Self Directed Support
The main aim of this guidance is the prevention of abuse or harm by ensuring all reasonable steps have been taken to minimise the risk of abuse for people who are self-directing their own support and to ensure they enjoy the benefits of having more control over their support. Particular attention needs to be given to those people who may be vulnerable to abuse or harm and who lack the capacity to make decisions related to these matters and need someone to assist or make decisions on their behalf.
The intention is to:
- Recognise that abuse and harm can occur with personal budget arrangements
- Recognise that whilst self-directed support is intended to give maximum choice and control to the service user, it does carry some specific safeguarding risks
- Identify particular adult safeguarding issues that may arise for people who will be taking responsibility for arranging their own support e.g. financial abuse, neglect, poor quality of support, discrimination
- Clarify the risk management processes needed to deal with the above situations
Self directed support is part of a process aimed at transforming public services, taking control away from professionals and officials and enabling service users to have much more choice and control for themselves about how their needs are met.
Experience and learning from the implementation of existing safeguarding policies can be used to manage or resolve the risk of abuse during this transformation process in public services. At the heart of this transformation is the need to recognise that, for the most part, organisations and professionals do not need to make decisions for people. Individuals should be able to make real and informed choices some of which will include risks of harm and abuse.
People need to be made aware of any potential abuse or harm that may occur in the arrangements they are making. All types of abuse are possible but there are particular risks around financial abuse where direct payments are involved.
There is also a risk with self directed support that people who have demonstrated themselves to be unsuitable to care for vulnerable adults may seek employment as a personal assistant (PA) due to the fact that PAs are not part of regulated or inspected services.
An evaluation of risk is central to any assessment. A risk assessment is a careful examination of what could cause harm to people. Risk management and risk enablement is part of the person centred support planning process.
Support plans should record all risks associated with identified needs and any other safeguarding issues identified in assessments. There will be specific reference to how the personal budget will be spent to meet needs and outcomes.
Good prevention of abuse or harm starts with awareness and moves on to good recruitment and employment practices. These can include the scrutiny of potential PAs criminal background via Disclosure and Barring Service (DBS) formerly known as CRB checks. It is a good idea to examine previous employment history, check qualifications and references. Information and advice on safe processes and procedures around recruitment should be made available to all people considering arranging their own care.
Whilst not mandatory, service users should be strongly encouraged to require an up to date DBS check on anyone they are considering employing via their direct payment. This is available free of charge to the service user via the service provider.
There are national standards in relation to a code of conduct for workers providing care and support which includes PAs.
Direct payments enable the service user to choose to employ a neighbour, friend or relative to be their PA. This has the potential to work better for the service user than employing someone they do not know. These standards provide a helpful checklist of what should be normally expected.
People with limited or lack of capacity to manage a direct payment can be readily supported to manage one where there is a responsible, informal carer or a trust circle able to oversee the direct payment and act in their best interests. This is known as a third party arrangement.
Most third party arrangements work very well ensuring the individual's needs are met as flexibly as possible according to their everyday choices and preferences. However there are some risks attached to these arrangements and if cause for concern is raised staff need to be vigilant.
- Vulnerable adults need someone they can trust and talk to when they feel they are being abused. This may be a relative, a friend or a member of staff (health or social care.)
- An adult safeguarding leaflet must be given to all individuals receiving a direct payment as part of the information pack provided by the service provider. This should be provided in alternative formats and languages where required. The purpose of the leaflet is to alert anyone considering a direct payment or what to do if they feel they are being abused and to ensure they are aware of any risks. The service provider has a key role to play in giving the prospective direct payment user good balanced advice about direct payments and where to seek advice and support in the future if difficulties arise or further support is needed.
- The assessment, support planning, monitoring and review process should also continue to address any issues about individuals' capacity to manage a direct payment and ensure appropriate arrangements to assist or support are in place.
