Co-Producing Direct Payments that Work for Everyone in Adult Social Care

As a council, we have been on a journey to build on our strengths-based approach to service delivery and take our work to the next level to achieve proactive, innovative and inclusive adult social care through the Kirklees Vision for Adult Social Care 2020-2025. The Vision provides direction for the entire council and was developed in partnership with staff and people with care and support needs, describing the type of social care services Kirklees residents want by empowering people and focussing our collective efforts on the things that matter through our Vision statement:

“We want every person in Kirklees who needs social care to be able to live the life that matters to them; with the people they value, in the places and communities they call home, and with an equal voice in coordinating their care.”

With the above as our guiding principle, we took the initiative as a council to recognise that some peoples’ lived experience of managing a Direct Payment has been falling short of the intentions enshrined in policy and in our Vision for Adult Social Care. The principle that people should be able to maximise the choice and control they have over the care and support they are entitled to, as this relates to Direct Payments, is also underpinned by the Care Act:

Care Act Guidance section 12.4 ‘For direct payments to have the maximum impact, the processes involved in administering and monitoring the payment should incorporate the minimal elements to allow the local authority to fulfil its statutory responsibilities. These processes must not restrict choice or stifle innovation by requiring that the adult’s needs are met by a particular provider, and must not place undue burdens on people to provide information to the local authority.”

To this end, we recognised the opportunity to improve Direct Payments, with our Vision as our guide and to establish true co-production as everyday practice by developing the Direct Payments Review.

Establishing True Co-Production

The review of Direct Payments has consisted of two phases:

1. Refreshing the Direct Payments Policy, Guidance and Third-Party Agreement in partnership with direct payment recipients in a mutually respectful and co-produced way.
2. Embedding the principles, values and ways of working outlined in the new documents through co-production with staff, the DP Working Group and wider council services.

To achieve this, there has been a lot of work to improve people’s experience of Direct Payments in Kirklees. It has required concerted and continuing effort to make them work better, with ongoing engagement with people drawing on care and support and carers through true co-production.

Priorities to achieve this include:

• Co-production at all levels – individual, family, peer support, formal support, policy, and strategy.
• Governance and partnership structures can be used to receive feedback from people and agree on any necessary changes at an overall level.
• At an individual level, co-producing support plans and ensuring they are person-centred and outcomes-focused

The Think Local Act Personal report, Improving Direct Payments Oversight, which was published in March 2022 and has been one of the guiding documents for our work on the review, outlines 8 priorities:

1. Initial information for those using Direct Payments  
2. How a personal budget is set, including a fair contribution, determining the direct payment
3. The level of flexibility around how a direct payment can be used
4. Accounting for the money including contingency
5. Reasonable expectations of those actually using or organising Direct Payments including family members, recognising that they are often employers
6. Having a supportive culture that sees Direct Payments as a positive option and written and verbal communication that reflects this
7. Initial set-up time
8. Oversight of Direct Payments in a way which values co-production.

To this end, a new Direct Payments Policy and supporting guidance and Third-Party Agreement have been rewritten in partnership with a diverse group of 15 people who draw on care and support/carers including at least:

• 1 person under the age of 25
• 1 Person over the age of 65
• 1 Person with a learning disability
• 1 Person with a physical disability
• 1 Person who primarily draws on Mental Health Services
• Unpaid carers of both adults and children who draw on care and support to live their lives

As well as 5+ Kirklees Council officers (including those involved in administering and overseeing Direct Payments) and 5 VCSE representatives.

As well as the new documents, the group also co-produced a shared vision for Direct Payments:

“Direct Payments in Kirklees will embody the principles of flexible and creative support and will be designed and developed with the people who use them, to enable them to live the life that is important to them.”

