1. Cash for Care HCE Annual General Assembly London - September 2008

2. Introduction This presentation looks at changes to the way in which social care is delivered in the UK Why cash for care schemes/self-directed support have been introduced in the UK The national and international context of cash for care schemes Issues/challenges

3. Cash for Care Schemes Cash for Care schemes have developed in many developed welfare states. Money is given to the service user to buy their care direct, rather than services being provided /purchased on behalf of the service user, by the state. In the England this has been through Direct Payments and Individual budgets

4. Social Care Reform in England Clear political direction to modernise social services reinforced by legislation Delivery of personal services that are sensitive to individual need and give people greater choice and control over the design and delivery of their own services - in every setting and at every stage and ranging from advocacy and advice services, prevention and self management to complex care situations in partnership with professionals Self- directed support to become mainstream

5. Social Care Reform in England By 2011 all Councils in England will be expected to have reshaped their services Moving from the use of block contracts with homecare providers to a payment system linked to work done and based on outcomes agreed with the service user Rather than following a rigid care plan, home care providers to negotiate with service users how care time is used and to take their direction from the service user direct. By 2011 everyone eligible for statutory support should have a personal budget - at least in part as a direct payment.

6. Cash for Care Schemes in developed Welfare States Various studies have looked at Cash for Care schemes in an international context For example: Ungerson and Yeandle( 2006)* who looked at Austria, France, Italy, the Netherlands and USA In all countries policy on how to provide support for older people has developed in a context of the implications of important demographic changes and a need to contain the cost of care Cash for Care schemes are relatively recent in England but other countries have had schemes in place for many years – for example, the Dutch since the 1990s. * Cash for Care in Developed welfare States. Edited by Clare Ungerson and Sue Yeandle. Palgrave Macmillan (2006)

7. Issues /challenges identified from international studies Developments initially destabilised existing qualified jobs in domiciliary care and created additional unskilled and casual labour Changes needed to be made to maintain and develop the professionalisation and accreditation of care staff In some countries cash could be used to employ family and friends but not in others. Alongside the development of personalised care most welfare systems appear to have brought in greater control of service provision

8. Issues and Challenges contd Greater regulation of services has included the introduction or tightening up of formal and explicit standards for home care; the accreditation and statutory checking of standards in provider organisations and checks on criminal records for individual workers. There have been new workforce issues arising from people who need care choosing and directing who they will employ. In some cases this has been seen to lead to greater vulnerability for care workers – job insecurity, health and safety issues the content and boundaries of the job. It has also led to an expansion of unofficial migrant labour delivering domiciliary care

9. Implications for English Local Authorities There are three main features of Self –directed support in England. Control Choice Flexibility It involves major change for Local Authorities who could cease to be the dominant purchaser and commissioner of home care services It is a time of huge uncertainty for home care providers. As well as commissioning new types of services there will be significant decommissioning of others. Where local authorities have mostly block contracts in place change will be more difficult.

10. Issues and Challenges for Local Authorities contd Local Authorities are working hard to get the right programme of work in place to manage radical change to all homecare systems and they need to get the balance right between maintaining the services and changing services to existing users They are expected to commission services from a wide range of providers, opening up opportunities for formal and informal carers and working more with the voluntary sector. It will change the role of professional staff, such as social workers, who had previously assessed peoples’ needs and then put a care plan in place for providers to follow

11. What has your experience of self directed support/cash for care schemes What evidence do we have of the benefits of self-directed support / cash for Care schemes in your own organisation/country? What issues have you had to face? What solutions have you found? What examples of good practice/ training and development opportunities can you share: Service users Home care staff Home care provider organisations Commissioners and professional staff