It's a Fact: A Recent Survey Shows that Personal Budgets Improve the Lives of Their Recipients

Introduction

This article is aimed at people who are receiving domiciliary care or who are thinking about choosing domiciliary care for themselves or another.

A recent survey (published 28 October 2014) conducted by three bodies working together, In Control, Lancaster University and Think Local Act Personal, looked at the use of personal budgets in adult social services and health in England.

A striking finding of this survey is that 80%  of respondents (over 4000 people were included in the survey) said that personal budgets had made things better or a lot better for them in terms of dignity in their support and their quality of life. You can read more of the report for yourself here.

If you know all about personal budgets, you’ll understand just how significant that finding is. If you’re a little unsure about what personal budgets are, what follows is a brief introduction to them. Let’s start with a look at personalisation.

Personalisation

There was a time, and it was not so long ago, that the providers of domiciliary care took a paternalistic approach towards their customers. Paternalism means that somebody else knows what’s best for you. In the context of domiciliary care, it was usually social services who thought they knew what was best for you.

Personalisation is an approach to domiciliary care that is the exact opposite of paternalism. Personalisation recognises that you are the person who knows best what is suitable for you when it comes to choosing domiciliary care.

Therefore, personalisation places you at the centre of everything that happens with regard to your care. It’s all about your independence to choose. Control is handed over to you to be able to choose what type of care you want, who you want to provide that care for you and when you want it provided to you.

Personal Budgets

Of course, the obvious question is how you can have this independence, control and choice over your care if social services are paying partly or in full for your home care? And this is where personal budgets come in.

To get a personal budget there are two assessments that have to undergo. First, you need to have your care needs assessed. This is called a community care assessment. For more information on community care assessments see Eight things to know about Community Care Assessments by Kent County Council.

Second, you need to have a means test, sometimes referred to as a financial assessment for more information about financial assessments see How to get financial help for home care from Kent Social Services.

If you are found to have eligible needs following a community care assessment and qualify to have all or some of those needs met by social services you will be offered a personal budget. This is a sum of money that is given to you to pay for the care that you need to meet your eligible needs.

Your personal budget can be held by you or by a friend or relative on your behalf. It is also possible for a care provider to administer the budget for you. In some cases, you may want the local authority to administer your personal budget.

Direct Payments

Once you have been awarded a personal budget, you should also be offered an opportunity to receive this in the form of a direct payment. Direct payments work in a very straightforward way. Kent County Council pay an amount of money into your bank account or onto a Kent Card. The Kent Card is a Visa debit card and you can find out more details here. You then use this money to buy your care from a provider of your choice.

For more information on direct payments see How to get direct payments to buy home care and How to get financial help for home care from Kent Social Services.

What Is the Significance of the Survey Mentioned above?

Now you know about personalisation and personal budgets you’re in a position to appreciate just how important the findings in the survey are.

The whole idea of personalisation – and personal budgets - was (and perhaps remains) controversial. Many saw its introduction as a way of reducing costs for local authorities. There may well be some element of that. However, if personalisation is to be seen as a success, it has to improve the lives of those receiving home care.

Personal budgets are a central part of personalisation. If personal budgets are bringing about improvements in the lives of those in receipt of them then personalisation is bringing about the effect that was intended.

The Research Findings in Brief

1. Over 4000 people took part in the survey. 2679 were personal budget holders and 1328 were carers of people who hold personal budgets.

2. At least two thirds of respondents said their personal budget had made things better or a lot better in 11 of the 15 areas of life that were asked about: dignity in support (82%),  Independence (78.9%), arranging support (79.9%), relationships with people paid to support them (75.9%), quality of life (81.4%), mental health (66%), control over life (70.6%), feeling safe (72.8%), family relationships (74.6%),  paid relationships (67.8%), self-esteem (73.2%).

