Direct Payments & Extra Care

Discussions with provider colleagues have identified that direct payments in VSH/Extra Care create potentially significant financing problems for both purchaser and provider as well as the HR difficulties of de-stabilising staff teams.

In Suffolk we contract on the basis of core and flexi budgets. On 2 occasions individual tenants have opted out of support and care from the dedicated staff team, (out of 21 VSH schemes housing approx 650 tenants, open for up to 9 years). Both times the decision was family rather than tenant led. On both occasions the different arrangements, (1 direct payments and 1 self funded) did not stretch to funding night care and support which had to continue to be provided by the staff team 'unfunded'. Within 2 months for one and just under 4 months for the other the tenants was requesting a return to the dedicated staff team provision, this was primarily because of the unreliability and inconsistency of their staffing arrangements.

The main issues seem to be :-

1. How to fund a dedicated quality staff team on an ever changing core budget amount.

2. How to control a succession of people working in a scheme who do not deliver the same quality holistic service that's dedicated team do.

3. How to reconcile the need for immediate and flexible responses and the service users choice to opt out.

4. As a purchaser how to justify the amount that it would cost to provide a comparable serve to that of the dedicated staff team through direct payments

5. VSH/Extra Care offers a package or bricks and mortar, support and care that people choose to take because it meets their needs, It is a high quality place to live that gives them a community with whom to interact. That is their choice but in choosing it they opt for the whole package - discuss !!!

6. If a group of people club together their direct payments they may be able to recruit the staff team that they need - but are at risk every time the group changes of not having enough aggregated funding to afford the 24 hours support and care that they may need.

We have been considering whether intellectual support and activity (and entertainment !!) could be funded via direct payments either for individuals or a 'club' or people pooling direct payments together. We are working with our direct payment person on this at the moment and will get back with news if we can make it work.

If Direct Payments take off in VSH/Extra Care, providers may have to think about providing services in a different way. This might include ideas around contracting directly with tenants; sharing care and support arrangement with other paid third parties; having staff teams based in VSH that work both in the scheme and locally in the wider community in order to take up the slippage when care shifts from dedicated team to direct payments, tripartite contractual arrangements between tenant, dedicated staff team and third party provider to pursue the good practice of holistic service, (this could potentially build on the positive benefits of the Single Assessment - discuss again !!!).

Judith Hawkshaw
Housing Champion & Partnership Manager
Suffolk County Council
01473 264 432
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