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The Self-Defined Training Needs of People who use Direct Payments and Personal Budgets in Wiltshire in 2011.

Wiltshire CIL delivers training to disabled people

Report of the Survey Results by Clare Evans January 2012

Published by: Wiltshire Centre for Independent Living, Learning and Research Centre Devizes 2012

Author Clare Evans to whom any correspondence about this publication should be sent:clareevans@wiltshirecil.org.uk

CONTENTS
Foreword and acknowledgements Introduction Methodology Characteristics of respondents in table Findings Discussion Policy and practice recommendations References 4 5 5 6 7 10 12 13

FOREWORD
We hope this small piece of research will be used to inform the development of support service design and specification for direct payment users and also inform the wider personalisation agenda nationally. In conducting this research we have been concerned to follow an emancipatory approach throughout so disabled people have led the process from the point of identifying the need for it to publicising its availability and developing an action plan based on the findings. Thanks are due to all the disabled people who have been involved in this process including the 100 people who responded to the survey. Whilst only a small research project, we hope the results will be of interest both locally and nationally to all those seeking to move forward the personalisation policy. Our thanks are also due to a number of other people who assisted in the research process: to Mel Pow and Louise Farrant, social work students on placement, who collated the survey results and represented them virtually in preparation for analysis, to Janette Moore and Diane Zeitzen for further collation of results, to Ruth Evans for professional research advice and Polly Hannan for cover design.

Clare Evans Chair of WiltshireCIL Geraldine Bentley Director of WiltshireCIL

January 2012

The Self-identified training needs of Direct Payment & Personal Budget users in Wiltshire in 2011 Introduction
This report discusses the results of a survey conducted by Wiltshire Centre for Independent Living from October to December 2011. The aim of the survey was to ask direct payment users to identify the workshop training they considered would be useful to them, both in managing their own self-directed support and in leading a full independent life in the community. In carrying out this training needs analysis we had the clear purpose of gathering information to use in planning the training disabled and older people wanted in our first training programme in 2012. The training needs analysis is part of a strategy we are currently pursuing which also includes looking for funding to put on training events free of charge for disabled people. This training programme, the first provided in Wiltshire since the inception of direct payments in 1997, will be delivered by disabled trainers and mentors through day workshops and will be free at the point of delivery with travel costs paid. The national policy of Personalisation in Putting People First (2007) and the increasing emphasis on self help and peer support (2010) makes this research of some interest nationally, particularly in relation to rural areas. The survey results reveal that some direct payment users were interested in receiving training delivered by their peers to enable them to manage their direct payments more effectively. Peer-led training provided in a safe environment may be a cost effective way of supporting users to manage their direct payments and lead fulfilled lives in the community. The results also demonstrate employers' desire for training for their personal assistant employees at a time when this part of the social care workforce is increasing. After an overview of the methodology used in this research the results of the survey are given and there follows a discussion within the policy context and policy and practice recommendations are made.

Methodology
Our awareness of the need for this research grew from informal comments made by direct payments users at Wiltshire CIL direct payment peer support groups across Wiltshire about their training needs. We have been committed to using an emancipatory approach at all stages of the research. The research was led by an experienced disabled researcher who uses self-directed support. Other disabled people were involved in the survey design.
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1037 questionnaires were distributed in hard copy to users and carers listed by Wiltshire Council as using direct payments, including a small number of people involved in a pilot on personal budgets. Freepost envelopes were provided to return questionnaires and recipients were encouraged to contact Wiltshire CIL office if they required the questionnaire in another format or required assistance in completing it. 100 completed questionnaires were returned to the Wiltshire CIL office and the information was collated by 2 social work students on placement from Wiltshire College and by the researchers personal assistants. The draft report was circulated to disabled people and allies for comment. Table 1 shows the profile of 100 respondents. Table 1 PROFILE OF 100 RESPONDENTS TO TRAINING QUESTIONNAIRE Length of Time on Direct Payments Less 1-3 years 3 years than + 1 year 12 11 44 33 Male Female 26 53 20-35 36-50 Over 50 10 18 60 White White Black Asian British Other British 82 0 1 1 Phys LD MH Old Hearing Sight Imps Issues Age Imps Imps Probs 46 17 11 16 13 9 Not at all