3. Less than 5% of people reported their personal budget having a negative impact on any of the 15 areas that were asked about

4. Over two thirds of the carers surveyed said that things had got better or a lot better in three out of eight aspects asked about: continuing care (78.6%), the quality of life of the person cared for (79.6%) and the carer’s quality of life (71.3%).

5. People were more positive about their personal budgets when they felt that their views were considered when their needs were being assessed.

6. Personal budgets were held by the individual budget holder in 34% of cases. In such cases the individuals received a direct payment. For more information on direct payments see How to get direct payments to buy home care and How to get financial help for home care from Kent Social Services.

7. In 21% of cases, direct payments were made to friends or family of the person receiving care. In 19% of cases the budget was administered by a care provider. In just 18% of cases did a local authority remain in control of the personal budget.

Personal budgets put you in control of your care. They promote your independence, give you choice and help enhance the quality of care you receive.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Eight Things You Should Know about Community Care Assessments from Kent County Council

Introduction

In order to get financial help from Kent social services for your home care needs there are two assessments that social services must undertake.  

To take these in reverse order; the second assessment that is carried out is a means test. This determines whether you are entitled to have your home care provision paid for in full by social services; partly paid for by social services or not paid for at all by social services –  in this last case, in other words you have to pay for it yourself. There is, though, an assessment that comes before this.

The first assessment is one of your care needs. This is known as a community care assessment. You may also hear it referred to as a care needs assessment. This article deals with the community care assessment only.  

The information that follows applies specifically to adults. It is also aimed at people looking for domiciliary care (home care) although much of what is said applies to people seeking residential care.

Here are eight things you should know about community care assessments from Kent social services. 

1. Kent County Council (KCC) has a statutory duty to carry out community care assessments. 

Local authorities, like Kent County Council, often have statutory duties placed upon them. What this means is that there exists a law that has been passed by Parliament – a law contained in an Act of Parliament, also known as a statute – that places the local authority under an obligation to do something. When such a duty exists, it is something that a local authority cannot fail to do. Such is the case with community care assessments. Local authorities, like KCC, therefore, are under a duty imposed by law to carry out community care assessments.  

2. The Duty to carry out community care assessments is interpreted in such a way that means that in practice it is highly improbable that KCC can refuse to carry out an assessment of your care needs.

The law imposing the duty says that if it appears that you may need community care services that your local authority may be able to provide then your local authority has a duty to carry out an assessment of your care needs.  

Even in circumstances where the KCC believes that you have little chance of qualifying for community care services: it must still conduct the assessment. Even in circumstances where KCC believes that you will not qualify financially for social services help: it must still conduct the assessment.

If you are disabled Kent County Council has an additional duty imposed upon it by law to carry out an assessment. 

3. If you are a carer who looks after someone (your wife, husband, relative or friend), you are also entitled to have a community care assessment. 

If you look after someone, you can request a community care assessment when the person you care for is being assessed. You are entitled to an assessment even if the person you care for decides not to have an assessment of his or her needs undertaken. 

4. To get a community care assessment your first step is to make a referral to Kent social services. 

You can do this yourself. Alternatively, a relative, friend or carer can do this on your behalf. You can also be referred by your GP or another health or social care worker. To contact Kent Social Services you can telephone: 03000 41 61 61 (text relay 18001 03000 41 61 61) or email social.services@kent.gov.uk.  You can also drop into a Gateway Plus Centre. There are several of these in Kent and you can find their locations by following this link. 

5. To get an assessment takes about 28 days from the day of referral.  

Although local authorities have a duty to conduct community care assessments, there is no duty placed on them that dictates how quickly they must deal with referrals. There are guidelines; however, and the guidelines state that referrals must be processed within 48 hours and the whole procedure completed within 28 days. Kent County Council says that in most cases it completes assessments within a month. In an emergency, a local authority can put in place temporary care services.

