Report on the pa market and options paper V3


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Report on the pa market and options paper V3

  1. 1. Directly Employed Personal Assistants in Bradford: Market Analysis and Options for Development
  2. 2. 2
  3. 3. 1.Executive Summary......................................................................................................................4 2.Introduction...................................................................................................................................9 3.Personal Assistant Market Overview.........................................................................................10 3.1.National Perspective................................................................................................................................10 3.2.Bradford and District...............................................................................................................................12 4.Best Value and Personal Assistants............................................................................................20 5.Personal Assistant Market Barriers and Challenges................................................................21 6.Role of Local Authorities............................................................................................................25 7.Existing Personal Assistant and Employer Support in Bradford ...........................................26 8.Safeguarding Vulnerable Adults in an Unregulated Market...................................................28 9.Personal Assistant Accreditation and Registers........................................................................28 9.1.Overview..................................................................................................................................................28 9.2.Accreditation and PA Support Schemes – Legal Issues .........................................................................29 9.3.Accreditation and Register Options.........................................................................................................31 9.4.Function and Purpose of a Register.........................................................................................................31 9.5.Online and Electronic Register Service Providers...................................................................................33 10.Personal Assistant Project Recommendations........................................................................35 11.Appendices.................................................................................................................................41 11.1.Examples of PA Schemes......................................................................................................................41 11.2.Legal Advice on LA run PA Accreditation & Register.........................................................................43 11.3.Comparison of Online Solutions: Features & Cost...............................................................................45 3
  4. 4. 1. Executive Summary 1.1.In Bradford lives are changing as people begin to choose to use their allocated public funds to arrange their own social care. Direct Payments Recipient June 2010 “I used to have home care. It was ok, but they didn’t come early enough for me and weren’t prepared to come earlier. Then I had [name of agency]. It was a shambles. There were different people every time and I kept having to explain everything. I advertised in the paper for my staff. I guess I was just lucky with getting the right people. My wife does the payments. The payroll system [Bradford CVS] is excellent. My life is much better now. I have my own converted van. The girls take me out and about, they even come on holiday with me. It’s worked out really well. I wouldn’t change anything”. 1.2.Putting People First milestones sets a target for 30% of eligible service users to take up self-directed support by April 2011. As a result it is expected that more people will directly employ their own personal assistants for personal care and also to achieve quality of life outcomes. 1.3.While flexibility of direct employment is clearly beneficial there is also potential lowering of service costs compared to the more traditional home care options. A model based on a 5% shift away from Council arranged personal care to directly employed personal assistants shows a potential saving of £211,000 per annum (comparing average hourly wages for 2009- 10, see 4.10). The difference is mostly due to the removal of third party costs (for example, agency fees and on costs). 1.4.However, very little is known what capacity there is in Bradford and District for the personal assistant market to achieve this level of change, which this report aims to address. The Council’s role in stimulating the personal assistant market’s capacity and quality is also discussed. 1.5.Demand Analysis – main findings 1.5.1. Up to 50% of people on direct payments employ a PA. However, the majority are employing people known to them (friends and relatives). Few are advertising for ‘career’ PAs who work independently. 1.5.2. In Bradford there is a downward trend in referrals to the Direct Payment team, which has not increased as a result of the SDS process being implemented. The indication is that most SDS recipients are referred to the home care team and continue to have services arranged on their behalf (in-house, locality contracts and All-Inclusive Rate spot purchasing). 4
  5. 5. 1.5.3. A number of structured interviews with direct payment recipient’s in June 2010 found that insufficient information earlier on in the process may be an issue. National surveys found that less than 8% of older people knew anything about personal budgets. However, once explained (options and support available as an employer) 44% said they would consider employing a PA. 1.5.4. Based on the current trends the actual demand by people using cash to directly employ personal assistants could remain low. 1.6.Supply Analysis – main findings 1.6.1. The supply of directly employed PAs (not agency care workers) is also estimated to be low. 1.6.2. We judged that between 200 and 250 PAs are currently employed by adult direct payment recipients in Bradford & District (the majority employ someone already known to them and are unlikely to be ‘career’ PAs). The rate of PAs to Direct Payment recipients is approximately 1to1, which is lower than the national average of between 1.64 and 2.4 PAs to each Direct Payment recipient. 1.6.3. A survey of people who previously replied to adverts for PAs work had 41 responses. 50% had no previous PA work experience. Of those with some experience working as PA only 19% worked full time while 38% worked between 2-4 days per week and 31% had no PA work at all. Anecdotal evidence suggests that most career PAs get job satisfaction but the infrequency of work and lack of employment security are major barriers. 1.6.4. National surveys found 8% of employed PAs were on the minimum wage, only 7% of employers arranged formal training and 40% had no formal contract job description. 1.7.While demand remains low for career PAs, and the cash pool from direct payments is modest, there is unlikely to be the incentive needed to grow the PA market. 1.8.Safeguarding and PA registers 1.8.1. A concern exists among practitioners that abuse is more difficult to detect with directly employed personal assistants in what is an unregulated and potentially ‘grey market’. 1.8.2. One response to this has been for local authorities to consider introducing some form of ‘approval’ or ‘accreditation register. However, our research could only find one Local Authority that has a comprehensive programme to ‘approve’ PAs (which by April 2010 had only managed to train and approve only 12 PAs). 1.8.3. Most Councils have entered into a philosophical debate regarding the tension between safeguarding and personalisation principles, not least 5
  6. 6. because 71% of SDS recipients say that is they who should decide and some perceive that accreditation to be local authorities clawing back control. 1.8.4. The model emerging acceptable to most people are externally hosted registers that are not compulsory or exclude anyone although may provide validation and credential checks (it is up to the employer to use this information to make an informed choice). 1.8.5. The function of a register can be broader than safeguarding and information. Some examples: • Improve speed of access to the market by connecting people looking for work with those seeking personal assistance. • Create a ‘community’ for personal assistants and platform for engaging the sector in workforce development and standards. • Signpost PA employers and employees to where they may get support resources. • Opportunities for economy of scale benefits through organising the sector in joint procurements (insurance, recruitment drives, training etc.). 1.8.6. Some registers are using subscriptions as revenue for development. However, this appears to be a very poor strategy and few employers are signing up (PA Pool West Yorkshire 4 signed up; North West PA only 11 signed up). Registration fees may need to be free for a register to be viable and have enough users to generate a market. Any safeguarding function would be restricted by low service user participation offering little incentive for PAs to join. 1.8.7. The cost of setting up a register varies widely. Higher end is over £100,000 and a lower cost bespoke development, with external hosting, had a one off cost of £15,000. 1.9.Holistic Approach 1.9.1. No compelling evidence was found in our research to support the view that a register in itself will stimulate the market. A holistic approach is required by the Council to prime pump the market through investment and coordination: • Inform – get information about direct payments and knowledge about employment support out to service users very early on in the SDS process and to increase recipients’ confidence to employ a PA. • Develop - Shaping the market through workforce development, partnerships and co-production of standards with service users and PAs. The role of the Council is to support coordination of these 6
