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New Legislation on Equal Opportunities
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NEW TYPES OF WORKER PROJECT
Developing the role of personal assistants
Executive summary
This report is about the role of personal assistants (PAs).1 This is the term used to describe those who are employed by direct payments recipients (DPRs).2 These are people with assessed community care needs who are receiving direct payments (DP) to buy support for themselves, or for whom a relative has negotiated direct payments, by making use of the Community Care (Direct Payments) Act 1996. They are doing this rather than accepting the support directly offered, or arranged, by a local social services authority. Since 2003, direct payments can also be made to older people and to the parents and care-givers of disabled children and to disabled teenagers. All of these people, however, must be willing and able to manage their direct payments, either independently or with assistance. Skills for Care is interested in learning from people who receive direct payments and their personal assistants because: • it is funded to make sure that people whose jobs involve helping others are trained to do this well there are nearly 13,000 people who employ personal assistants in England. Their personal assistants are doing work that used to be seen as the work of health care and social care professionals. it wants to know how training is seen by people getting direct payments and by their personal assistants •
Researched and compiled for OPARATE – a Skills for Care pilot project examining new and emerging roles in social care – by Margaret Flynn, University of Sheffield
it wants to know how people who are interested in becoming personal assistants learn about, and prepare, for their work.
In 2004 a direct payments team in the North West and the Instream Partnership (which helps people with a range of support needs to obtain direct payments in a different locality) asked direct payments recipients and/or their relatives, and their personal assistants, if they would be willing to talk about their experiences. The focus of the study was the circumstances of 16 people (nine men and seven women). These included: six people who had physical disabilities (one of whom is an older person); six people who had complex needs, including learning disabilities (two of whom are young people); two people who had mental health problems; and two older people. Of the 16 people, four were from ethnic minorities and English was not their first language. Of the 14 personal assistants interviewed, 12 were women (including the mother of a person getting direct payments) and two were men. Only six of these interviews were carried out one-to-one.
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Key findings
• This study found no evidence that the support available to supplement and/or replace family care-giving before they received direct payments had been experienced as adequate. People gave many examples of damaging, inflexible, irrelevant and disrespectful services. They saw direct payments as having freed them from these.
•
This term was identified by the Advisory Group although, in this study, it was mostly used by people with physical disabilities 2 This term was identified by the Advisory Group but was not used by any interviewee
1
Developing the role of personal assistants, Executive summary, p.1
•
The work of personal assistance is about ‘people skills’, common sense, experiential knowledge and the right disposition. There is considerable agreement about the range of tasks for which assistance is required and the personal qualities that are sought by people getting direct payments, and their families: • personal care activities requiring ‘hands on’ contact • household tasks such as cooking, cleaning, washing, ironing, and pet care • knowledge of a person’s biographical life and background • being effective communicators and listeners, and demonstrating empathy and sympathy • trustworthiness (which was not as frequently cited) • sharing activities and pastimes feature most for young people, older people, people with complex disabilities and mental health problems. Interviewees also described personal assistants’ personal qualities, perhaps captured by the phrase “going the extra mile”, e.g. doing more than the hours for which they are paid. •
personal assistants with insufficient ‘common sense’, and one couple did propose that they should be ‘trained’, this was not a widely shared view, but most wanted to play a lead role in customised training. A few spoke of wanting to offer training opportunities to their personal assistants but had not done so since there was no dedicated funding for this purpose. Neither did they know about social care training routes and opportunities. They confirmed that training ‘on the job’ had its limitations. The personal assistants had work experience that was relevant to their current work, many had pertinent qualifications, and some had many years’ experience of supporting vulnerable people. They downplayed their personal experiences, their background in care service settings, as well as their training. This may be linked to claims of ‘friendship’ with employers. It may be linked to issues of gender, since several women claimed, I’m just a carer. Also, it may reflect the rhetoric which is associated with promoting direct payments. Eight personal assistants asserted that they had no training needs. Human resources matters abound in circumstances which are neither wholly professional nor wholly ‘informal.’ The work of personal assistants prompted some direct payments recipients to assert that they are ‘friends’ and others to say that they could not be. The discipline of getting rid of unsuitable personal assistants was seen as a minefield – most particularly for women – and out of step with claims of ‘friendship.’ Not everyone wanted to live with this responsibility and the consequences of being ‘in charge’. Four people with physical disabilities shared very detailed and specific job descriptions or information about health and safety and daily routines and
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Recruitment and anxiety about getting the right personal assistant affects people very deeply. Several expressed concern about the limited employment pool from which personal assistants can be recruited, and the longer term implications of inadequate pay. Many people receiving direct payments downplayed and dismissed the previous experience and qualifications of their own personal assistants. The majority of people receiving direct payments, and their relatives, valued neither ‘formal training’ nor appointing personal assistants with experience of working in care- settings. Although they expressed dismay and frustration at having had
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•
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Developing the role of personal assistants, Executive summary, p.2
statements of contractual particulars. However, six relatives (who were coordinating the work of 10 personal assistants) reported that the personal assistants did not have job descriptions. The rest had job descriptions of a few lines only. • The support of a peer group engaged in similar work is not an option for those personal assistants who work with people who are receiving only a few hours of support per week. The support of a peer group engaged in similar work (‘affiliation’) is highly valued by people getting direct payments ‘around the clock’ or receiving many hours of support a day. There were concerns about the equity of the lack of norms for how many hours of direct payments services people should receive, and the impact on families of low levels of support. Serious downsides of direct payments included broken trust, dishonesty, discourtesy, incompetence and even abuse – physical, sexual, financial and psychological. Half the people getting direct payments in this study described abuse they or their loved ones had experienced. Safeguards included only employing people they knew well and trusted, and being around when personal assistants were present. No formal alerts had been made, and no complaints or adult protection procedures invoked.