6. Assessments usually take place in your home.

If you are seeking home care this is the best location for an assessment to take place. It is possible for alternative locations, like a GPs’ surgery, to be used. If you are a little unsure about explaining your needs to someone, you might like to have someone with you at your assessment. This person will sometimes be referred to as your advocate, that is, someone who speaks on your behalf. 

It is also possible for assessments to be done by telephone. This may be fine for simple assessments but it is not advisable if you have more complex care needs. Telephone assessments are controversial because they can be used as a means of screening out people before the formal assessment is conducted.  

You may also be asked to carry out a self-assessment of your care needs. This may help you focus your mind on what your needs are but in no way should it be used as a substitute for a formal community care assessment.

7. Your care needs will be assessed as falling into one of four categories. 

The community care assessments measures the risk to your independence and well-being if nothing more is done – in other words what is the risk to your independence and well-being if no care is provided. 

The four categories are referred to as eligibility criteria and they are called: critical, substantial, moderate and low.These criteria are a measure of how serious your needs are. 

In the first, and most serious, category your needs are judged to be critical. If your needs fall into this category then your life may be at risk, and/or you have significant health problems, and/or you are at risk of serious abuse or neglect if nothing else is done. 

In the second category your needs are deemed to be substantial, which means that if nothing more is done you will havelimited choice and control over your living environment and/or you will be at risk of abuse or neglect. You will not be able to carry out most of your personal care or domestic tasks. 

The third, moderate category, without more being done you are not able to carry out several tasks relating to your personal care or domestic tasks. You are not able to maintain a lot of contact with society or take an active part in family life. 

In the final, low category, will not able to carry out one or two tasks relating to your personal care or domestic tasks without more being done. 

Many local authorities will provide funding for care only where your needs fall into one of the first two categories. Kent County Council provides funding for care falling into the first three categories. 

If you qualify for funding you are said to have an eligible need or eligible needs. However, even though you have an eligible need you will still need to qualify on a means test. 

8. If you are assessed as not having eligible needs, or you feel the assessment of your needs is inadequate, you can appeal. 

You must ask for the decision in writing. You need to know the reason why you have been assessed as you have. Make sure that you are aware of the local authority’s complaints procedure. Kent County council has a complaints team at: Brenchley House, 123-135 Week Street, Maidstone, Kent ME14 1RF.  Telephone:  03000 410 410 or:  Brook House, Reeves Way, John Wilson Business Park, Whitstable, Kent CT5 3SS.  Telephone : 03000 410 410. Alternatively you can email them at: complaintsteamadults@kent.gov.uk.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 23591001843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Is It Right That GPs Should Be Paid for Diagnosing Dementia in Patients?

The Background

It was announced yesterday by NHS England, Wednesday 22 October 2014, that GPs will receive a payment of £55 for each patient that they diagnose with dementia. To say the least, this proposal has prompted a good deal of debate. It has its supporters and its detractors.

The statistics on dementia are stark. The following are provided by the Alzheimer’s Society:

1. By 2015 there will be 850,000 people with dementia in the UK.
2. There are 40,000 younger people with dementia in the UK.
3. There are 25,000 people with dementia from black and minority ethnic groups in the UK.
4. There will be 1 million people with dementia in the UK by 2025.
5. Two thirds of people with dementia are women.
6. The proportion of people with dementia doubles for every five-year age group.
7. One in six people aged 80 and over have dementia.
8. 60,000 deaths a year are directly attributable to dementia.
9. Delaying the onset of dementia by five years would reduce deaths directly attributable to dementia by 30,000 a year.
10. The financial cost of dementia to the UK is £26 billion per annum.
11. There are 670,000 carers of people with dementia in the UK.
12. Family carers of people with dementia save the UK £11 billion a year.
13. 80 per cent of people living in care homes have a form of dementia or severe memory problems.
14. Two thirds of people with dementia live in the community while one third live in a care home.

The NHS England initiative is motivated in no small part by the further statistic that estimates that less than half of people in the UK who have dementia receive a diagnosis. That’s something like 400 000 people who have dementia but have not been diagnosed.