  7. 7. activities either directly or through investment in a non-profit voluntary or User Led Organisation. • Empower - Support service users and carers to take more direct control of their own arrangement, such as having employment ‘toolkits’, and easy, quick to access PA registers in order to broker these services for themselves. 1.9.2. A register needs to be embedded in a broader ongoing PA project that drives this holistic approach. • Coordination of stakeholders and partners to develop a systematic policy approach that finds a balance between safeguarding initiatives and principles of greater freedom of choice and control. • Research and identify workforce issues • Research, indentify and find solutions for barriers • Produces a common induction and training standards for PAs (employers taking a lead) • A register maintained that is current, clear and with sufficient factual information to promote informed decisions via different media including print outs, telephone and internet. A system is put in place to check the validity of the identity and credentials of PAs. • A Code of Conduct for PAs is developed together with employers and PAs. • Coordinate recruitment drives. • Create toolkits with guidance and resources for both employers and PAs, including safeguarding information and advice. 1.9.3. A holistic PA project would require investment without which it is difficult to see how this immature and unregulated market will consolidate. However, given the low demand trend any development should be scalable starting with a pilot. Demand and supply could be reviewed and the project scaled up as required. We recommend (reasons described in this report) an externally hosted project that prevents the boundary between the Council’s role of providing information blurring with that of a representative of PAs. 1.9.4. A register would be required as the backbone of a project. High cost PA register solutions are not best value, as the current demand for a registers is probably small. However, a useful system with demonstrable benefits for PAs and Employers should generate interest and grow. Therefore, a low cost register and additional investment for the broader project developed (by a voluntary or ULO) is estimated to include a set-up cost of £15,000 and a project management resource cost of 7
  8. 8. approximately £22,000 to £25,000 per annum, which initially could be pro rata part-time while testing the market. Russell Cox and Shona Grange Commissioning Support - Market Development 15 June 2010 8
  9. 9. 2. Introduction 2.1.The Putting People First policy aims to ensure that person-centred planning and self-directed support becomes mainstream. Personal budgets or individual accounts are envisaged to become the usual way for everyone who is eligible for publically funded social care to achieve outcomes that meet their individual needs and aspirations. 2.2.Bradford MDC has fully committed to the Putting People First personalisation programme. Everyone eligible for publicly funded adult social care will have the option to take up self-directed support (SDS) with the allocation of a personal budget or individual accounts. 2.3.The SDS national indicator NI130 minimum target by the year 2010-11 is for 30% of people who have a community-based social care package in that year having taken up SDS. 2.4.An anticipated result of increased uptake of self-directed support is more people directly employing their own personal assistants. 2.5.Person-centred and more flexible support planning is likely to widen the role and expectations of personal assistance from the traditional focus on personal care to support accessing universal services. 2.6.A significant barrier to a mature and stable market of directly employed personal assistant has been the relatively low uptake of direct payments. Simply put, relatively few people on direct payments did not encourage many career personal assistants to enter the market. However, the Putting People First objectives have renewed the efforts to achieve better uptake of self- directed support. 2.7.The flexibility of directly employed personal assistance has appeal to service users who find traditional models of procurement not flexible enough for their needs. 2.8.Personal assistance directly employed generally costs less than that procured from a registered agency or an in-house homecare service. 2.9.However, these benefits are offset by concern that Personalisation could unintentionally stimulate a ‘grey market’, where people employed directly as personal assistants work unofficially with some not paying national insurance or income tax, having few employment rights and do not meet any minimum professional standards. 2.10. Currently there is no national regulatory system in place for Personal Assistants. The General Social Care Council (GSCC) has indicated that a national regulatory system for personal assistants is unlikely to be introduced. 2.11. Therefore, the flipside of the advantages and opportunities created by personalisation policy is the potential for the growth of an unsupported 9
  10. 10. personal assistant market, where risks exist include exploitation of the workforce and safeguarding concerns for the employers. This highlights a tension between the personalisation and safeguarding agendas. 2.12. This report focuses on the role of the Local Authority in supporting the development of the capacity and quality of the personal assistant market in a way that achieves a balance between the benefits of SDS recipients being direct employers and mitigating against the unintended consequences of an unregulated market. 3. Personal Assistant Market Overview 3.1. National Perspective Demand 3.1.1. The demand for PAs by people on SDS is expected to increase. UK research of people opting for individual budgets suggests 50% will go on to employ personal assistants1 although this may vary according across user groups and nature of disability. 3.1.2. Research carried out by Demos from December 2008-July 2009 found that found 62% of service users knew nothing at all and 20% knowing just a little about direct payments of personal budgets. 3.1.3. Few older people (less than 8%) knew anything or very little about personal budgets. However, once informed almost half said they would change at least some things about their care package if they had a personal budget. In particular, 44% saying they would want a PA if they had a personal budget. 3.1.4. A 2008 Skills for Care workforce report found that the majority of direct payment recipients are in the physically disabled adults and older people categories. Combined they accounted for nearly two-thirds (62%) of direct payments recipients, followed by carers receiving direct payments (16% of users) and learning disabled adults (14%). 1 Priestley M et al. (2007) ‘Direct payments and disabled people in the UK: supply, demand and devolution’, British Journal of Social Work, (October), vol 37, no 7, 1189–1204; Glendinning C., et al. (2008a) Evaluation of the individual budgets pilot programme: summary report, York: Social Policy Research Unit, University of York. 10
  11. 11. 3.1.5. The trend was expected to continue with the older people becoming the majority group of direct payment recipients from 2008 onwards. 3.1.6. With the emphasis on preventative and re-enablement services, diverting older people away from residential care with greater numbers remaining longer in their own home could significantly increase the demand for personal assistance at home as more and more older people get to know about and start to understand how personal budgets may benefit them. 3.1.7. Demand for personal assistants is expected to be linked to the rate of uptake of SDS. People gaining access to their own budgets through SDS is forecast to rise from 114,000 in 2006 to 646,000 in 2025 (State of the Adult Social Care Workforce in England 2008 study). Supply 3.1.8. Research found that the supply of high-quality, trained and skilled personal assistants is limited and this reduces choice for direct payment employers. Supply shortages are greater in rural areas. 3.1.9. The Skills for Care England estimates that the number of personal assistants employed by direct payment users would need to increase nine-fold by 2025 to achieve maximum choice2 . However, this figure does not take into account that many may choose to employ their previously unpaid carer relatives instead of employing a career personal assistant. 3.1.10. Surveys conducted by Skills for Care of direct payment users and their personal assistants estimate the number of personal assistants per direct payment recipient at between 1.64 and 2.4 respectively3 . 3.1.11. However, of the Direct Payment recipients surveyed by the Skills for Care, only 66% could find an appropriate personal assistant previously unknown to them within a month and 36% said the process had been difficult. 3.1.12. Expanding the market to meet the demand holds and safeguarding risks associated with an essentially unregulated market emerging with few quality checks, poor pay and transitory work force and some PAs operating outside of employment law (the ‘grey market’). 3.1.13. While there is limited information in England it is expected that the personal assistant/care support worker labour market is characterised by migrant, mostly female workers with a high turnover. In Scotland recent research of the PA market found the workforce was largely female, white and on average over 40 years4 . 2 Eborall C., Griffiths D. (2008) The state of the adult social care workforce in England, 2008, Leeds: Skills for Care. 3 Skills for Care Annual Workforce Report 2008, Skills for Care pp 46 4 Howie R et al (2010) Workforce and Employment Issues Surrounding Self-Directed Support. Social Research. The Scottish Government 11