Gender of Respondents Age of Respondents Ethnicity of Respondents

Impairments of Respondents

Notes 1. 2. Not all respondents answered all questions Some respondents had more than one impairment

Some comments implied family carers were completing the form in their own right as well as others completing them on behalf of the person they cared for. This reflects the fact that some family carers received a direct payment in
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their own right to give them a break from care work. There was no question to identify the numbers of family carers receiving direct payments in the questionnaire. 12 of the 100 respondents reported that they were not currently using Direct Payments. This may be because they had recently stopped using direct payments or had been circulated with the questionnaire in error. Their responses have been excluded from this report and the results are therefore based on the responses of 88 current direct payment users.

Findings
The questionnaire results show a number of findings relating to the training needs that direct payments users identified. Over two thirds of respondents (68%; 60 out of 88) identified at least one workshop they wished to attend. Those who responded came from all adult age groups, all impairments and differing lengths of time that they had been using direct payments. The Workshop that most direct payment respondents felt would be useful, 35 out of 88 (40%) direct payment respondents, was Dealing with Problems as they Arise. More older people (42% over 50s) chose this workshop compared with Direct Payment Respondents generally. This suggests it was a workshop valued by experienced direct payment users and older people who still needed assistance when new problems arose. 23 (26%) direct payment users wanted to attend workshops on Planning & Support and the majority of these respondents (13) had been using direct payments for between one and three years. This suggests that people recognise, after receiving direct payments for a year or more, that opportunities to learn about planning that support etc. would enable them to use direct payments more effectively. A larger proportion of people with learning difficulties (25%) and with mental health issues (25%) were interested in this workshop compared to direct payment users with other impairments since these impairment groups represented only 18% and 8% of the overall sample of respondents. 18 people out of 88 (20%) requested a workshop on accounting for expenditure, suggesting that a proportion of direct payment users were concerned about the returns they had to complete for their direct payment and wanted more control over their own budgeting. 30 (34%) of the direct payment users did not want training. 14 were keen to point out the reasons why it was not practical. Some reasons related to difficulties in attending workshops while others felt there was no need for them.
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For example some respondents said: Sorry very elderly and restricted in travelling. As the person being cared is bed bound, this is not relevant. None at present as I only use money for day centres at present. Filled out by partner/carer our direct payments are very simple and we do not need any further help. Thank you very much for offering further support. Housebound I am 99 years old. Figure 1

Percentage of respondents who require training in identified areas


45 40 35 30 25 20 15 10 5 0 Dealing with Planning and Accounting Problems Support for that Arise Expenditure Managing Pas Recruiting Choosing an Pas Agency Running a Payroll 20% 18% 14% 14% 26% 40%

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As Figure 1 shows, the other 4 workshops we proposed (Recruiting PAs, Managing PAs, Running a Payroll and Choosing an Agency) were requested by smaller numbers of respondents. Respondents were offered a choice of 4 workshops that were not directly related to direct payments Assertiveness and Speaking Up, Becoming a
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Volunteer, Taking Part in Local Area Boards and How to Influence Social Care. Compared with other training offered, there was less interest in these apart from How to Influence Social Care. The second most popular workshop for Direct Payment users overall was How to Influence Social Care which was selected by 28 out of 88 (32%). This suggests respondents using direct payments still sought to influence general social care policy although they did not now receive direct services. Those choosing these other workshops were 14 (16%), 11 (13%) and 6 (7%) respectively. Despite the development of localism in Wiltshire the opportunity to learn to participate in this by direct payment users appears not to be seen as a priority. We also asked direct payment users if they would be interested in Wiltshire CIL running training for the personal assistants they employed. 22 respondents identified they would value this, whilst 45 replied they would not. 1 A further question about, Is there anything else you want to say about your training needs etc? brought comments from those who recognised the value of Wiltshire CIL providing training and others who had wider support and training needs:I am confident I can contact you when my needs grow i.e. Alzheimers help, lifting etc. I just do not have the time or energy for classes. I have received direct payments from you but have no idea where to go for help. More training on benefits/direct payments. Appreciate the availability and scope.