The coproduction work has included:

• Paid membership with groups and organisations that can effectively lead engagement opportunities.
• Involving carer and service user groups to attend partnership boards and be a standing agenda items at meetings further up the governance structure such as the Mental Health Alliance.
• Reaching out to expert self-advocacy groups for their leadership and consultation on projects.
• Establishing partnership boards that are led by people with lived experience.
• Employing(paid) people with lived experience to co-lead projects.
• Attending groups and forums to build relationships and trust to enable more meaningful engagement
• Database of VCSE that we contact to share engagement opportunities

To support our efforts to develop our local approach to co-production across Adults with people who have care and support needs the council commissioned SCIE in August 2020 to support Kirklees to develop a vision for good coproduction arrangements.  
This work has involved local people who draw on care and support and council staff in a series of events to develop a vision and a model for how people want to be involved in co-production.

SCIE has also been supporting two projects exploring how people can coproduce in partnership with professionals:
1. Developing an Integrated Call Centre Service for Health and Care in Kirklees
2. Reviewing Direct Payments in Kirklees

As part of this work, the following definition of co-production has been created to guide all projects related to coproduction:

“A way of working whereby people and decision-makers, or people who use services, carers and service providers work together to create a decision or service which works for them all. The process is realistic, value-driven and built on the principle that those who use a service are best placed to help design, evaluate, and influence it.”

In addition to the definition above, the following value statements were also coproduced with service users:

Value Statements

• A Culture in which people are valued, respected, and recognised as assets 
• Clear communication in plain language
• A Culture of openness and honesty 
• Commitment to sharing knowledge, power, and decisions 
• Striving to ensure that co-production is accessible to everyone involved
• Taking pride in equality, inclusion, and diversity

A New Approach to Direct Payments and a new relationship with the people we support

Direct Payments can be complicated and misunderstood, and a 2022 staff survey highlighted a lack of confidence in promoting self-directed support or a belief that people can make good and safe choices and arrange good care and support themselves. We have worked with the Working Group as equal partners to unpick these issues and lay the groundwork for much better Direct Payments in Kirklees.

To date, there have been 36 meetings to review and rewrite the Direct Payments Policy, Guidance and Third Part Agreement. There have also been many additional conversations, working groups and written communications. The activities have primarily involved people who draw on care and support and carers with officers who have supported the coproduction practice, VCSE representatives and with support from Social Care Institute for Excellence.   

There has also been some engagement with adult social care staff with 5 reflections sessions involving those who administer and oversee Direct Payments and a staff survey which attracted over 60 responses from across adults and children’s services.

The work around co-producing a new direct payment policy and its implementation has been high profile, with many local authorities across the country looking to learn from our Kirklees approach. We have accepted the reputational risk if this work does not continue as well as the risk to damaging the trusting relationships that have been nurtured with the citizens involved in this work. Through coproducing, we are extending our restorative approach with and alongside residents of Kirklees which is a long-term commitment.

The next phase of this project is now focused on successfully embedding the new policy, processes and practice in a way which continues to honour the principles of power sharing and collaboration, and which allows people to have more choice and control. The coproduction group now meets every month in order to maintain an overview of progress for Phase Two, with extra sessions to progress the development of the staff briefing sessions which are being coproduced with the council’s Learning and Development team. We are anticipating 8 briefing sessions with staff across the spectrum of Direct Payments, which will include interactive content with information available prior to the sessions and feedback/ booster sessions available after the initial roll-out. Currently, we are undertaking Phase Three to coproduce training sessions on outcomes and support planning and then to set up the DP Forums with a panel of experts to support case-specific issues.

As with all truly co-produced projects, there is a possibility of moving into unchartered territory with a need to learn as we go, let go of control, share power, and take risks. These risks are minimised through the support from Social Care Institute for Excellence and Think Local Act Personal, who are leaders in this approach and allow us to connect with and learn from other local authorities who are also on a journey of improving Direct Payments and their approach to co-production in general.

Overall, we are confident in the strides the Direct Payments Review has taken to enshrine the principles of the Kirklees Vision for Adult Social Care, the guiding advice of SCIE and TLAP, and most importantly, the views and experience of our staff and the people they support.