  12. 12. 3.1.14. In the UK one in three PAs considered themselves underpaid; with the average hourly wage in 2008 being £7.60 (£8.45 average reported by the Scottish Government’s 2010 research) and 8% PAs were on the minimum wage. It was also found that one third wanted training but only 7% of employers arranged formal training5 . Two fifths of PAs had received no formal contractual job description from their employer. 3.1.15. The PA workforce in the rest of the UK is likely to be similar to the finding from Scotland having a low level of provision of sick pay beyond Statutory Sick Pay, little if any pension provision and few PAs belong to a trade union. 3.1.16. In conclusion, the directly employed PA market place as it exists today is unprepared and ill equipped to meet the anticipated increase in demand for good quality personal assistance. 3.2. Bradford and District Demand 3.2.1. There should be a correlation between the demand for personal assistants and the number of people receiving cash payments to purchase directly their own support. Without this ‘cash’ market the personal assistant market will not thrive. Therefore, it is important to analyse the trend of self directed support in Bradford relative to the number of people who are taking direct payments. 3.2.2. For the Mid-April 2010 return NI130 the number of adults in receipt of direct payments or individual budgets was 610 (509 direct payments and 101 individual budgets). The figure includes one off payments. In June 2010 the number of people receiving regular direct payments was 467 with one off payments accounting for the remainder. 3.2.3. In April 2010 33% of people in receipt of a Direct Payment or Individual Budget for Personal Assistance in Bradford & District were over 64 years, which is similar to the National trend (see 3.1.4 above). 3.2.4. Mid-April 2010 of all direct payment and individual budget recipients 31% were adults 18 to 64 years with learning disabilities (higher than average National prevalence) and 21% adults 18 to 64 years with physical disabilities (lower than the average National prevalence). 3.2.5. Referrals to the Direct Payment Team from January 2009 to May 2009 suggest that the number of older people being referred is of similar proportion to the existing recipient groupings (the majority of referrals from the Adult Area Teams and hospital are older people – approximately 37%. However, referrals of people from the learning and physical disabilities teams is lower while children make up a third of all referrals, 5 IFF Research (2008). Employment aspects and workforce implications of direct payments, Leeds: Skills for Care. 12
  13. 13. Referrals to DPT Jan 2009 to May 2010 by Referee Group 31% 35% 6% 14% 8% 5% 1% 37% Adult Area Teams Children &Young People Physical Disability Learning Disabilities Mental Health Hospitals Sensory Needs 3.2.6. Of the 467 clients in May 2010 in receipt of a regular direct payment 219 (or 47%) employ at least one PA. The Direct Payment Team do not think that there are many people with more than one PA, so the estimate is 250 directly employed personal assistants, which is generally in line with the national trend of 50% of direct payment recipients employing a PA. 3.2.7. The overall trend of referrals to the Direct Payment Team would appear to be declining since January 2009 (see chart below). This is more pronounced for adults. This is counter intuitive in that one would expect the referrals to rise with the promotion and increased take-up of self directed support. Referrals to Direct Payments Team Jan 2009 to May 2010 Trend Line over 17 Months 0 5 10 15 20 25 30 Jan-09 Feb-09 M ar-09 A pr-09 M ay-09 Jun-09 Jul-09 A ug-09 Sep-09 O ct-09 N ov-09 D ec-09 Jan-10 Feb-10 M ar-10 A pr-10 M ay-10 Month NumberofReferrals Adults Children Linear (Adults) Linear (Children) 13
  14. 14. Adult New DP Contracts by Month 2009-10 0 5 10 15 20 25 30 Apr-09 M ay-09Jun-09 Jul-09 Aug-09 Sep-09O ct-09 N ov-09D ec-09 Jan-10 Feb-10M ar-10 NewContracts Trendline 3.2.8. The RAS assessments were piloted in areas from around September 2009 and the process was fully rolled out to all areas by the end of December 2009. This data shows that there has not been an increase in Direct Payments as a result of the SDS process being implemented. 3.2.9. While further analysis is required to understand a downward trend the reasons could include: • Information about direct payments and option to employ own staff is not fully understood by recipients early on in the process at the point of the initial assessment. • In the Self-Directed Support customer journey the majority of people assessed are referred for re-enablement to the Home Care intake team. • There is a possibility that referrals to Direct Payment team could increase post re-enablement although this is not yet showing up in the current trends. • People are continuing to choose services that are familiar to them and the Council. 3.2.10. The average weekly hours and number of clients supported by Home Care services has over 12 months remained relatively constant without significant variations (see chart). 14
  15. 15. Home Care Average Weekly Hours & Clients 2009-10 15000 16000 17000 18000 19000 20000 21000 01-Apr-09 30-Jul-09 31-Aug-09 30-Sep-09 31-O ct-09 30-N ov-09 31-D ec-09 31-Jan-10 28-Feb-10 31-M ar-10 Hrs 1900 2000 2100 2200 2300 2400 2500 Clients Hrs Clients ` 3.2.11. Using the number of recipients supported to place adverts for PAs, as a proxy demand indicator for ‘career’ PAs, the number of people employing PAs not previously known to them would seem to be quite low. However, people may be placing adverts independent of support from the Direct Payment team but this number is thought to be nominal. The experienced Direct Payment officers believe that few PAs employed to support children were previously not known to them or their families. Number of Direct Payment Recipients Supported to Advertise for Personal Assistants 20 23 14 3 0 5 10 15 20 25 2006 2007 2008 2009 2010 Year Numberof Recipients Data for 2007 unavailable 3.2.12. The distribution of people who employ personal assistants do not seem to be influenced by geographical or constituency factors and is quite even with no noticeable patterns (such as clustering in certain areas). Again, this may be indicative of employing personal assistants known to them. 15
  16. 16. 3.2.13. The Putting People First milestone for April 2011 is for 30% of eligible service users/carers to have a personal budget (referred to in Bradford as an individual account). In Bradford this represents a target number of 5000 people. 3.2.14. Based on the national trends of 50% this could potentially represent 2500 people in Bradford wishing to employ a PA with their individual account by April 2011. 3.2.15. However, the analysis above of both the up take of direct payments (the cash needed to stimulate the PA market) and potential PA pool in Bradford is comparatively low possibly because of a combination of a number of factors: • A high proportion of people taking up individual accounts may still have the Council holding the money and arranging services on their behalf most often as intake to the Home Care services. • Safeguarding concerns may influence how these arrangements are made when care managers perceive that abuse by personal 16
  17. 17. assistants is less likely to be detected than abuse of people in more traditional services6 • Further, at least initially the demand by older people for employing PAs themselves will be less (see 3.1.3 above). • A significant proportion of people recorded in the NI130 return will be those receiving vouchers (7%) or winter warmth payments (19%), as found in the March 2010 returns. • Many people will seek to employ someone that they already know and trust. In many cases this will not be a career PA who they have no previous acquaintance. Supply 3.2.16. The actual number of directly employed PAs in Bradford and District is difficult to estimate. We can only estimate the supply relative to the number of SUs in receipt of direct payments and individual budgets who employ a PA. However, the number of personal assistants employed by self-funders is not known. 3.2.17. For June 2010 there were 219 people who employed at least one personal assistant. 3.2.18. Using the national estimate for the number of personal assistants per direct payment recipient ranges between 1.64 and 2.4. If in Bradford there is a similar rate then the number of directly employed personal assistants by direct payment or individual budget recipients is between 360 and 525. 3.2.19. However, the view of the Direct Payment Team is that in Bradford the majority of people only have only one Personal Assistant and would estimate the true number of personal assistants between 220 and 250 (most are likely to be someone known to the employer and not a career PA). 3.2.20. Therefore, the initial indication is that the number of personal assistants per direct payment recipient is less than the national average. 3.2.21. One reason for this may be that there has not been enough local demand to stimulate the PA market. Historically the uptake of direct payments in Bradford has been below the national average of the percentage of Social Care Clients receiving Self Directed Support (Bradford 3.1% compared to 5% comparator average and 6.9% National Average for 2008-09). 3.2.22. A list held by the Direct Payments team has a further 385 names of people who at some time have responded to adverts for personal 6 CSCI (2008) Safeguarding adults: A study of the effectiveness of arrangements to safeguard adults from abuse 17
  18. 18. assistants but were not employed. It is thought unlikely that many of these individuals will be working as individual career personal assistants. 3.2.23. A survey of personal assistants working in Bradford and district was undertaken in June 2010 targeting two distinct groups. First a group of 219 adult direct payment recipients, known to currently be employing a PA, were asked to forward the survey to their employees. The second group was a list held by the Direct Payment Team of people who have at some time responded to adverts for personal assistants (340 surveys sent out as 45 names removed, as known to be unsuitable). 3.2.24. In total 47 completed survey forms were returned. The response rate for both groups was very low but particularly poor for the first group (only 3%). For the second group the response rate was slightly better at 10%. 3.2.25. Although limited the survey does provide some initial understanding in particular of the people responding to adverts for PA employment. The charts below show the key results. Respondents with Previous PA Work Experience 40% 58% 2% No Previous PA Experience Previous PA Experience (blank) PA Employment Status 39% 29% 25% 7% PA is Main Employment PA Supplements Main Employment PA not main Employment Not Stated Primary Employer 12% 40% 12% 12% 8% 4% 12% 36% Agency Only Direct Payment Recipient Only DP & Agency DP & Self-Funder Mix of All Other Self-Funder Only Frequency of PA Work 19% 38% 12% 31% Full-Time 2-4 Days Less than 2 days Not at All 3.2.26. In summary the following observations can be made: • A high proportion of respondents had no previous experience of working as PAs (40%). Of the respondents on the Direct Payment List 50% had no prior experience (possibly replying to adverts out of interest). 18