Respondents were asked about practical arrangements for training workshops such as the choice of day of the week, time of training and geographical location. Respondents were equally divided about whether training should be in the morning or afternoon but only 4 identified evenings as the most convenient. These responses may be an indication that those Direct Payment users working full time did not constitute many of the survey respondents. Tuesday was seen as the most convenient day for training although some respondents chose each weekday but only 5 people felt they would prefer training on a Saturday. Respondents expressed preferences for a number of locations for training workshops, with Devizes as the most popular (21 respondents, 24%), followed by
There is no record of the number of direct payment recipients who choose to employ personal assistants so we do not know what proportion of PA employers this number represents.
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Trowbridge (17 respondents, 19%) and Chippenham (13 respondents, 15%). For practical reasons, it is unlikely that we would be able to offer training in the other locations requested by less than five respondents. Direct payment users were asked how they would travel to training, and were given the choices of taxi, car, bus, link community driver and on foot. Some respondents pointed out that arriving by wheelchair was also an option. 43(49%) respondents replied they would travel by car with other means of transport being chosen by less than 10 (11%) people each so public transport was not seen as a viable option. This reflects the reality of rural areas where the lack of public transport means people need to use cars to travel. Only 9 respondents said they would need taxis to attend training workshops. Respondents were also asked if there were any other areas they would like support from Wiltshire CIL about. These responses fell into 3 categories: equipment needs, advocacy support such as making complaints in the case of poor service and issues directly related to Direct Payments such as redundancies.

Discussion
There is increasing emphasis in the personalisation policy on the importance of encouraging those needing social care support to receive their personal budget as a direct payment to give maximum choice and control. One important issue relevant to this is consideration of what range of support to direct payments users is required in order to enable them to use their direct payments as effectively as possible. In the 1980s and 1990s when only a few disabled people were able to negotiate first, indirect payments and then from 1997, direct payments, to purchase their own support, support services were usually run by local centres for independent living the roots of which were founded in the Independent Living Movement in Berkeley, California. This philosophy shaped the pattern of support services with an emphasis on peer support and using the lived experience of disabled people in delivering quality of service. The pattern of these services was explored fully by Barnes and Mercer. (2006) In the last 10 years the growth in the market of direct payment users has led to the development of more variety of service provision of direct payment support services with the increased involvement of national commercial organisations and charities. These have often been chosen by local authorities in a tender process on the grounds of cost.

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A more recent trend is for local authorities to add a sum to each individuals direct payment to purchase the kind of support they wish from within the community. Whilst this trend is philosophically attractive because it gives a direct payment user the maximum choice of support services and is also cheaper for the local authorities who do not need to resource the infrastructure of a support service, it seriously disadvantages local disabled peoples organisations seeking to tender in this market. Such organisations often lack the infrastructure of larger national organisations funded from other sources. It is also questionable whether the individual direct payment user can exercise full consumer choice at a time when he/she is at crisis point as is often the situation when first being offered local authority social care resources. Meanwhile recent studies about the value of peer support provided by disabled peoples organisations and the Think Local, Act Personal publications highlight the value of support (OPM 2011) (DOH 2010). The OPM evaluation of direct payments in Essex showed that more people moved effectively to direct payments when supported by a local organisation of disabled people than by the local authority. However there needs to be more exploration of the different kinds of peer support which can be provided within disabled peoples organisations and their appropriateness at different stages of each direct payment users journey. In Wiltshire CIL we are developing the following peer support services for direct payment users: A peer support group network across Wiltshire. A volunteer peer mentor service. A peer influenced online information resource. A peer delivered training programme.

