Direct Payments (including Health) The Reality v Rhetoric


I think things need to be cleared up in this area…

I have been a recipient of Direct Payments for six years and now, for the last couple of years, as Direct Health Payment user. I have seen some changes to what is promised (or what the intention was) and what is received. Having also been a voluntary advocate, I have advised many people on these matters, fought for their rights, and in a few occasions have even helped to sort out issues for health and Local Authority departments.

I have studied the acts, regulations, statutory guidance and case law on these issues to back up my arguments. I have gone through, as an exercise, to look in to the policies. Having examined twenty of them, both LA and NHS, the differences are unbelievable. Some policies go from twenty pages, to others, which run close to one hundred pages. I do not really understand the need for these, and the cost versus time element is a concern. We have perfectly good statutory guidance for Social Care, which covers everything needed, and similarly, there is statutory guidance for Health Budgets. So why have additional polices?

On both occasions, whether initially through Social Care, and now via the NHS, the fanfare and rhetoric was and still is about independence, choice and control. It was only five years ago, that I heard a Director of Social Care say in a council meeting that budgets can be used for anything apart from alcohol, cigarettes or drugs. I believe this intention is still there, as it has always been. I have even seen some unique and fantastic ways personal budgets have supported people’s lives. The universalised offer of personal budgets through the NHS though still in early days, is showing promise of practitioners showing unique ways for people to be supported for their health and care.

All this promise and fantastic work, and yet there is another side to this. There are in essence two parts to the issue. Firstly in the huge push, people were allowed to use their budgets for a very wide range of uses, having heard some of these even I, as a member of the public, had to question how people were allowed to buy such things. Personally I think people got caught up in the rhetoric and Local Authorities and the NHS did not really question the benefit to the person themselves overall and  didnt advice and help manage the budget appropriately.

Due to various austerity measures, and questions about some of the expenditure (quite rightly), instead of having straight forward conversations with people lot of Social Care and Health Authorities just went down the road of putting in polices which try to curb expenditure. Not all of it, legally or technically correct.

This led to a great deal of confusion for the public, with the advent of the internet and sites like Facebook and Twitter people talk, and often get angry that one person somewhere is allowed something whilst across the border in some cases miles away they cannot have it.

On the other hand, in the authorities things have worsened, where even minor much needed items often have to be justified through a unnecessary paper process involving many people.

Again, many of these issues could be solved with having proper conversations with people, discussing what personal budget are about. A proper care plan is essential. To many authorites these days rely on getting enough info so that they  are able to work out the budget rather than what people want or need. An example my authorities care plan fifteen pages, my own care plan twenty five pages but includes my daily routines, wishes and views. The authorites virtualy has none of my wishes or views.

The money is limited and just like everyone else a person (the budget holder) must make key decisions in things in their life. How often to go out, what is essential and what is a like? Is there a cheaper alternative option? After all these are decisions that have to be made by everyone in life, whether on a budget or not.

People in the services, can also try and understand and perhaps put a small limit aside that people can spend on with receipting without over questioning as long as it’s not for smoking, alcohol etc. These could be for items that are needed.

The argument I often hear is that this is public money, and we have to account for it. Yet the people are the very public, your supporting, and another argument from health, This is not new money, this is money already allocated to you. Well then, that again raises the question why cannot I use it how I want? 

Please also take note of the judges comments in last years Judical Review in Norfolk. What's the point of a budget if you can't spend it how you want?

One of the issues I come up against on ‘health’ is that it is ‘only for health related’. The National Framework is clear if the authority take on the running of the budget, it covers both health and care. The issues we have here is that health staff are not trained or even know what a care need is or what it means. Cross training and working together is essential. There are at least five pieces of legislation I can think of already which talk abput joint working  and yet, though a lot is talked about (particularly with ICS), I'm doubtful whether they will work together as long so there are two separate pots of money.

In the end Personal Budgets, are amazing, they work well, come and talks to me if you dont belive it, as long as people are left to manage them and get on with it. In some cases stronger  discussions are needed in individual cases, to discuss appropriate usage, however not everyone should be tarnished with the same brush. There is scope to use it properly and give people independence choice and control; I guess it is about working and talking together about needs, proper conversations are always in the best interest of all parties.


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