Let’s have a look at the arguments for and against GPs receiving payments for dementia diagnoses.

The Case for Payments Being Made

1.      It is nothing short of a scandal that less than half of those with dementia receive a formal diagnosis. This is the view of Jeremy Hughes, the Chief Executive of the Alzheimer’s Society.

2.      Incentives for GPs work, something that has repeatedly been demonstrated since the introduction of new contracts in 2004.

3.      Doing nothing is not an option. Too many people without a diagnosis are left without the support they badly need.

4.      The payment is not just a payment for a diagnosis. GPs will need to have a plan and show improving rates of diagnosis.

5.      Patients who receive a diagnosis are in a position to access treatment and plan their lives.

6.      Improved diagnosis rates may lead to improved research into dementia treatments.

The Case against Payments Being Made

1.      A payment for a diagnosis is a “bounty on the heads” of certain patients. This is the view of Katherine Murphy, the Chief Executive of the Patients Association.

2.      Good GPs already diagnose dementia without an added incentive.

3.      Do GPs fail to diagnose not because they can’t diagnose dementia but because:

a.       Each diagnosis is a cost to the practice

b.      Each diagnosis adds to GPs workload

c.       GPs fatalistically believe that a diagnosis leads to nothing being done

Each of the above is unethical and should not lead to GPs being rewarded to change their practice.

4.      Money is needed not so much for diagnosis, which doctors are able to do, but for treatment and support following diagnosis.

5.      Any money available would be better spent on research to improve the treatment and care of patients.

6.      If it is the case that GPs cannot diagnose dementia because they lack the diagnostic skills, the payment will do nothing to improve their skills.

7.      Incentive payments to make a diagnosis may lead to GPs erring on the side of a diagnosis. 

Conclusion

I do not for a moment suggest that the above points, for and against, represent the arguments to exhaustion. They are, though, some of the main points that are put forward but each of the sides in this debate.  

On which side do you fall?

 

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

 

 

 

How to Get Financial Help for Home Care from Kent Social Services

What this Article Is About

The purpose of this article is to guide you through the procedure for gaining support from Kent Social Services for your home care needs. This applies to adults only. 

To qualify to have your home care paid for fully or in part by Kent Social Services you have to have two assessments. The first one assesses your care needs and is called a community care assessment.

The second assessment is a financial assessment that decides if you are entitled to have your home care paid for fully or in part by Social services.

Community Care Assessment

To receive funding from Social Services, the first step is to have your care needs assessed. This is called a community care assessment.  

The assessment can be done face to face or by telephone. You explain what your care needs are and Social Services use this information to decide if you are eligible for Social Services support. To arrange an assessment you need to contact Kent Social services on the following number:

03000 41 61 61 (text relay 18001 03000 41 61 61) or email social.services@kent.gov.uk.

Your needs are assessed as falling into one of four bands.

1. Critical

2. Substantial

3. Moderate

4. Low

You only qualify for Social Services support if your needs fall into one of the first three bands. If your needs are assessed as low you do not qualify for Social Services Support.

If your care needs fall into one of the first three bands, Social Services will then work out how much this will cost. This is called your actual personal budget. This is not necessarily how much you will get from Social Services. How much you get depends upon your financial circumstances.

Financial Assessment

This is a type of means test. First of all, you will be asked how much you have in savings. This does not include your home. If you have more than £23 250 you will be asked to pay for your care in full. 

If you have less than £23 250 in savings, Social Services then assess the amount of income that you receive each week. Income includes your pension and benefits. If your income is over a certain amount, you will be asked to contribute to the cost of your care. 

Everyone’s circumstances are different. However, for everyone there is a protected income level of £185.44 (in 2014-15) per week. There are various allowances that increase the amount that Social Services cannot make you use to pay for your care. Certainly if your income is below £185.44 you will not pay at all. For more information, you can take a look at this booklet. 

