

sQ

ueen

’sQ

ueen

’sQ

ueen

’s Best

horp

eBe

stho

rpe

Best

horp

eHa

vers

crof

tHa

vers

crof

tHa

vers

crof

t

Buck

enha

mBu

cken

ham

Buck

enha

mSp

ringf

ield

sSp

ringf

ield

sSp

ringf

ield

s

Crom

wel

lsCr

omw

ells

Crom

wel

lsBe

rner

sBe

rner

sBe

rner


Long

Row

Long

Row

Long

Row

East

Gui

ltcro

ssEa

st G

uiltc

ross

East

Gui

ltcro

ss


Hem

pnal

lHe

mpn

all

Hem

pnal

l

Valle

yVa

lley

Valle

y

Beck

Val

eBe

ck V

ale

Beck

Val

e



Depw

ade

Depw

ade

Depw

ade

Diss

Diss

Diss

Tow

nTo

wn

Tow

nBo

ylan

dBo

ylan

dBo

ylan

d


Harli

ngHa

rling

Harli

ng

Pedd

ars W

ayPe

ddar

s Way

Pedd

ars W

ay

Heat

hlan

dsHe

athl

ands

Heat

hlan

ds

Thet

ford

–Gui

ldha

llTh

etfo

rd–G

uild

hall

Thet

ford

–Gui

ldha

ll

Thet

ford

–Bar

nham

Cro

ssTh

etfo

rd–B

arnh

am C

ross

Thet

ford

–Bar

nham

Cro

ss

Thet

ford

–Sax

onTh

etfo

rd–S

axon

Thet

ford

–Sax

on

Thet

ford

–Abb

eyTh

etfo

rd–A

bbey

Thet

ford

–Abb

eyWee

ting

Wee

ting

Wee

ting

Way

land

Way

land

Way

land

Tem

p lar

Tem

p lar

Tem

p lar

Wat

ton

Wat

ton

Wat

ton

Tasv

ale

Tasv

ale

Tasv

ale

Rege

ntRe

gent

Rege

nt

Yarm

outh

Yarm

outh

Yarm

outh

Nor

thN

orth

Nor

th

Nor

thga

teN

orth

gate

Nor

thga

te

Nel

son

Nel

son

Nel

son

Clay

don

Clay

don

Clay

don

Lich

field

Lich

field

Lich

field

and

Cobh

aman

d Co

bham

and

Cobh

am

St A

ndre

ws

St A

ndre

ws

St A

ndre

ws

Mag

dale

n Ea

stM

agda

len

East

Mag

dale

n Ea

st

Mag

dale

n W

est

Mag

dale

n W

est

Mag

dale

n W

est

Gor

lest

onG

orle

ston

Gor

lest

on

Lynn

Cen

tral

Lynn

Cen

tral

Lynn

Cen

tral

St M

arga

rets

St M

arga

rets

St M

arga

rets

Lynn

Nor

thLy

nn N

orth

Lynn

Nor

th

Chas

eCh

ase

Chas

e

Lynn

Lynn

Lynn

Sout

h W

est

Sout

h W

est

Sout

h W

est

Gay

woo

d N

orth

Gay

woo

d N

orth

Gay

woo

d N

orth

Gay

woo

d Ce

ntra

lG

ayw

ood

Cent

ral

Gay

woo

d Ce

ntra

l

Gay

woo

d So

uth

Gay

woo

d So

uth

Gay

woo

d So

uth


wst

on W

est

Spro

wst

on W

est

Spro

wst

on W

est

Sprowston Cen

tral

Sprowston Cen

tral

Sprowston Cen

tral

Spro

wst

onSp

row

ston

Spro

wst

onEa

stEa

stEa

st

Spro

wst

onSp

row

ston

Spro

wst

onSo

uth

Sout

hSo

uth

Crom

eCr

ome

Crom

eTh

orpe

Thor

peTh

orpe

Nor

thea

stN

orth

east

Nor

thea

st

Thor

pe S

outh

Thor

pe S

outh

Thor

pe S

outh

Man

crof

tM

ancr

oft

Man

crof

t

Mile

Mile

Mile

Cros

sCr

oss

Cros

s

Thor

pe N

orth

wes

tTh

orpe

Nor

thw

est

Thor

pe N

orth

wes

t

Mou

seho

ldM

ouse

hold

Mou

seho

ld

Thor

pe H

amle

tTh

orpe

Ham

let

Thor

pe H

amle

t

Lake

nham

Lake

nham

Lake

nham

St S

teph

enSt

Ste

phen

St S

teph

en


Eato

nEa

ton

Eato

n

Uni

vers

ityU

nive

rsity

Uni

vers

ity

Nel

son

Nel

son

Nel

son

Hend

erso

nHe

nder

son

Hend

erso

nBo

wth

orpe

Bow

thor

peBo

wth

orpe

Heigha

m

Heigha

m

Heigha

m

Helle

sdon

Nor

thHe

llesd

on N

orth

Helle

sdon

Nor

th

Helle

sdon

Sou

thea

stHe

llesd

on S

outh

east

Helle

sdon

Sou

thea

st

Helle

sdon

Wes

tHe

llesd

on W

est

Helle

sdon

Wes

t

New

Cos

tess

eyN

ew C

oste

ssey

New

Cos

tess

ey

Catto

n G

rove

Catto

n G

rove

Catto

n G

rove

Cosl

any

Cosl

any

Cosl

any

70


Map 5 Wards classified by geographical type

GR

EA

T Y

AR

MO

UT

H

KIN

G’S

LY

NN

NO

RW

ICH

AR

EA

War

ds

Cla

ssif

ied

by

Geo

gra

ph

ical

Typ

e

Larg

e u

rban

Sm

all u

rban

Nea

r ru

ral

Far

rura

l

010

20

Kilo

met

res

War

d b

ou

nd

ary

Dis

tric

t b

ou

nd

ary

Wal

sing

ham

Wal

sing

ham

Wal

sing

ham

Wel

lsW

ells

Wel

lsBu

rnha

mBu

rnha

mBu

rnha

m

Crea

keCr

eake

Crea

ke

Nor

th C

oast

Nor

th C

oast

Nor

th C

oast

Dock

ing

Dock

ing

Dock

ing

Hunstanton

Hunstanton

Hunstanton

Heacham

Heacham

Heacham

Snet

tisha

mSn

ettis

ham

Snet

tisha

m

Ders

ingh

amDe

rsin

gham

Ders

ingh

am Valle

y Hi

llVa

lley

Hill

Valle

y Hi

ll

Rudh

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any

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any

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any

71

Appendix 3

Map 6 Norfolk SSD district boundaries at 1 April 1999

Wal

sing

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Documents

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