Social Care Agency v Self Employ (Direct Payments)

After reading some differing views on carers being employed by companies via care agencies and individuals managing and employing the care for themselves via direct payments. I thought I would try and evaluate both types and what it can mean for carers, service users ,Local Authorities (this article is based on what happens locally in my county and may not reflect the picture everywhere), and NHS Personal Health budgets.

From the actual carers point of view working for an agency obviously means a structured working environment, where you get paid and the terms and conditions are set down.  This should be the same for if the care staff where employed by the end user. However in the present environment with 0 hour contracts there can be even less protection for carers in both areas. As some people on Direct Payments may lack knowledge or experience with staff rules and regulations, there are times when it may feel like it’s not as structured. However with a bit of research this can be overcome. 

See mycarebudget.org for some great resources, with templates for most things on managing and employing  for your own care. 

Being employed by a care company will mean that as the Agency will always be driven to make a profit. Even if it is a charity, it will still need to pay additional staff to manage the running of the organisation. As a company therefore it will try and trim down as much as possible on costs, restricting actual visiting times and pay and conditions, wherever it can. 

Our Authorities seems to prefer this model. As it puts the end user one step further away. Though still legally responsible many authorities will often use this as an excuse that it’s the care company not managing the care, rather than the local authority. Even though the actual responsibility in the end still lies with the Authority.

If you get paid by someone who’s managing their own care usually by direct payment. It can be a completely different environment. Though you only work for one person, there are probably less structured rules and duties are more flexible, (though you should still get your basic rights subject to type of contract you have). Some users will still insist on adherence to a strict business approach but generally it is more relaxed. Over time a relationship is built up between the carer and the end user, it’s less strict so you may be asked to do more additional duties but it does tend to be a more relaxed atmosphere. In some cases almost become a familial relationship. There are plus and negatives for this. For the end user then this can become a bit more difficult in managing the carer as feelings do get in the way, whether we like it or not. Hopefully if the budget has been sorted properly they should be able to get similar or in some cases better pay than the companies. Unfortunately this is not always the case, as the Authorities does seem to think because the company has more costs they should receive a higher rate. In our area it is strange that we get letters from the Authority telling us that annually the Care companies have had raises in line with pay and rates, and then receiving letters saying that as a person employing the staff through direct payments, you won’t get a raise.

I’ve tried to argue this a number of times and basing my argument on Market Choice, you get what you pay for, and arguing that the costs are the same yet I’m not in it to make a profit and have been partially successful in getting my care staff decent remuneration for the work they do.

Obviously there are other options like a third party company doing the payroll for end users and help with recruitment and management, but this has to be set against more money in the budget for the user  thus more availability of hours care or using it on paying for the management services.

Authorities in my opinion, though required to imbue end users with independence, choice and control generally in my experience don’t like people to do self-care. Obviously if things go wrongs the service user comes back to them. They also have to spend time in managing and auditing budgets, one of the reasons there seems to be a push for managed bank accounts or pre-payment cards. Whether you have a pre paid card or not, its should be your choice, not a done deed ( see statutory guidance Care Act).

One of the other issues with direct payments is that Authorities and staff are just not geared up to being able to help users set up self-care. Even though I believe this is a cheaper option for the Authority than through an agency. Too often questions asked of authority staff about employment policies are left unanswered.  Having researched this area, there is very little information out there on how a service user actually sets up and manages their own care. Even with all the rhetoric around sustainable transformation plans and self-care. There is very little information on the exactly how to advertise, interview, contracts, employment practises, pay, tax, annual leave, training etc. 

There are many online sites that can help and offer free resources. As mentioned you can find links to these sites by visiting mycarebudget.org . This site has been developed by a carer for the benefit of users. Its free and completely coproduced with other people on personal budgets. There are over 75 templates free to download.

These sites offer an alternative option but are not promoted at all by  Authorities ( i cant see the reasoning behind this) which can still help retain the independence, choice and control  for  Service users. 

If you need assitance managing remember the provisions under the Care Act statutory guidance that allows for family members to be paid administration and management costs for doing the necessary paperwork. A great idea, as there’s still no profit margin, so costs can be kept to a minimum, and those who need assistance can get a little help to take the strain out of having to manage their care.

Whether one is better than the other isn’t really the point. There is room for both models and possibly others too. What is important that in this day and age with Adult social care  & NHS costs spiralling, Authorities seriously need to consider and support all models fully. This means ensuring those who actually want to manage their own care get the full support and same provisions as the care companies do. 

At present this isn’t the case at least in my Authority, where we receive annual letters telling us that care companies have had increases in line with growth and pay conditions around minimum wage. Yet if individual’s managing their own care want this they have to go and argue the case. A lot of users just do not have the strength or wherewithal to be able to do this, so receive a lesser service.

For me it’s an easy choice, managing my own care truly gives me the independence, choice and control that I want and allows me to manage my care needs with people I want around me. 

For others the care agency model may be more appropriate as it keeps it strictly professional and at least you have minimum paperwork. 

What I don’t understand though is how those wishing to save the Authorities money, and want to self-care are often left with the least resources to do just that?

I do believe the Market has room for both current models and others including not restricting payment for management just to family, as this gives the best independent, choice and control for the end user.