  19. 19. • Of those that do have previous experience 39% stated this to be their main occupation while only 19% worked full time as a PA. The majority (38%) only worked 2 to 4 days a week and 31% were currently not employed as a PA. • While 40% stated that their primary employer was a direct payment recipient the rest are finding employment from a mix of employers including agencies, self-funders and direct- payment respondents. • The particularly low return of surveys by Direct Payment PA employees may be on account of the higher proportion being people previously known to the recipient and not a career personal assistant. • Despite the above stated limitations of this survey the findings suggests that there may be a very small and predominately part-time pool of career personal assistants. Supply & Demand Gap 3.2.27. For reasons already noted the future demand for PAs is difficult to predict and the trend between the uptake of SDS and those wanting to directly employ a PA is unlikely to be linear. 3.2.28. Early indication is that the number of intakes to the Direct Team is modest relative to the increase in the overall SDS uptake. 3.2.29. A chicken and egg relationship exists where the demand for PA’s will be determined by how well organised and dependable the PA market is perceived. However, a critical mass of demand is necessary before a viable market can flourish and thrive to meet these expectations. 3.2.30. However, for illustration purposes if the current demand for PAs (see 3.2.6 above) doubled by April 2010 there could be approximately 500 people wishing to use their individual account or direct payment for directly employing a PA. 3.2.31. Assuming the national prevalence of a minimum of 1.64 PAs to each individual budget or direct payment recipient then the gap would be in the region of at least 460 PAs. However, the majority of PAs will already be known to recipient so the gap for career PAs is likely to be much less. 3.2.32. The early indications are that the majority of people who do not already know someone, to employ as a personal assistant, may continue to use agency and home care team services. 3.2.33. However, an investment to develop a directly employed PA marketplace could result agency workers switching to this way of working 19
  20. 20. should there be more cash reaching the market from self directed support. 4. Best Value and Personal Assistants 4.1.The development of a personal assistant market of people recruited and employed directly by a SDS recipient has potential to deliver services at a lower unit cost than if arranged or provided by Bradford MD Council. 4.2.In theory the growth of the personal assistant market operating independently of an agency or the local authority would redistribute demand by reducing reliance on higher cost suppliers. 4.3.In Bradford the majority of personal assistance (personal care) is provided by in-house, locality contracts and AIR or All-Inclusive Rate (domiciliary care agency approved provider list) services. 4.4.The locality contracts do not have a minimum guaranteed hours requirement so a reduction in use would not result in any penalties and there is also no tie in with the AIR agencies. Therefore, there is no apparent contractual barrier to commissioning directly employed PAs as an alternative to traditional home care. 4.5. As discussed in 4.1.14 above the hourly wage for directly employed Personal Assistants vary greatly and the national average in 2008 was £7.60. In Bradford the current average hourly wage (direct cost) is £7.50 per hour and approximately an average of £2 paid from the direct payment to cover employment costs (for example holiday pay, insurance, payroll costs). Therefore, together this works out to an average £9.50 per hour. 4.6.People on SDS determine what rate they are prepared to pay for a personal assistant. The Direct Payment Team state that recipients may choose to pay more for fewer hours of good quality service than having more time receiving a lesser service. 4.7.Where people get PAs from an agency the rate would depend on the costs of agencies in their geographical area. 4.8.Bradford MDC retains £13.75 per hour from a person’s agreed budget if the Council were asked to continue to provide or purchase personal care, and represents the Council’s calculation of the average cost per hour to the Council of procuring such services. 4.9.In comparison with home-care services the delivery of personal assistance by directly employed PAs will be on average more cost efficient. For example this year to date average cost of in-house home care provision (includes intake) is £21.38 per hour (including management and running costs) or £15.45 per hour as direct cost only. The average hourly rate for Locality Contracts is £13.36 per hour and All-Inclusive Spot contracts this is £13.62 per hour. 20
  21. 21. 4.10. The example in the table below models the potential lower cost where service users directly employ individual PAs that are not arranged through an agency or the Council’s home care service. The calculation assumes a 5% reduction in home care commissioned services and is based on the average gross cost (direct and employment costs) of £9.50 per hour for directly employed PAs by direct payments or individual account. (A) Average Overall Weekly Hours (B) 5% of (A) (C) Average Hourly Rate (D) Cost Difference = £8 - (A) (PA national average rate) (E) Estimated Annual Cost Difference =(B)x(D)x52 Locality Contract 5447 272 £13.36 £3.86 £54,596 All Inclusive Spot 4223 211 £13.62 £4.12 £45,205 In-House (including intake) 7221 361 £15.45 £5.95 £111,693 Total 16891 844 £211,494 Based on year to date averages 31 March 2010 4.11. With only a 5% shift of hours away from Council procured personal assistance this example suggests an annual reduction in the cost of personal assistance by £211,000. Further, this does not include any efficiency savings that may result from reduced management and running costs of the home care service. 4.12. While this is a crude analysis, and the actual saving would be influenced by fluctuations in needs and the actual (but still unknown) average hourly rate of the PA market in Bradford, it is highly probable that a robust and organised independent PA market has the potential to provide an alternative and more cost efficient choice for service user employers. 4.13. An inherent risk is for these potential financial savings to influence commissioning patterns without investment in the quality and standards of the independent Personal Assistant Market. 4.14. Individual transaction costs will be higher and will not benefit from other economies of scale. A consequence of this is that personal investment in training and other practice support could be neglected by employers. 4.15. A strategy for developing the market needs to therefore address the quality of directly employed PAs and address the potential risks of under investment and support. 5. Personal Assistant Market Barriers and Challenges 5.1.The history of direct payments has shown that three main factors have hindered progress with up-take of SDS: • concern about managing direct payments amongst service users and carers; • staff resistance; 21
  22. 22. • difficulties regarding the supply of personal assistants7 . Below are a few examples of common barriers and challenges to the expansion and quality of the PA market: Employers 5.2. While a national survey found that 79% of employers were satisfied with their current PA a third found it difficult to cope with the administration of being an employer and had difficulties recruiting an appropriate worker. 5.3.Concerns about lack of understanding and experience of managing the business, such as administration and paperwork, payroll and pensions, insurance and other employer’s responsibilities). 5.4.Difficulty arranging emergency cover (i.e. unplanned absences of PA). 5.5.Limited choice of PAs (more pronounced in rural communities). 5.6.Most local authorities allocate service users less money to buy their own services than would have been allocated if the councils arranged the care themselves8 . 5.7.Employers are generally unwilling to fund training for their employees citing costs – only 7% have arranged or paid for PA training and many feel it is not their responsibility. 5.8.Initial feedback from Bradford care managers identified that Service Users are interested in having a PA but stated a reluctance to become and employer and concern about the length of time to employ the right person. 5.9. In June 2010 twenty structured interviews were conducted with direct payment recipients in Bradford to learn about the opportunities and challenges of self directed support and employing a personal assistant. The common themes included: • Most people had been told about direct payments by their social worker but sometimes only after their care packages had gone wrong. • Compared to making their own arrangements most direct payment respondents were dissatisfied with services arranged by the Council on their behalf. • Everyone liked having their own budget because of the flexibility and the choices it gave them. 7 ESRC (2006) Disabled People and Direct Payments: A UK Comparative Study 8 Davey, V et al (2007) Direct Payments: A national survey of direct payments policy and practice 22
  23. 23. • However, managing accounts and administration is sometimes both difficult and complex. While a payroll system helped it did not alleviate all the difficulties of administration. • The majority chose to use agencies or to employ people they already knew. Only two people had advertised for a PA with mixed success. Getting the right PA through advertising was regarded as ‘luck’ and repeated advertising proved expensive and unreliable. • Those using PAs for personal care reported being content with the service they received. In respect of support by PAs to assist inclusion activities the main concern expressed was difficulty getting to know about what was available and a lack of suitable places to go for outings and activities. Quotes from Interviewed Direct Payment Recipients – June 2010 “I spoke to the members of my group. None of them had heard about direct payments. Nobody had told them even though they had problems with their support. I told them they could do this much better.” “I use an agency. Why? Can you really employ people yourself?” “Mum used to refuse services sometimes. She doesn’t like them to give her a bath, so I end up doing it. The flexibility of payments has been good for us though, because now I get a break while mum goes shopping with her PA, so I don’t mind. It works out well because we’ve timed it to fit in with the access bus. That way she keeps her independence; she collects her own pension and she likes to browse and choose her own things. The staff are so patient and I know she is safe. “The only downside has been the accounts. I would say people need to fully understand what they are taking on. I’ve been doing it since 2004, but lately it has got so much easier since we started using the Community payroll. Mum doesn’t want to be bothered with stuff like that- she just wants to know where she is going that day!” “There were times we couldn’t get any support and as a result we had money left in the bank and we had to pay it back. But she pays £160 per month towards her support and we didn’t get any of that back. They said ‘tell us which days she got no support and we’ll try to sort it out’, but I couldn’t remember which days. It seemed so complicated I said, ‘don’t bother’.” “There’s direct payments and ILF, plus her own money. You never get the same story twice about who should be paying for what and every four weeks you have to send money back because we don’t use all of it if she’s been unwell or at appointments.” “Finding out information like services, changes to benefits, legislation, things like that can be hard. We’re not on the internet, but we get a newsletter from Carers Connection. It’s very good. Perhaps information about using direct payments well could be put in there?” 23
