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Direct Payments Manifesto

With the general election coming on 4th July, the main political parties are all putting together their manifestos.  Sadly, I fear that social care won't get much of a look-in, but if it did we would love to see some policies and plans that move the Direct Payments agenda forward.  

PPL are therefore publishing our 'Direct Payments Manifesto', which are some of the ideas that we think central and local government could adopt to ultimately deliver more choice and control.  


1. Set some targets for Direct Payments

Currently 26% of people who could receive a Direct Payment do so.  As we have reported previously, the number of Direct Payments has been on a downward trend over the last six years.  One way to address this is to set some targets and then monitor progress against those targets.  NHS England has targets for the number of Personal Health Budgets, so why wouldn't social care have targets for the number of Direct Payments? 

2.  Give people clarity on the self-employment status of PAs

The 'grey' area of whether or not a PA can be self-employed is creating confusion for everyone involved in Direct Payments.  Some local authorities are proactively promoting introductory agencies that are based on the self-employment model, whilst others are understandably expressing caution because of the risks involved.  The National Direct Payment Forum published an insightful report on this topic in June 2023 and called for  "clear and synchronised guidance" to be issued by the multiple agencies with interests in this space.  Taking a simplistic view, it would likely aid the growth of Direct Payments if the self-employed PA model could be relied upon as being valid and legal.  Here at PPL, we don't know enough about the regulations or the impact on other sectors to know what the right answer is, but we strongly believe that until someone does, this will continue to be an albatross around the Direct Payment neck.  

3. Proactively promote the employment of friends & family as PAs

We all know there is a workforce shortage in social care.  Most solutions boil down to money, specifically paying people more.  However, the idea that a Direct Payment recipient can pay a family member or friend to provide support to them may mitigate the 'people can earn more at a supermarket' argument.  A change in the rules is not needed - the only prohibition tends to be that the carer cannot live in the same household.  There is however a difference between permitting it and promoting it.  We believe that promoting it would enable the sector to mobilise a whole new workforce that is perfectly placed to provide support without it costing a fortune.  A potential pushback is the disruption it may cause to the unpaid carers model, but logic says that at a macro-level this concern falls away. 

4. Develop a national 'fast-track' Direct Payments solution

At co-production events up and down the land, we hear people saying again and again that the Direct Payments process is overly complex, burdensome and slow.  In mitigation, there are good arguments that it needs to be.  Our caveat to that is: it needs to be SOME OF THE TIME.  We believe there is an opportunity to create a 'light-touch' model for "simpler DPs", with standardised templates that strip away some of the admin and timing delays.  Doing so would also free-up the mainstream DP processes to be able to progress those DPs that need more input.  Working with some ICBs and NHS England, PPL have developed a model for rapid-PHBs that sees support being arranged within 48 hours of referral.  We night not be able to get social care to that timescale, but we could certainly shorten it for some people if the sector works together to bring together best practice.    

5. Professionalise the delivery of Direct Payment support services

There is a whole system of support for Direct Payments that is fragmented and largely unregulated.  It would be easy for someone to take a lead on establishing standard processes, template documents, target SLAs and agreed KPIs.   There could be recognised qualifications & training for independent living advisors.  There should be financial safeguards given the huge amounts of public money involved (see our 'Why FCA matters' article).  There could even be a centre of excellence or a specific trade-body for DP support services, covering in-house services, third-sector and private organisations. 

6. Create Direct Payments pathways that are specifically focussed on older people

Analysis shows that take-up of Direct Payments in the over-65 age group lags behind the 18-65 group and is woeful in some areas.  One reason for this is that Direct Payments journeys and associated support were developed initially in the disability rights movement.  We all agree that is right and proper.  However, some of the processes, language and models are not conducive to engaging the older person cohort.  It would be great to see local authorities working with third-sector organisations in the older persons space in the same way as has happened in the disability sector.   


Closing Comments

Nothing in the above is meant as a criticism of the excellent work that all of those involved in the Direct Payments sector currently do.  Indeed, this a rallying call to others to join in and support the Direct Payments movement so that we can go further and faster.  Whilst we would love some centrally-led initiatives to spearhead some of the above ideas, the interesting thing is that a lot of them (ideas 1, 3, 4 and 6 for example) could easily be taken forward at a local level.