- Finance officers employed to check and support users of direct payments also have a key role to play in the early identification of any misuse of a direct payment. Finance officers should be aware that failure to provide statements could mean either the service user is struggling to manage their direct payment and needs support or is misusing their direct payment or they are the subject of abuse by other parties. They should know what the safeguarding procedures are, their role and how to report it.
As part of any review of self directed support arrangements there should always be consideration of any safeguarding issues.
- Direct payment recipients who become employers need to understand their responsibilities to inform the DBS of any staff they dismiss as a result of an abusive incident. This is to ensure that proper consideration is given to whether their dismissed PA is suitable to continue working in the area of health and social care and caring for other vulnerable people.
This responsibility should be explained by the service provider before the direct payment is set up.
The service provider should also give the service user advice and guidance in relation to being a good employer as part of ensuring that the direct payment works successfully, so the service user benefits from all the potential advantages a direct payment can bring for them and the risk of any potential future difficulties are minimised.
Self directed support
Self directed support is a change to the way people with ongoing social care needs are supported. There is a focus on increasing people's independence and promoting inclusion in their community. Every person receiving support should have as much choice and control as possible over how this is provided.
A personal budget is the name for money allocated to individuals, who are eligible, to pay for ways to meet their social care needs. Where there is more than one funding source, such as Supporting People or Independent Living Fund, these can be added to the personal budget and called an individual budget. A personal budget may be managed by councils or by another organisation. People choosing to manage their own personal budget will usually be paid via a direct payment. Direct payments are a nationally recommended of giving an individual more choice, control and empowerment.
Supporting people with direct payments
- A specific service provider which is an independent agency commissioned by the council to offer support and advice to people who use direct payments.
- Staff and members of this service provider must ensure they are aware of safeguarding issues and routes to reporting concerns.
- The service provider and the council will aim to ensure there are good channels of communication in relation to adult safeguarding issues.
- This should include strong links with the operational teams in particular the adult social care contact team and the adult safeguarding unit.
- Safeguarding is concerned with assisting people to keep themselves safe. Individuals need good quality information related to how to make referrals about abuse situations and also what to do when they have concerns or issues about their care.
- Training of safeguarding investigators will emphasise the need to explore individuals preferred outcomes and to meet these whilst taking account of any other relevant factors in deciding how or whether to progress an investigation.
- All training in respect of personalisation and self directed support should include elements of adult safeguarding and risk management.
- Staff involved in assessments, support planning, monitoring, reviewing and supporting people using direct payments must have received training in basic awareness of adult safeguarding. This would include any people providing peer support via the local user led organisation.
- Support should also be available to PAs employed to support individuals under a direct payment.
Personalisation and the transformation of adult social care promotes independence and gives people who use services more choice and control over the way their support is provided.
This includes where a vulnerable individual is subject to a safeguarding incident. People or their relatives (if appropriate) and /or advocates should always be asked about the outcomes they want and work should be focussed on achieving this, including where their choice is not to proceed with a safeguarding investigation.
There are some necessary exceptions to this as follows:
- Where the abuse could affect other individuals - an example being where a victim clearly states they do not want their home carer getting into trouble when it appears the home carer may have financially abused them. The home carer is likely to have access to other vulnerable individuals as a result of their job role.
- Where the victim states they do not want anything to happen but this seems to be a decision based on being subject to undue duress - an example being where the victim has said they have been abused by a relative but they do not want action to be taken due to fear of the perpetrator.
- Where a crime has been committed or the abuse is sufficiently serious to warrant at the very least a professional’s only meeting.
- Where there are issues of mental capacity and a decision is needed in the individual's best interests.
Individuals and their advocates should also always be kept informed of progress, included in meetings or provided with a written record of meetings about the matter if they choose, advised of what protective measures have been put in place and informed when an investigation has been concluded.
Think Local, Act Personal and SCIE have developed a number of resources which you may find useful.
Details of all the latest news from Salford Safeguarding Adults Board.