  24. 24. “I advertised in the paper for my staff. I guess I was just lucky with getting the right people” “Finding a PA can be hard. Because it’s only 8 hours, nobody is going to do this as a permanent job. The DP team were very helpful, but advertising through the paper has cost £400! The person we picked only stayed 8 months because they didn’t hit it off. There has to be a better way” “Maybe my PA could meet up once a month with others to find out about what’s going on and how other people use their budgets and what services and equipment you can get”. Personal Assistants 5.10. Take up of direct payments has historically been insufficient to create a sustainable market of personal assistants and the specific services that payment holders require. 5.11. Little or no dedicated support for PAs (compared to employers who may get support from Direct Payment teams). 5.12. Barriers can include difficulty in finding out about becoming a PA, unable to find the right opportunities and isolation in marketing and promoting their services. 5.13. Terms and conditions of employment may be unattractive (low wages, limited sick pay or pension contributions etc.) and not conducive to stimulating a skilled and stable PA workforce. 5.14. Lack of awareness or understanding of employment rights. Research nationally has found that two fifths had no formal contractual job description. 5.15. Employers not supporting training or difficulty identifying and accessing suitable training. 5.16. Poor job security because there may be only one employer who is totally dependent on Local Authority funding. If assessed needs change there is a risk of loss of funding. 5.17. Lack of status associated with low pay, unsociable hours, limited career progression and training opportunities. 5.18. Respondents to a survey conducted June 2010 of Personal Assistants in Bradford found half had none or limited previous experience of working as personal assistants. 5.19. While limited the initial comments from personal assistants working in the Bradford region cite training, qualifications and not enough hours of work as principle barriers. 24
  25. 25. 5.20. Most respondents indicted that they would be very interested in support for a range of needs including: • Receiving news and information relevant to working as a Personal Assistant; support that promotes career development (such as training opportunities) and help to source work (rated on average 9 out of 10 in importance) • Contact with other personal assistants (peer support) & advice about employment rights (rated on average 8 out of 10 in importance) 5.21. A number of respondents commented that they would like information to support there employers to access resources and help when problems arise. Quote from Personal Assistants in Bradford June 2010 “How to get around the qualifications or training! Most employers want one or both before they take you on, but how are you supposed to get trained if no-one will [train you]!?!” “I fill in many forms leaving my contacts for PA employment but always seem to be chasing work. I see many jobs advertised but when I send in application process takes a long time”. “Am waiting for my CRB to come through. I've got a job with a 12 year old boy but at the moment it's only 2 days a week. My car is also insured for business use. I would like more hours”. Would like “Info for things to do to get out and about to aid the people I care for, i.e. sightseeing, places of interest and discount tickets etc for things like national Trust, Cinema, parks etc”. Would like a “Newsletter on a regular basis ….. Where to seek advice for clients re any problems etc” 6. Role of Local Authorities 6.1.The role of local authorities in developing and supporting the PA market is varied with most doing so by collating and providing information. 6.2.The LAs role may include, for example: • Provide information and advice including factsheets for both PAs and Employers • Ensuring safeguarding and quality concerns awareness • Investing in community organisations that will develop a PA support service. • Publicising PA support services and coordinating recruitment campaigns 25
  26. 26. • Policy decisions such as creating flexibility in assessed need payment rates so that PAs fees can match complexity of needs • Establishing fair charging policies for any PA support services and support brokerage services. • Subsidise or pay for CRB checks and training. • Promote the development of a personal assistant list or register. 6.3.In the case of PA registers these tend to be external and independent (with branding distinct from that of the LA). Appendix 11.1 provides example of PA Schemes including some with registers. The only examples we found of Authorities that do host registers are Merton and Wigan & Leigh. 6.4.Our research did not find any ‘accreditation schemes’ for PAs run by a local authority. Only one LA has a comprehensive programme of ‘approved’ PAs (Oxfordshire) which is run in conjunction with Trading Standards ‘Buying with Confidence’ scheme. The Council trains, complete checks, and ensures signing up to a code of conduct before ‘approving’ PAs although they still recommend that the service-user, as an employer, also completes their own checks. The scheme went operational in January 2010 but by April 2010 had only trained and approved 12 PAs. 6.5.Councils do not in the main offer any specific training or approval checks for PAs. However, most do offer a support service to the service users in terms of advertising for a PA, help with the recruitment process and to offer services such as a Box number and interviewing space away from the employer’s home. 7. Existing Personal Assistant and Employer Support in Bradford Bradford MD Council 7.1.Bradford Council does not provide any specific support or training for PAs. Enquiries about training for PAs are signposted to external providers to give advice. 7.2.However, Bradford MDC Workforce Development Unit undertakes training for Council staff in Common Induction Training. A whole time equivalent post exists to support external market development and it is feasible for this to include directly employed PAs. There is capacity to train additional groups of 20-25 people approximately four times a year. 7.3.The Council’s Direct Payment team assist service-users with assessed need to find and employ a personal assistant. Support includes help to advertise and recruit (supply application forms, help with short-listing, interviewing and information packs). The Direct Payment team does not approve or recommend PAs and the onus is on SUs to complete checks, including CRBs (although helped in doing so) at their own expense. 26
  27. 27. 7.4.The Direct Payment team is currently running a capacity of 4 direct payment officers to 187 direct payment recipients. Other Local Resources 7.5.Some CQC registered domiciliary care agency providers in Bradford area are offering services that resemble the work practice of a PA (carer workers who work exclusively for specific service users) although the PA is still employed by the agency and not the service-user. 7.6.Bradnet’s Independent Living Service, their CQC registered domiciliary care agency, operates a PA register and has a rolling programme of training. Support includes matching disabled people with PAs across the whole of Bradford and Keighley. They undertake references, CRB checks and provide support for supervision and review. They also complete assessments where no statutory assessment has been made (e.g. self-funders). Bradnet are the employers and not the service-user. 7.7.Other registered domiciliary care agencies providing this type of flexibility include St Anne's, Supported Lives, Active, and Able Community Care. These agencies have historically worked with service-users with learning disabilities, physical disabilities, and those who require someone to live-in. 7.8.Older people's care has tended to centre around block contracts based on geographical area and typically traditional service offerings focused on personal care needs using rotas, where a variety of carers could call at a time that suits the agency. 7.9.However with the introduction of Individual Accounts, there is now scope for older people to choose an agency that offers PAs. Service providers should be encouraged to develop further opportunities and choice for personal assistance. 7.10. Age Concern Bradford & District already has trade registers including ‘personal care’ listings9 . Currently they have only domiciliary care agencies registered. They do not do not advertise or solicit traders to come on to the register. A documentation vetting and checking process is undertaken based on an application for registration process before the information is made available to clients. The demand for registration has been low from agencies and currently only three are registered. Career PAs would be able to apply to register (free) but are required to pay for an enhanced CRB. They would have to produce three references, public liability insurance and evidence of any professional membership before the PAs details are included on the register. Essentially this is an approved list but cannot be accessed online by PA employers (they need to telephone and are given 3 names from the list). The scheme may therefore have some limitations in facilitating easy access. 9 27
