It is a statutory duty as defined by the Care Act 2014, to offer a person a Direct Payment as a cash alternative to a directly commissioned care and support service where a person has been assessed as having eligible needs. This applies both to carers and people in need of care and support. The regulations of the Children Act 1989 also place a duty on Local Authorities to offer a Direct Payment to disabled children.

The review of Direct Payments was presented to the Adult Social Care and Public Health Committee on 29 November 2022 and approval was given to explore how a Personal Assistant (PA) register could best be delivered with the intention of increasing the numbers of people, carers and families choosing to use a Direct Payment. This report sets out the options as they relate to the Personal Assistant (PA) register as identified by the Direct Payments working group. The proposed model (Appendix 1) and Implementation Plan (Appendix 2).

This review has been a collaborative exercise and included, as equal partners, officers of the Council, people with lived experience, and representatives from Cheshire and Wirral Partnership NHS Foundation Trust (CWP) and the Wirral Community Health and Care NHS Foundation Trust (WCHCFT). The report supports the following priorities from the Council’s Wirral Plan:

· Working for safe and vibrant communities where our residents feel safe and are proud to live and raise their families.

· Working to provide happy, active, and healthy lives for all, with the right care at the right time to enable residents to live longer and healthier lives

Resolved – that,

1. The proposed service model (Appendix 1) and implementation plan (Appendix 2) be endorsed

2. The Director of Adult Social Care and Health be authorised to progress with implementation of phase 2 of the proposed service model as detailed in Appendix 1 , commence the proposed procurement exercise and award the contract.

3. A further report be brought to a future Committee with proposals for implementation of the remaining phases of the model.

Option 1 is the recommended option. It will provide a matching service for PAs, people and families and will run in parallel with the contracted managed accounts service. The recommended timescale for the pilot will enable ongoing evaluation providing the evidence necessary to enable us to recommend a single provider or a framework of providers for the delivery of the next phase of the model. (Appendix 1).

Option One

Option 1 is the recommended option. The review has identified a range of delivery models, across several Councils. In some areas a single provider delivers a PA Register, support, and a managed accounts service and in others, a framework of providers where the functions are shared. There is insufficient evidence to define which model has generated the best outcomes. A 1-year pilot, for the delivery of a PA register is, therefore recommended. This allows the Council to establish if direct payment recipients report improved access to PAs for support. A phased introduction does not require a significant financial investment. It avoids the limits that a protracted contract imposes and enables us to return to committee with a recommendation on phase 4 of the plan. The recommended option, if approved, can become operational in September 2023. A soft market exercise was undertaken in August 2022 to identify organisations that could provide a PA Register. A further soft market test exercise was undertaken in May 2023 to gather further information and to establish if there was any further interest. Following analysis of the interested providers, a short, closed procurement process is proposed, following evaluation it is anticipated that the contract could be awarded by mid-June 2023, allowing for provider mobilisation the pilot service could potentially be started by mid-September 2.2 Monthly targets for the level of recruitment of PAs will be agreed with the accredited provider prior to the service going live. The percentage increase in people taking up a DP in the community and from inpatient settings will be monitored. The cost of the service is broadly comparable with the funding arrangements in other Councils and will be in the region of £27,000.  

Option Two

The inclusion of a PA register as part of the Council’s provider arm was considered. Current capacity within this service would prevent the development of a register at the pace required.

Option Three

inclusion of a PA register as part of the Council’s Personal Finance Unit was considered. Current capacity within this service would prevent the development of a register at the pace required. It will however continue to provide the current administrative function.

Option Four

Tender for a full Direct Payment Service to include a Personal Assistant Register, Payroll, and Managed Accounts Service, information advice and support. This could be a protracted and potentially expensive service limited by a pre-defined specification.