Transcript Factors Aiding and Hindering Implementation

Factors Aiding and
Hindering Implementation
of Direct Payments
Paul Swift
Foundation for People with Learning Disabilities
Focus of the study
• Commissioned by the Dept of Health under the
Modernisation of Adult Social Care (MASC)
research initiative
• Main aim: to evaluate the impact of the social
care modernisation programme on access to
and take up of direct payments amongst four
adult care groups
• Key objective: to identify principle explanatory
factors for variable implementation of direct
payments & development of support schemes
Main aiding factors (England)
% Local
Authorities
indicating (N=109)
% Support
Organisations
indicating (N=105)
Effective support scheme
89%
89%
Training and support for front line
staff
86%
77%
Leadership within the local
authority
81%
82%
Positive attitude of staff
80%
80%
National legislation, policy and
guidance
82%
91%
Accessible information for service
users and carers
78%
87%
Demand from service users and
carers
78%
89%
Factor
Two items rarely mentioned
• Ring fenced budgets for direct payments
(25%)
• Support of public sector trade unions
(12%)
Variations between authority types
• Variations generally quite slight
• Partial exceptions
• Lower rates of identification of importance of
local leadership and demand in new unitaries
• Staff attitudes deemed less important in
metropolitan authorities
• Any regional variations likely to be associated
with variations in presence of types of authorities
Main hindering factors (England)
Factor
Users and Carers’ concerns
about managing direct
payments
Staff resistance to direct
payments
Lack of people to work as
personal assistants
% Local
Authorities
indicating
(N=109)
% Support
Organisations
Indicating
(N=103)
68%
64%
65%
74%
63%
78%
Predictors of successful
implementation
• Tendency for higher spending authorities to be
more likely to identify aiding factors (exceptions:
flexibility of commissioning and impact of
monitoring and inspection.
• Overall disposition of an authority towards direct
payments (through political support, managerial
leadership and staff attitude) was a strong
predictor of successful implementation.
• The presence of a ring-fenced budget also
distinguished high from low performers.
The impact of modernisation
policies on direct payments
• Statutory requirement to offer direct payments viewed as
a positive factor, especially by slow starters
• Doubt about the impact of inspection and monitoring and
performance monitoring & concern with the emphasis on
performance rather than quality
•
Employment of close relatives considered important
especially for meeting the needs of BME communities
• The Direct Payments Development Fund (DPDF)
appears to have been important in stimulating direct
payment use
Policy congruence between direct
payments & aspects of modernisation
• Fair Access to Care (FACS) did result in some
perceived benefits, tempered by concerns about
eligibility and resource constraints
• Some conflicting attitudes towards the use of
Criminal Records Bureau (CRB) checks and
POVA policies in relation to direct payments
• Perceived lack of fit between Supporting
People and direct payments
Common factors across care groups
• Expertise around the needs of specific
groups
• Partnerships between health and social
care a complicating factor in implementing
direct payments
• Processes and systems discouraged
applications
• Having leaders and champions for specific
care groups
Common factors across care groups
• Lack of awareness amongst frontline staff
• Belief amongst frontline staff that direct
payments were not appropriate for a
majority of their clients,