  28. 28. 8. Safeguarding Vulnerable Adults in an Unregulated Market 8.1.A concern regarding directly employed personal assistants is that if employment checks are voluntary, people with criminal records may be able to persuade the person employing them that checks are not necessary. 8.2.The future role of regulation in relation to self-directed services is not clear. How best to protect people directing their own support from abuse has to be balanced with people having control and choice over their own support. 8.3.Innovations by Councils to address these concerns while also promoting the principles of personalisation will reflect organisational culture and attitude towards risk and risk taking. 8.4.In November 2008 no Council receiving a service inspection had a systematic approach in place to address the balance choice-control and safeguarding10 . 8.5.CSCI (now CQC) found examples of Councils offering options to people that help to prevent abuse and minimise risk without undermining choice and independence, tailoring arrangements to individual circumstances. These options included: • Good information on safeguarding in card form • Obtaining CRB and career history checks and references for personal assistants • Recruitment support from a third party • Training and support on financial and employment issues and potential abuses for people directing their own support • Routine council checks on progress through care plan reviews • Organising forums of people directing their own support to share experience and good practice. 9. Personal Assistant Accreditation and Registers 9.1. Overview 9.1.1. An emerging response by Councils to safeguarding concerns is to promote a register of personal assistants that allows employers to have more detailed information about potential employees enabling better informed choices based on the character and competency of the people offering services as personal assistants. 9.1.2. A secondary function of registers is to stimulate and promote the personal assistant market. The potential for this will depend on the nature 10 CSCI (November 2008) Safeguarding adults: A study of the effectiveness of arrangements to safeguard adults from abuse 28
  29. 29. of the system put in place although the aspiration is that a well run register could possibly: • Consolidate and promote the visibility of the local market for personal assistants • Increase confidence of employers to employ PAs previously not known to them • Promote work opportunities with increased volume providing job market stability needed to attract more PAs to enter the directly employed market. • Have secondary gains by strengthening both employer and employee communities where sharing of support (including workforce development and standards) can be organised in a coordinated way. 9.1.3. A policy decision that the Council needs to address is its role in putting in place a system of accreditation or approval of personal assistants that promotes safeguarding, while at the same time is flexible enough to meet the diverse nature of peoples’ wishes given the increased choice they will enjoy controlling their own funding. 9.1.4. A Council accreditation or Approved list would by definition exclude a sector of the market place that does not meet the set criteria for inclusion on a list. 9.1.5. The support for a compulsory register by employers is mixed. The Skills for Care survey found that 58% of employers felt that having an official register would be useful although half wanted it to be voluntary and the other half compulsory. However, 71% stated that they wanted to retain the right to choose their own personal assistant including someone who is not registered. 9.1.6. There is a view held by some service users and disability groups that accreditation or other approved lists is actually a backdoor to restrict their freedom of choice and decrease the power they have in employing who ever they wish. 9.1.7. Therefore, introduction of a compulsory accreditation or approval list would potentially be a politically sensitive development. 9.2. Accreditation and PA Support Schemes – Legal Issues 9.2.1. A concern by some Local Authorities is that the development of an accreditation process, led by a Council, could potentially blur the line between the Council’s role in providing information to promote choices and its role as an employer (since the Council may be seen as introducing, training, vetting and giving approval/accreditation. This is 29
  30. 30. compounded by the fact that the source of money for pay comes from the Council). 9.2.2. Bradford MDC Corporate Law Team has been consulted regarding this concern. The legal view is that, “It is difficult to see how this arrangement could result in the inference of an employment relationship”. The full response is included in appendix 11.2. However, the main points include: • This arrangement appears to be similar to that provided by some children services in local authorities in relation to registered childminders. • Ultimately the service user dictates how the service is provided while input from the Council concerns safety and standards. The key decisions affecting the employment relationship will continue to be determined between the service user and the personal assistant. • An appropriate disclaimer by the Council should reinforce that the employment decision is that of the direct payment recipient and they need to carry out their own checks, using the list as a source of information only. For example, Wiltshire Direct Payment Support Service operate this register to assist disabled people living in Wiltshire in finding Personal Assistants (PAs). This in no way acts as a recommendation of any PA and we do not CRB check PAs or carry out any other suitability checks prior to entry on the register. It is therefore important that the potential employer carries out any checks they feel necessary before employing anyone. 9.2.3. The key questions for deciding the extent of the role of the local authority in supporting a registration list and personal assistant support scheme are: • Do direct payment recipients in Bradford want an ‘approved’ list and is this compatible with the aims of personalisation? • Or is an inclusive register (providing information about the skills, CRB status and other attributes but is not a closed list) more appropriate to allow greater choice while also sharing information about standards and quality? • Can the Council take a leading role in supporting personal assistants while having a paramount duty of care to service users or does this present a potential conflict of interest? • Who keeps (hosts) and maintains the register, as this may reflect the degree to which the recipients of direct payments or individual accounts perceive they have control over the resource? 30
  31. 31. 9.3. Accreditation and Register Options 9.3.1. The key decisions about the above will be based on a policy or philosophical considerations rather than legal principles. 9.3.2. A register can validate credentials and the PAs qualifications / skills without endorsing or recommending the registered personal assistants. In contrast an accreditation or approved register or list restricts membership to those PAs who have met certain minimum criteria. 9.3.3. The principle of Personalisation is to allow maximum choice to service- users. There are advantages to having some form of approval or accreditation scheme for PAs to allow peace of mind. However, because people employ PAs for a wide variety of tasks it would not be beneficial to insist that everyone needs the same training, or even any formal training at all. Equally, although it is universally recommended that checks are carried out, this isn’t always welcomed, particularly when family or friends will be employed. 9.3.4. The options are set out in the diagram below: 9.3.5. From our research the majority of councils appear to have opted for registration system that are voluntary and provides information to support informed choice and are not approved lists of PAs. (See appendix 11.1 for more detail of various schemes). 9.4. Function and Purpose of a Register 9.4.1. The primary purpose of a register is to facilitate and energise the marketplace of long term, regular Personal Assistants who are directly employed (‘career’ personal assistants). 9.4.2. The register also could function as a source of short term cover by personal assistants that are CRB checked and able to respond quickly (this may include people employed by an agency or working independently who are willing to respond at short notice). Accreditation or Approved List Hosted & Managed by Council e.g. only one example found - Oxfordshire CC support with confidence scheme Accreditation or Approved List Hosted & Managed by VCS. No examples found Register Hosted & Managed by ULO e.g. Essex Coalition of Disabled People; NW-PA (Age Concern & Cheshire CIL coalition). Register Hosted and Managed by VCS or Council e.g. Compass Disability Services, Wilts; Merton Council; Wigan and Leigh 31
  32. 32. 9.4.3. An option for the register is to provide a link with domiciliary care agency workers where care is organised in line with a personal assistant model including support for inclusion (however, this is likely to be at a higher cost). 9.4.4. Potential uses of a register are: • Provide a platform for a visible personal assistant marketplace that is updated and current. • Improves speed of access and connects people looking for work with those seeking personal assistance. • Good information facilitates informed choice by service users by giving details, skills and credentials of people on the list. • Create a ‘community’ for personal assistants where information that supports their career development can be developed and shared. • Provides signposting to impartial and reliable information for both PA employers and employees (for example, the Personal Assistant Network at 9.4.5. Potential users of a register: • People in receipt of direct payments or individual accounts • Relatives and friends supporting a service user • Professional brokers / care managers • Self-funders 9.4.6. Consultation in the West-Midlands found that what people want: • Employers recruiting PAs want to get the service at the right price and quickly • For PAs it is having sufficient employment to make it viable and to not keep filling in application forms. 9.4.7. A Personal Assistant register could be electronic or paper based or both. However, the organisation and resourcing of the register will need to be dynamic otherwise it would soon become out of date and not useful to the end users. 9.4.8. As noted earlier Bradford MDC Direct Payment Team already has a ‘list’ with 385 names of people who have responded to PA adverts. However, very few on this list are actually known to be regular PAs and 32
