A few weeks ago, something seismic happened in the whole direct payments ecosystem. Lancashire County Council had to concede a judicial review claim that they had made unfair repayment demands, that their blanket policy of reclaiming funds was unlawful and that there had been pressure to reduce support worker pay to minimum wage.
This last point in particular will be familiar to anyone with experience of this sector. But the Care Act states that personal budgets must be sufficient to meet assessed needs – without imposing arbitrary pay restrictions.
It goes back to what we were saying in our last post – when budgets are tight, the first thing to be impacted could well be the quality of care.
It doesn’t have to be this way.
Yet even though Lancashire County Council are in the process of acknowledging its failings and issuing an apology, this post is not intended to point the finger at them specifically.
In fact, we can absolutely see how this situation has come to pass.
Frankly, if your organisation does not have full oversight over direct payments, then these claims are always likely to happen. This is why we at Alocura developed Rostrata in the first place – because we could see the gaps and inefficiencies in the financial management of care packages meant that the care itself was suffering hugely.
We set about trying to find out how many care packages were fully audited to ensure consistent, high-quality care was taking place in accordance with the initial care plan. It was 0%. This is because commissioners focus their financial audits on transactions from bank statements. Transactions do not tell you that the care has been delivered, they tell you that the money has been spent, with who and when.
That means that most budgets are issued and spent almost entirely on trust. To fully audit a budget, you need to compare the actual care delivered directly to the care plan itself. The NHS and local authorities are extremely exposed and could well now find themselves in the same position as LCC, facing potential legal challenge to their clawback policy.
Of course, audits have to take place in a proportional way too; a £3k budget may well need less oversight than a £100k budget. But Rostrata can fully facilitate that anyway.
There were other key takeaways from this Judicial Review. Rather than just repeat them, we’d like to explain how Rostrata can help embed them in your organisation.
Personalised care planning (s. 25(6)):
Local authorities must ensure care plans reflect assessed needs, personal budgets, and how direct payments support outcomes. Blanket policies or rigid repayment demands undermine this statutory requirement.
With Rostrata, the care plan is input at the beginning of the process, after the assessed needs have been agreed. This means that staff with the correct competencies are allocated to shifts and a budget forecast before the care package has begun. This allows for full transparency and, with the connected rostering and payroll engine, the ability to see at any time how the package is performing against the agreed budget.
Rostrata’s reporting suite, therefore, makes the explicit and obvious link between what direct payments are being used for and how they support long term outcomes and all of that is reported around the individual’s NHS number.
– Needs assessment (s. 9(4)):
Assessments must address not only care needs but also individuals’ desired outcomes, well-being, and broader circumstances (e.g., family or community resources). This ensures decisions are tailored and promote independence.
My Life Support are a care provider who use Rostrata to understand how the care packages they operate are performing. For them, it is more than just a means by which to understand the finances involved in a package. Because they can see what their staff are doing and where they are with Rostrata, they are able to monitor the independence and well-being of the individuals they support – but also where they might need more help. They can then speak with the funder to forecast where pinch points in the future might be.
Indeed some cases, packages of care have worked so well because of this oversight, MLS have been able to return unused monies to funders with everyone’s agreement (and without the funder having to resort to the unlawful blanket policy in this case).
– Flexibility in Direct Payments:
DPs should empower recipients with choice and control over their care arrangements. Local authorities must avoid policies that fetter discretion or impose unnecessary constraints.
Direct payments and personal budgets were supposed to be all about empowering people to have choice and control. Yet trying to manage a care package these days is more like running a small business – without an accountant. Rostrata was set up to help commissioners, providers and individuals have a clear, connected system by which they can deliver high quality care to the agreed plan and on budget.
So you can appreciate how we don’t see this Judicial Review as a failing of the system but an opportunity to manage care packages far better. With Rostrata, commissioners and providers can do just that. Get in touch with us today.