If you have savings between £14 250 and £23 250, Social Services assume that part of this makes up your income. For every £500 that you have above £14 250, Social Services will add £1 to you income.  

For example, if you have £16 250 in savings (that’s £2000 above £14 250), Social Services will add £4 per week to your income. So, if your income is £200 per week, the extra added on because of your savings makes your income £204 per week. 

The amount of money that you have left after Social Services have deducted all your allowances is called your available income. It is the money that Social Services assess you as having available to contribute to your care each week. Available income is your actual income less your protected income plus other allowances. 

An Example

Let’s say that you the following figures apply to you: 

Income: £250 per week

Protected income plus other allowances: £225

Therefore, your available income is £25 per week (£250 - £225) 

This means that Social Services will say that you can contribute £25 per week to your care costs. 

Now let’s assume that your actual personal budget is £150 per week. Remember that your actual personal budget is how much your care is going to cost based on how it has been assessed by social services. 

To meet this figure of £150 per week, you will have to pay £25 per week and Social Services will pay £125 per week. 

Direct Payments

Once you are receiving financial help from Social Services, make sure that you asked to receive you money by direct payments. Social Services should inform you of your right to direct payments.  

Social services can arrange everything for you. However, if you want to take control over who provides your home care you need to request to receive direct payments. If you receive direct payments it means that you are given a sum of money that allows you to purchase your care from whichever company you choose. And the importance of this cannot be overstated.  For more information about direct payments; go to this page. 

Direct payments work in a very straightforward way. KCC pay an amount of money into your bank account or onto a Kent Card. The Kent Card is a Visa debit card and you can find out more details here. You then use this money to buy your care from a provider of your choice. 

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Do You Remember 1972 and the £10 Christmas Bonus

Broadstairs has had its fair share of famous residents. Perhaps none of its celebrity residents are more famous than Edward Heath, who was the Prime Minister between 1970 and1974. I guess it all depends on how you measure fame, but let’s face it there have not been that many Prime Ministers – the current incumbent of the office is number 53, if we start counting from Robert Walpole – so for a small town to have had one of its residents become Prime Minister is no little achievement.

The Heath government will be remembered for many things and you'll be relieved to know that I'm going to mention only one of them. One that many people forget about. Did you know that it was the Heath government in 1972 that introduced the £10 Christmas bonus for people on certain benefits? Over forty years later, it is still being paid "before Christmas... to people who get certain benefits in the qualifying week. This is normally the first full week of December."

Back in 1972, a £10 payment really was something to shout about. As Ruth Jackson from Moneywise explains: "It was worth £98 in today's money and was considerably more than the £6.75 a week basic state pension that pensioners of the time received." Imagine that: a Christmas present from the government that is almost 1.5 times the amount of the basic weekly state pension. Not bad at all.

In 1972, a dozen eggs cost about 25p - we were still talking about new pence in those days, though - petrol was about 8p a litre - but we bought it in gallons - and you could go to the cinema for about 30p - but there'd be a choice of just one screen.

By now you're probably thinking that things simply could not get any better: well you'd be wrong. That Christmas, not only did some people get a bonus but we could all enjoy this classic Christmas number one:

Christmas day fell on a Monday that year. These were the days when there were just three television stations. On Christmas evening on BBC1 you could watch:

5.55pm  Bruce Forsyth and the Generation Game

  6.55pm  Christmas Night with the Stars,
               
  8.15pm  The Morecambe and Wise Christmas Show

  9.15pm  Film : Barefoot in the Park (1967)  starring Robert Redford and Jane Fonda

11.00pm  The Good Old Days 1953-1973

Bring back a few more memories of Christmas television gone by here.

If you're one of those people who got a £10 bonus this year, why not raise a glass to Ted, listen to Little Jimmy and and look out for any repeats of Morecambe and Wise.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.