2. Direct payments recipients can and do know – in some cases, with the assistance of relatives – both what they want and value in their personal assistants. There is a case for identifying the unique ‘non-negotiables’ of personal assistance and ensuring that these are honoured by specifying them in contracts with personal assistants. 3. It does not appear that current pay provides an adequate reward for supporting people with a wide range of conditions and support needs. As pay and conditions say something about the value that is conferred on the wide-ranging tasks that personal assistants undertake, now is the time to invest in these. Sensitive, flexible and high quality services for vulnerable people, which are delivered to them in their own homes, are not cheap. The human cost of regarding them as cheap is too great. The pay and conditions of personal assistants, and the implications of these for family caregivers, must feature prominently on political and professional agendas. 4. If it is accepted that personal assistance is an emerging profession then the competences of recruits should be seen as an investment and developed accordingly. In the experience of personal assistants, ‘learning while earning’ is not yet endorsed, prioritised, funded or embedded, nationally, regionally and locally. There is enormous scope for working with direct payments recipients and e-learning facilitators, for example, to design and customise learning opportunities. 5. The negative impact of direct payments on the lives of family care-givers (most particularly on mothers and daughters) who are negotiating direct payments on behalf of their loved ones, should not be ignored.
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Recommendations
1. The realities of directly delivered or arranged care services, as described by individuals in this study, should not be concealed. If accessing direct payments gives people the confidence to describe prior experiences, then contract monitoring personnel should take account of, and learn from, this most valuable information.
Developing the role of personal assistants, Executive summary, p.3
6. Although the direct payments teams in the two localities offered assistance to people drafting job descriptions for personal assistants, this should be revisited. It is accepted that the work of personal assistants is fluid, and even though pinning it down may be challenging, a job description is a safeguard and can be an asset where a personal assistant’s practice is found wanting. 7. If solo-operating personal assistants are to experience the benefit of being part of a peer group and/or a ‘community of practitioners’, the means for achieving this has yet to be realised. 8. There should be service provision targets for people receiving direct payments and there should be a ring-fenced budget for direct payments, the value of which is known locally, and publicised. Decisions about levels of service support, which are currently made by those required to match resources, in terms of individual packages, to available budgets, should be made explicit. Monitoring on a local basis should determine whether women, people from ethnic minorities and people living in less prosperous localities are being assessed fairly and in line with predetermined norms based on targets for the population as a whole.
9. Seek out negative feedback. Direct payments cannot be a cue for the government or local authorities to sidestep continuing child and adult protection issues. The gap between the portrayal and ‘selling’ of direct payments and the abusive experiences described in this study must be addressed locally, regionally and nationally. There can be no substitute for: a) visiting people in their homes and talking to them about their safety and their experience of being supported and asking why particular personal assistants are no longer working with them or why they have discontinued the services of particular domiciliary care agencies b) exploring with direct payments recipients and their relatives how their efforts to keep people safe might be supplemented now and in the future (when they themselves may not be able to undertake this role) c) developing core proactive and reactive monitoring systems. The sum of these activities requires prioritising and funding.
The full text of Developing the role of personal assistants (50pp, 460kb), is downloadable free from www.skillsforcare.org.uk (go to Our Projects/Types of Social Care/New Types of Worker). Other materials from the New Types of Worker project are also available there.
© Skills for Care, 2005
Albion Court, 5 Albion Place, Leeds LS1 6JL. info@skillsforcare.org.uk
Skills for Care is the strategic body for workforce development for adult social care in England. It is part of Skills for Care and Development, the DfES-licensed Sector Skills Council for Social Care, Children and Young People.
Developing the role of personal assistants, Executive summary, p.4
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