Yesterday, I was engaged in a (very brief) discussion on Twitter about this article in the Guardian on Wednesday which highlights a case where direct payments were used fraudulently with tragic consequences.
The thrust of the discussion was that while there will always be isolated incidences of potential abuse and criminal actions, highlighting the method of delivery of the service (through direct payments) was unhelpful at best when there is so much abuse in the delivery of ‘standard’ care packages especially with the follow up article here about ‘how to prevent fraud in direct payments’ which itself states that
There is as yet no evidence that having more people on personal budgets in Enfield has increased the amount of fraud. In fact, of all the fraud cases identified in the area in the past year, only one was related to personal budgets.
Having been involved in the provision and delivery of direct payments since they were first established (Community Care (Direct Payments) Act 1996) I’ve never personally come across an instance of them being misused intentionally.
My gut feeling is that the man in the first article who was killed by his son – after receiving a direct payment for a couple of years – may not have experienced a different outcome if the means of delivery of the care had been different.
Increasingly staff are pushed and monitoring is not as tight as it should be but that isn’t confined to monitoring direct payments. That is happening in all care settings.
My concern is that while while of course, all issues of safeguarding need to be addressed, we can’t throw away the issues the positives of promoting choice and extension of different ways of delivery for fear of fraud and potentially stalling the roll out of direct payments.
There is already a lot of (often justified) scepticism in the sector regarding direct payments. My own scepticism isn’t wholly blown away because I think the methods of delivery are clunky and unsuitable however focusing on fraud or abuse will just give those who beat the personalisation agenda up, another stick to use.
I have said before that I am frustrated with the constant positive glows to stories about direct payments with the seemingly endless supplies of cash to promote adults to attend football matches and the like. It is equally frustrating to be presented with these disproportionate stories of fraud.
Abuse is abuse regardless of the methods of delivery of the services and while councils move towards a lighter touch review process, it is increasingly likely that more issues will not be addressed, regardless of whether they are delivered by ‘direct payments’ or ‘managed budgets’.
Much more concerning is a story like this of a nurse in a care home who kicked a resident with dementia. While he was struck off by the NMC, he was acquitted of assault.
I have been involved in a number of cases where evidence against a perpetrator was too sketchy to be picked up by the CPS because the alleged victim of abuse has dementia or otherwise ‘lacks capacity’ to give ‘credible’ evidence to court. While there has been some movement in the law regarding the Mental Capacity Act (2005) and new offences committed against people who lack capacity, the adult safeguarding procedures need to be tightened up much more.
We should be focusing on safeguarding whatever the means of delivery of that service. Direct Payments often have a hard time being ‘sold’ by the sector because of the mess that has been made of the delivery and process. For all the problems though, it is the perfect method of delivery for some people and focusing on potential fraud can whitewash some of the wider issues of safeguarding processes, increasing cuts and the very poor quality of ‘standard’ care packages which muddies the waters.