The survey findings reported here clearly demonstrate the need for peer training amongst other peer support services. A consequence of the growth in direct payments has been a growth in the use of personal assistants directly employed by disabled people and there is concern that this new section of the workforce should have opportunities for learning relevant skills and career progression. The recently published DOH Framework (2011) explores this subject further but does not consider the possible advantages of training being provided by disabled peoples organisations. Such training is a sensitive issue for individual employers who are concerned that their staff should assist them as they wish and who may find training
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threatening if delivered by an unknown external organisation. Local disabled peoples organisations have credibility with disabled people and are able to design courses embedded in disability equality as well as incorporating practical skills PAs may need such as Manual Handling. The Cardiff Coalition of Disabled People who provide the local direct payment support service, have developed and obtained accreditation for a 6 session training course for personal assistants which they are able to run at regular intervals (Goodwin 2011). Their experience shows the need for local authority assistance in providing extra financial support to direct payment users to enable them to support staff to attend the training whilst also employing another personal assistant to have the support they need during the duration of the course. The survey findings reported here suggest there is a demand for such a course to be developed in Wiltshire.

Policy and Practice Recommendations


National The value of training for direct payment users by disabled peers in organisations of disabled people should be recognised and funded as part of support for direct payment users. Further research is needed into the different kinds of peer support disabled peoples organisations can provide to direct payment users and its effectiveness including the role that can be played by peer training. Disabled peoples organisations are trusted by direct payment users as places to provide personal assistants training. Therefore Skills for Care and the Department of Health should support disabled peoples organisations wishing to do so, and enable them to gain national accreditation for training for personal assistants at NVQ level 1 qualification. Local authorities should be encouraged to commission training from centres for independent living for direct payment users and make financial support available to enable direct payment users to release personal assistants to attend accredited courses of training.

Wiltshire The need for peer training to support direct payment users should be recognised by the local authority and built in to any plans to support direct payment users.

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The travel cost for direct payment users to attend training in Wiltshire rural county, should be met by the local authority. Wiltshire Centre for Independent Living should develop a programme of training for direct payment users to start in spring 2012. Wiltshire Centre for Independent Living should begin a dialogue with Skills for Care staff to develop an accredited training course for personal assistants as soon as possible.

References Barnes C. and Mercer G. (2006) Independent Futures Creating user- led disability services in a disabling society. Policy Press, Bristol. Department of Health (2007) Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care, Department of Health, London. Department of Health (2010) Putting People First: Planning together peer support and self-directed support London:Department of Health Department of Health (2011) Working for personalised care: a framework for supporting personal assistants working in adult social care. Social Care Workforce Policy, Adult Social Care Workforce Department, Department of Health, Leeds Goodwin A. Personal email correspondence (2011) Awetu and Cardiff and Vale Coalition of Disabled People Office for Public Management (2011) Briefing papers 1 4 findings from the second round of a three year longitudinal study in Essex London ECDP/OPM Office of Disability Issues (2011) Independent Living Strategy Support planning and brokerage. London Office of disability Issues Think Local, Act Personal Partnership (2011) Think local act personal; a

sectorwide commitment to moving forward with personalisation and community based support London ; Think Local Act Personal Partnership
Think Local, Act Personal (2011) Re-thinking support planning: Ideas for an alternative approach London: Think Local, Act Personal Partnership

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Other publications available from Wiltshire CIL

Quarterly newsletter Annual Reports Publicity leaflets: What We Do Hows it for you? Peer Mentoring Scheme Support to those funding their own care & support, and their carers Peer Support Group Network for Direct Payment Users and Personal Budget Holders How you can help

These can be downloaded from our website www.wiltshirecil.org.uk These are available in other formats by request from 01380 725400 or info@wiltshirecil.org.uk

Unit 1, 11 Couch Lane, Devizes, Wiltshire SN10 1EB Charity no. 1120611 Company no. 5480761

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