Direct Payments and fraud

One of the things that is often heard in discussions about Personal Budgets, Direct Payments and mental health is the drugs and alcohol gambit, i.e.

People with mental health problems will probably spend the money that’s meant to be for their support on drugs and alcohol.

Really?

The Audit Commission identified some £2.2m of Direct Payments (probably in 2010) that was spent fraudulently. In 2010/11, a total of £960m was spent through Direct Payments.

As such, identified Direct Payments fraud made up the positively DWP-levels (see point 10 here) of 0.2% of all expenditure on Direct Payments.

In the same way people rightly ask for evidence to make the case for this, that or the other, we should also ask people who prefer things as they are what their evidence is against.

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Spending in mental health: 80% in and out

In 2011/12, the total spend on Direct Payments for Mental Health was £30.5m. This was 0.56% of all mental health spend.

Of the total mental health spend, over 80% (83.3%, in fact) is spent in the NHS. However, when someone with a mental health condition is given money to spend to meet their mental health outcomes, over 80% (84.5%, in fact) is spent on non-statutory providers.

That is, when there is no choice for mental health services users, over 80% of mental health spend is in the NHS. When there is choice, over 80% of mental health spend is outside the NHS.

What does this tell you?

Demos’s report on pre-payment cards

I’ve just had a quick read of Demos’s report published today on pre-payment cards.

Recall that pre-payment cards (also called prepaid cards) are like debit cards, where funds are loaded into an account linked to the card and then spent by the card holder until the balance reaches zero. They can be used to make purchases, set up direct debits or standing orders, and sometimes withdraw cash at ATMs.

There has been an increased usage of pre-payment cards by local authorities, especially in the area of administering Direct Payments in social care, and the Demos report makes recommendations about them being considered for wider use, for example in benefits administration and other forms of public payments.

The topic of pre-payment cards is an emotive one, since it symbolises the concept of the state potentially or actually prescribing what Direct Payments or benefits can be spent on. This is fascinating in itself because, as the report highlights, pre-payment cards are essentially a question of the “nitty-gritty of implementation”.

Of course, I have views on pre-payment cards and whether they should be used. This comes from being pretty heavily involved in two areas of work – Direct Payments implementation and making the Right to Control a reality – and especially from the perspective of service users. I’m painfully familiar with the both the advantages and disadvantages that can arise in making payments to people or trying to integrate several types of payment. As I told the judge, I now know more about the appearances of money laundering than I probably should do.

For those interested in the issues, the Guardian has an article by Ally Fogg which covers a lot of the debate.

The wider point to make, though, is that Demos should be congratulated for at least bringing the topic out into the open. Pre-payments cards are a growing phenomenon and there is a need for an open debate on their merits and demerits, rather than their use growing in the absence of a debate.

It would be great if a space could be created in which this debate can take place that brings together users, public bodies, government and those providing pre-payment cards.

7 practical suggestions to help Personal Health Budgets succeed for everyone

This week, ahead of the publication of a joint 3-year longitudinal study with OPM and Essex County Council evaluating the impact of Personal Budgets, I sketched out 7 very practical lessons that the current Personal Health Budgets work can take from the social care arena. This is cross-posted from OPM’s blog here.

Personalisation – and Personal Budgets in particular – are making a positive difference in the lives of lots of different people of different ages and impairment groups.

This finding comes from 3 years of work ecdp, OPM and Essex County Council have done in Essex, following 29 people on Personal Budgets, the first “longitudinal” study of its kind.

Older people, people with learning disabilities and people with physical and/or sensory impairments have all reported positive outcomes from using a Personal Budget, such as:

• Improved quality of care through increased choice and control. This included more choice and control over the providers used to deliver services, and more consistent, flexible or personalised care
• Improved wellbeing and the ability to live a fuller life
• Increased independence and dignity for service users
• Increased confidence, self-esteem and sense of empowerment.

Of course the road to successful outcomes through personalisation and Personal Budgets has not always been smooth. But in recording the lessons learnt – including the occasions when things didn’t quite work and key recommendations for making these processes run more smoothly – the final report tells us how to continue to make personalisation and Personal Budgets as good as they can be.

The challenge of personalisation and Personal Budgets in social care has been considerable. It will be even more of a challenge to introduce Personal Health Budgets in the health service. It’s a challenge I have every confidence will be met though, and that will therefore make a considerable difference in the choice and control people have over their healthcare.