  33. 33. their credentials have either not been checked or updated. As a result the usefulness of the list is limited. 9.4.9. Therefore, for a register to be relevant it needs to hold information about PA credentials, price and availability, as well as information that will help in skill matching (such as a PA profile of interests and personal attributes). For the PA it should provide a means of reducing form filling and marketing their services directly to service users (such as through a secure gateway where the identity of the service user is protected until they choose to make contact). 9.5. Online and Electronic Register Service Providers 9.5.1. Four online service providers were identified offering solutions dedicated to a personal assistant register. Other E-shop solutions have the potential for including personal assistants. Appendix 11.3 provides a more detailed comparison of features and cost. 9.5.2. There are a number of common characteristics: • None independently provide a vetting or checking feature and where these checks exist it is the responsibility of the local authority or an agency. • All have a secure online account registration system. • Most offer an inbox system for employer and PAs to communicate (although restricted by some for safeguarding reasons – i.e. PAs cannot see details of employers). • Very little direct support for PAs is offered through these services (for example none offer support for training although PA Pool is considering developing a PA support service including training, advice, payroll and CRB checks via partnering organisations). 9.5.3. For comparison PA Pool and the NW-PA model (determined by Age Concern and not Adomedia) impose subscription charges on service users ranging between £52 and £58.70 for 90 days respectively. Registration of PAs is usually free. 9.5.4. Slivers-of-Time is a form of agency working for anyone with spare hours to sell to local employers. Agencies operate the marketplaces for Slivers-of-Time. They vet the participants and see them into the market. The agencies’ payroll / invoicing systems take over once a timesheet for a booking is completed. A subscription fee is required for employers. 9.5.5. PA Pool is a “non profit distributing” company and user-led organisation building a UK-wide hub for PA recruitment. It offers a dedicated website for disabled people looking to employ a PA (PA Employers) and for PAs looking for work. PA Pool offers members the 33
  34. 34. opportunity to interactively manage their own recruitment or employment. Members manage their own profile content and members can view profiles containing information about a person and what they are looking for - whether they are looking for a PA or a PA job. They can search the database using specific criteria, and PA users only pay a subscription fee when they are actively looking for a PA and wish to contact a potential candidate. 9.5.6. Adomedia NW-PA has designed a website (North West PA Register, formerly known as Cheshire PA Register) to bring together people seeking employment as a Personal Assistant (PA), and Employers looking for potential PAs allowing access to information about people who want to be a PA or vacancies for PAs in an area. Employers and PAs register an account (registration is free only for PAs and employers pay a subscription). 9.5.7. Historically Opportunity Links has developed child minder registers with local authorities in East of England. However, the Company is excepting from July to create a register for PAs but also other people who would undertake activities in people's homes (trades people etc). PAs and service users will be able to register online but goes through back office vetting system, (managed by staff of the local authority). For safeguarding reasons they opted not to include service-user details for matching. SUs can select searched based on their requirements and online bookings are in real-time. 9.5.8. The cost of the registers varies widely from approximately £0 (PA Pool – national site already exists) to £106,000 (Slivers of Time) for set up. In respect of per annum charges these also range widely from between £330 per annum (Adomedia hosting fee) to over £24,000 per annum (PA Pool for licence option paid by LA per 200 users). 9.5.9. Initial indications are that the demand for these services by employers has not been significant. For example see tables next page: 34
  35. 35. PA Pool May 2010 registration statistics for Yorkshire: Region Registered Employers Registered PAs NW-PA June 2010 registration statistics: Region Registered Employers Registered PAs 9.5.10. PA Pool and NW-PA are established services. Possible reasons for the poor uptake by employers and PAs could be: • Both charge a high subscription to the service user, which may be a disincentive to register. • Without a dedicated PA support the services may not be achieving a potential or meeting a need beyond a place to advertise. In other words a register in itself is not addressing the barriers for entering and remaining in the PA market. 10.Personal Assistant Project Recommendations 10.1. A Holistic Systems Approach 10.1.1. The analysis suggests that both the demand and supply for and of personal assistants is low in Bradford (although some demand may be delayed because of the re-enablement process). 10.1.2. There is little evidence that a register or list alone is effective in increasing both demand and supply. Rather a holistic model needs to address any barriers that may exist that are unintentionally restricting the uptake of direct payments to buy personal care (as apposed to continued use of traditional channels of care). 35
  36. 36. 10.1.3. Without sufficient cash entering the market to provide sustainable income opportunities few career personal assistants will enter the marketplace. 10.1.4. An ongoing PA project is required that takes a systems approach that covers three key areas – inform, develop and empower. 10.2. PA Project Framework Partnership Approach 10.2.1. There is a good rationale to delineate in the roles of the supporting Personal Assistants and employers. The in-house options are considered below: Personal Assistants - Home Care Team • There is some capacity for the homecare team to absorb a register within the Time Out service. A management structure is already in place that could support PAs. • However, there are a number of problems associated with such a model: o Potential liability to the local authority, as may be viewed as being an agency requiring registration with CQC. o Blurring of boundary with other homecare services may leave the authority obliged to offer back-up cover. o Through association may reinforce continued reliance on traditional practices in delivering personal assistance. Inform EmpowerDevelop Early access to advice about using direct payments to employ a PA Shaping the market through investment, workforce development, partnerships, co-production of standards etc. Support service users and carers to take more direct control of their own solutions (i.e. an online a PA register) 36
  37. 37. o An in-house support scheme for personal assistants is unlikely to achieve the empowerment and control outcomes to the same extent as an independent, external host or provider such as schemes promoted by User Led Organisations or VCS services. Employers – Direct Payment Team • The Direct Payment Team already provides a service to support people who wish to directly employ personal assistants. While there are examples of such schemes being managed outside of the local authority there are no particular disadvantages in having an in-house service. • The direct payment recipients interviewed were happy with this service although most expressed that it would have been helpful to have accessed or known about the service earlier. The indication is that people who are assessed as eligible for social services do not always understand the option for using direct payments to directly employ their own PAs or the extent of the support they could receive from the Direct Payments Team. Better information and understanding of support offered earlier may increase the take up of direct payments to purchase directly their own personal assistance. • The Direct Payment officers are best equipped to provide this information. While information in leaflets and guides are useful face to face interaction is likely to be more effective in the initial stages. • The Council should consider an in-reach for Direct Payment officers earlier on in the customer journey (perhaps initially together with practitioners at the initial visit and assessment stage). This could be monitored to see if there is a resultant increase uptake for using cash to directly employing a personal assistant. 10.3. Personal Assistant Project. 10.3.1. Recommend that support for employers remains with the Direct Payment Team and capacity increases to support a proactive role in providing information and advice earlier on in the customer journey. This is key because without a better use of SDS money to directly purchase personal assistant the PA market will not expand. While options for support in the role of employer are not known or understood many people will not opt for direct payments. 10.3.2. Recommend that support to Personal Assistants is hosted external of the Council and developed in co-production with the Council, service users and their carers or advocates or other appropriate voluntary community service stakeholders. Existing initiatives, such as Age 37
  38. 38. Concern Bradford and District‘s trading register may be a potential bolt on for a PA register. 10.3.3. Hosting of the project for-profit provider (such as a domiciliary care agency that has a PA register) is not recommended because of the potential monopoly over the PA market by a single provider. A register hosted by a voluntary service would allow agencies to register employees that work flexibly as PA. 10.3.4. Further, non-restrictive Payment and Charging Policies (free for both PAs and Employers) are recommended, as it is likely that subscriptions are a disincentive to registration. The Council could support through investment so that the project does not need to find revenue from PAs or service users 10.3.5. The register needs to be part of a wider PA Support scheme. Therefore a holistic PA Support project could offer the following initiatives to support the development of both the capacity and quality of PAs: • Identifies workforce development issues and produces a common induction framework for PAs together with employers. • Provides an administration resource to validate the identify of the PA and the credentials, such as qualifications, that they provide in their listings (for example, a visual check of CRB or clearance of Vetting and Barring process11 where stated). • A register that is not an approved list but presents clear and factual information about a range of service providers. • Allows access to a register via different media including print outs, telephone and internet. • A Code of Conduct for PAs is developed together with employers and PAs. PAs using the register would indicate that they have understood and will abide by the Code of Practice. • Coordinate recruitment drives for personal assistants and communication about the role and responsibilities. • The online register is developed to have content features with guidance and resources for both employers and PAs. For PAs this may include: o Opportunities for free or reduced training costs by through volume bookings. o Updates on employment law and rights. 11 This is being introduced in England by the Independent Safeguard Authority (voluntary from July 2010, mandatory from Nov 2010) Total cost will be £64 and includes CRB and one off registration of £28). Benefit of this scheme is that the employer is notified if change to CRB status between annual renewals. 38