To help things along, here are the 7 very practical suggestions taken from the 3-year study that it would be worth those working on Personal Health Budgets keeping in mind.

1. It’s very unlikely someone will choose to have a Personal Health Budget if they don’t know about their existence. Make sure you let them know.
2. It is not possible to exercise choice and control if someone doesn’t know what options they have with their Personal Health Budget. Make sure you let them know their options.
3. It is entirely possible to forget to tell someone how much money they have available in their Personal Health Budget. Don’t forget to tell them.
4. It is entirely possible that someone can get good advice and guidance about Personal Health Budgets from health professionals. But it’s just as possible they can get that advice and guidance from someone independent. Make sure they have this option if they want it.
5. It is possible you’ll think a website will provide someone with all the information they need about Personal Health Budgets. It really, really, really won’t. Face-to-face contact, peer support, sources of information in the local community (such as voluntary sector organisations): these should all also be part of the information mix.
6. It is possible that holding a budget to meet healthcare needs is second nature to some people. But most likely, for the majority, it won’t be, particularly if they consider employing their own staff. Ensure support options for managing money and employing people are in place.
7. Finally, it is inevitable that assessing someone’s needs, establishing the level of financial resources this correlates to, describing the options they have available, planning and summarising how to meet these needs, signing it all off and putting the new system into place – is a complex process with many, many complicating factors. If people know it’s going to be a complex process, they’ll probably understand. Manage people’s expectations about how long the process will take, be honest about some of the common pitfalls and reassure them it will be worth it in the end (because, as we’ve seen, it most likely will be).

Where DPULOs make a difference

The West of England Centre for Inclusive Living (WECIL) asked me to talk about Disabled People’s User-Led Organisations at their Annual General Meeting today, which was a pleasure and a delight.

After talking about the Strengthening DPULOs Programme (on which more here) and hearing from one of the Ambassadors for the programme (you can find out who they are here), I talked briefly about the difference that DPULOs can and do make.

In social care, for example, I noted that were DPULOs provide support services, they can make a significant difference to the choice and control disabled people (and service users more generally) can have over their support.

To take one area: in Essex there is an independent support planning service which is run by and for disabled people. As a result of the different approach, 100% of the people who use this service end up with some form of cash payment – essentially giving them more choice and control. This compares to around 20% for the local council.

Similarly, across Essex, Thurrock and Cambridgeshire, an average of 92% of people who use an independent and peer-led information, advice and guidance service to find out about the social care process end up with a Direct Payment. This compares to global figures in social care of approximately 10% of users on a Direct Payment.

Even if it’s not quite comparing apples with apples, those are pretty significant differences that indicate the underlying difference DPULOs uniquely provide in enabling people to have more choice and control.

(The Office for Disability Issues published a significant report on the role of Disabled People’s User-Led Organisations in Support, Advocacy and Brokerage here.)

As well as thinking about the role that DPULOs can play in addressing disability hate crime (covered in a separate talk to Leicester CIL earlier this week), I also looked forward to two areas I think greater involvement of DPULOs could make a difference.

The first is Access to Work.

This was recently called the government’s “best kept secret”. I think there is a significant role that DPULOs can play in bridging the gap between Job Centre Plus, employers and potential employees in letting them all know about Access to Work: how to find out about it, how to get it, what to do with it.

The benefits from this won’t just be for disabled people or businesses, either: for every £1 invested in Access to Work, the government gets nearly £1.50 in tax and National Insurance contributions.

At a time when the economy needs to grow, this seems like a pretty good thing to do.

The second area is HealthWatch.

One of the areas that is potentially strong in the current NHS reforms is HealthWatch – the bit that is going to ensure the representation of the voice of service users and patients in the new system.

There’s an argument to say that Local Involvement Networks haven’t fulfilled the overall potential they had to hold health and social care to account. I’d argue that this was partly because it was the wrong types of organisations who were trying to run LINks. As far as I know, only two DPULOs were formally LINks bodies. If we can ensure that more DPULOs take on this function as HealthWatch, I have no doubt it will make the health and social care system better.

After outlining the difference I think DPULOs can make in just one or two particular areas (their effects, of course, aren’t just limited to these) I finished my talk with WECIL with a question to its members, which I’d like to offer more widely to readers and interested parties here: as the Strengthening DPULOs Programme continues to develop and make the case for DPULOs to decision makers and stakeholders, what messages do you think they should know about regarding DPULOs?