  39. 39. o Information about standards and good practice. o Forum for sharing good practice and knowledge. o Guides or ‘toolkits’ for employing and becoming a PA. o Links to Payroll and other Human Resource supports. o Information on safeguarding and how to identify/report abuse. 10.4. Project Costs 10.4.1. The Council should be cautious in investing in expensive technical solutions when the demand for online register is not fully understood and where projects have been established these seem to be poorly supported by employers (possible reasons described above). 10.4.2. However, given a ‘free’ registration service and dedicated promotion usage may improve. A register embedded in a wider support project (whole systems approach) would contribute to consolidating the PA market and provide a visible presence. 10.4.3. The core costs of a project include: • Development of an online register to be hosted by a non-profit organisation that is not also a provider of personal care. • Project coordinator / administrator or equivalent providing support to the registration process and developing knowledge and information resources (toolkits for PAs) • Increased capacity of the Direct Payment Team to improve earlier access to direct payment support, information and signposting to employment resources, such as payroll services. 10.4.4. The following is an illustration of a base cost for development of the PA register including a resource manager: • One off cost of £15,000 for a bespoke development of a register with both online and offline (printed) capabilities. For example based on the Adomedia model but without subscriptions. Approximately £500 per annum for hosting fees. • Resource coordinator at senior administrator level or equivalent (based on posts held in similar PA projects this would be equivalent to rates of pay at upper Scale 5 £21,519 to Scale 6 £22,221. 10.4.5. The project can be scaled up should demand increase and operating cost off-set by the expected reduction in reliance on more expensive, traditional forms of provision. 39
  40. 40. 40
  41. 41. 11.Appendices 11.1. Examples of PA Schemes Organisation Register updated accredit ation CRB Employ ment support Training Essex PASS Essex coalition of disabled people. Manually- PA must contact None- Recomme nded SU funded Yes-su no Web based By PA online none No no no Wiltshire- Web based and searchable online htm Online but cleared by staff none no no no Derbyshire with Centre for Indep. Living no n/a none none Yes-su For service user Dorking- Lifetrain trust no n/a Open college network Accredite d training no no For PAs And Sus Merton council Council website on-line assistant-database.htm manually no no Sample letters, forum no Manchester no n/a no no informati on no 41
  42. 42. Organisation Register updated accredit ation CRB Employ ment support Training Doncaster with South Yorkshire centre for inclusive living no n/a no Advice only Induction pack Disability equality and moving and handling Paid for by SU Lancashire Yes- linked to national site ? no no Yes, to SU no Oxfordshire with trading standards Yes g+control/Home/ ? ‘Approve d’ Yes, plus risk asst by OCC HR and trading standards yes Yes, 7 days NVQ standard- in house Wigan and Leigh- PASS personal assistant support scheme Yes ents/PASS.htm ? no no Yes Advice where to access Dorset, Nottingham, Solihull, Staffs Warwickshire: all with Rowan organisation no n/a no Expect LA to do but if not will do yes no NW-PA 42
  43. 43. 11.2. Legal Advice on LA run PA Accreditation & Register From: Marcia McFarlane Sent: 02 June 2010 15:00 To: Shona Grange Cc: Kerry Mosley Subject: Employing personal assistants Dear Shona, Please find below a summary of my thoughts on this matter- I understand the query is as follows: The council is in the early stages of scoping a possible approved/accredited personal assistant 'list'. This will be held by the Authority for 'customers' with direct payments/individual budgets. One arrangement is for the local authority to provide training and bench-marking, CRB and ISA checks, alternatively recognised training plus CRB and ISA checks. Either will be accessible to the public as a service so that service users are assisted in determining carers that are better suited to their needs. I understand there are concerns that this assistance might result in blurring of the lines between the Local Authority as a provider of information service as opposed to the Local Authority as an employer since the council may be seen as introducing, training, vetting and giving approval/accreditation. This is compounded by the fact that the source of money for pay comes from the council. On first glance the proposed arrangement appears to be similar to that provided by some children services in local authorities in relation to registered childminders (i.e details of the childminders available on a list from which the parent can select ( some lists carry more information than others). It is difficult to see how this arrangement could result in the inference of an employment relationship. I expect that the Local Authority will not determine who is appointed to a particular service user, instead the service user ultimately selects the worker (keeping in mind that the service user may choose someone not on the list). The service user will dictate how the service is to be provided, when holidays should be taken, hours of work, when the contract should end and how it ends. I would expect that if there are any negotiations on pay the service user will do this. In short the key decisions affecting the employment relationship will be determined by the service user and the worker, while decisions affecting standards and safety will have some input from the council. The service user provides the work and the worker provides the personal services, so if any employment relationship is to be implied it is most likely to arise between the worker and the service user. The fact that the council funds the arrangement will not necessarily result in an inference of a contract and provided we can explain any council involvement in terms of our obligations to assist and support vulnerable adults then the prospects of resisting an inference of an employment contract is better. I describe this arrangement as the council in the role of facilitator or information provider. The best reassurance I can offer is the suggestion that the list carries an appropriate disclaimer e.g ' The council has collated this information in order to provide assistance to those members of the public who are considering engaging personal assistants to provide support with personal care. Please note that you are not obliged to only consider the persons on this list. Most of the information in this document has been provided by the individuals and therefore the council does not give any warranty as to the accuracy of the information in this document. The public are therefore encouraged to take reasonable steps to confirm the information in this document and must make their own determination 43
  44. 44. on suitability. It is not the council's intention that any legal relationship be created or inferred from the provision of this information.' If this does not deal adequately with your question then please give me a quick call and I will look at the matter again in light of our discussions Marcia McFarlane Senior Solicitor Corporate Law Team 44
  45. 45. 11.3. Comparison of Online Solutions: Features & Cost Features Supplier Slivers of Time PA Pool Adomedia (Age Concern NW-PA) Opportunity Links Approves Entries LA or purchasing agency needs to set approval protocols. Approved on face value only & content moderation only. The local authority or host organisation staff approve the PA account details The local authority or host organisation staff approve the PA account details Vetting (i.e., CRBs, checking qualifications) LA agrees safeguarding framework and criteria. No validation or documentation checks No validation or documentation checks (unless LA or host organisation undertakes checks) No validation or documentation checks Database Maintenance Yes maintains the database and provides local area Yes Yes Matching Service No No No Do not hold SU details for safeguarding reasons Online Availability Time table Yes Yes Yes Yes Bookings Online Yes Yes but PAs and employers can communicate using an inbox system No but PAs and employers can communicate using an inbox system Yes, in realtime Statistics Yes Local areas specific Yes No PA Training & Practice Support No Plan to develop training, advice, information, payroll and CRB checks by partnering with organisations who are experts in these fields. No No Web development Cost £30k +vat None – nationally hosted register already exists IRO £10-15K for bespoke development for Bradford £15K Subscription Costs Monthly licence fee of £5k + vat pcm or if turnover is more than £250K per calendar pcm then 2.5% service charge on each transactions PA employer subscribes 3 days - £5 1 month - £20 3 months - £52 6 months - £98 1 year - £188 However, Local Authority can buy a license that gives service users free access(i.e. £24k pa for 200) Not required by Adomedia although client can set subscription policy. None Hosting Fee None £281 plus VAT £2.5k p.a. Estimated Total Cost to LA per annum £70.5K per annum inclusive (£105,750 first years with start-up) None if relies on SU subscriptions; or estimated minimum £24K per annum (limited to 200 SU or £120 per service user) Initially £15k then £330 per annum (incl. vat). Separate contract required for hosting agency to manage the register Set-up £15K then £2.5 per annum 45