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Direct Payments were introduced in April 2003 and its aim is to


Direct Payments were introduced in April 2003 and its aim is to

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									Direct Payments were introduced in April 2003 and its aim is to
offer those who are eligible, money as an alternative to social
service provisions. Direct Payments are designed to offer more
choice, control and flexibility to those who need services by
allowing them to purchase their own care to respond to their

The Leonard Cheshire Organisation was founded by the late
Group Captain Lord Cheshire of Woodhall in 1948. The Leonard
Cheshire Support Service was joined in partnership with Plymouth
City Direct Payments Team in January 2003 and the core purpose
of Leonard Cheshire is to ‘change attitudes to disability and to
serve disabled people around the world’. The support service
helps those who receive Direct Payments with the advertising,
interviewing, recruitment of staff, and they also provide information
and support on managing the accounting system.

This report is the findings of a satisfaction survey carried out by a
group of first year students at Plymouth University on behalf of the
Leonard Cheshire Support Service and Plymouth City Council
Direct Payments Team. The survey sets out to determine what
areas of the scheme works well and also highlights what areas the
Direct Payment recipients find difficult and suggestions on how
those areas can be addressed.

A total of 170 letters were sent to recipients of Direct Payments
within the Plymouth City area asking for help with this survey by
means of postal applications and one to one interviews. There
were a total of 70 responses; however, 19 recipients opted not to

take part in the survey. The findings from the 51 recipients who did
take part in this survey have been collated and where possible,
graphs have been produced to highlight these responses. We also
asked if we could use comments and quotes from the interviews
and questionnaires and where these have been included,
permission was given from the recipient.

The survey highlighted that 66% of recipients had found out about
the Direct Payment Scheme through Social services and 14%
found out through other sources, e.g. internet, support workers etc.
It was evident that the scheme is not widely promoted through
media and/or leaflets as only 2% were made aware of Direct
Payments through this medium.

               How did you find out about Direct payments?

                                                  Social Services
                                                  Leonard Cheshire Support
                                                  Service 6%
                                                  Friends or Neighbours

One of the most important aspects of this survey was to ascertain
the level of support that was offered to recipients when they first
started using Direct Payments. The graph illustrates that a high
percentage of those who took part in the survey considered the
support they received to be excellent from the Leonard Cheshire

Support Service and The Plymouth City Council Direct Payments

             How would you rate the initial supportyou received?



                                                               Leonard Cheshire
                                                               Direct payments Team


        Excellent   Good   Satisfactory   Poor   Support not

There were many positive comments about the support provided,
and some of theses comments are set out below.
“I was very pleased to receive this support as I‟ve had one
severe illness after another”.
“Lyn Fairmanner is very helpful and is always contactable”.
“The Direct Payments Team put me in touch with Leonard
Cheshire and it was very straightforward. I am fortunate as
there is no support in child services.”
Only 4% considered the support they received to be poor,
however, no specific comments were made about why they
thought this and 4% had never heard of the Leonard Cheshire
Support Service.
When asked to comment about how easy it was to contact the
Leonard Cheshire Support Service and the Direct Payments
Team, the graph illustrates that the majority of recipients felt that
they were able to contact someone from either agency without any

                  Did you find it easy to contact someone?

  50%                                                    Leonard Cheshire
  40%                                                    Direct Payments Team
            Yes              No             N/A

The ‘Eazypaye’ service was introduced to offer help with the
payroll system. They help recipients set up their scheme with the
Tax Office and work out the calculations for tax and National
Insurance. They run a payroll system for each member of staff and
provide the payslips to give to them on a monthly or four weekly
periods. ‘Eazypaye’ will also deal with the end of year tax returns
on the recipients behalf.

           Does 'Eazypaye' make using direct Payments easier?

                                                                  Yes       82%
                                                                  No        0%
                                                                  N/A   18%

The survey showed that 82% used this service and 18% stated
that it was not applicable. Of those who used the service, a few of
their comments are used below.

“It makes life easier as I just phone up with the information
and it‟s all worked out for you”
“I would be lost without them, I give them the details and they
sort out the salary and the tax and it‟s easy”
“One of the easiest bits to do, I just have to make a phone
“Those at „Eazypaye‟ are brilliant”
“Eazypaye are fantastic, efficient and really helpful”

One of the main aims of Direct Payments is to allow recipients to
purchase their choice of service. The survey highlighted that in
73% of the cases, this was the outcome and that in 22% of the
cases, this was mostly the outcome. Here are a few comments
that were made about how the recipients felt about being able to
make that choice.

          Do you feel that Direct Payments allow you to purchase your
                               choice of services?

                                                                    Yes   74%
                                                                    Mostly 23%
                                                                    N/A    3%

“I am able to get respite care which I wasn‟t able to get
“I like to have the freedom of choice of carer”.

“Plymouth City Council are extremely flexible in some
“I am not allowed to access other social services activities
and workshops such as pottery as I am receiving Direct
Payments and I miss the opportunity of group activities”

The question that provided the greatest number of written
feedback was ‘Has Direct Payments made a difference to your
life?’. A resounding 94% of those involved in the survey agreed
that Direct Payments had improved their life, 4% thought that it
had made no difference to their life and although no-one thought
that it had made their life more difficult, 2% did not answer this

        How would you say that Direct Payments has made
                    a difference to your life?

                                             Improved my life
                                             Made no difference to my
                                             life  4%
                                             Made life harder
                                             Did not answer

Overall the comments showed that the recipients felt that Direct
Payments gave them more choice about who supports them or
their child, it gives them more flexibility about when the care is
given and it also gives them more independence. Here are some
of the comments that highlighted these issues.

“It enables me to go out and about, I am not housebound”
“The fact I now have respite both physically and mentally, and
knowing that he is safe and wanted in an environment that
constantly stimulates him”
“I can now make my own choices and can live independently”
“I have a wonderful bond with my carer. She is like an
extension of the family”
“I can now access social activities without my parents”.
“It has enabled me to study a PHD at Exeter University”
“Financially, it has given me freedom of choice. Without
Direct Payments, I couldn‟t have afforded it”

“We currently receive 40 hours a week but feel periodical
increases are necessary over time as care and tasks become
more frequent and lengthy”.
“I hardly had any help or respite before. I now feel like an
employer and don‟t have to rely on family and friends as I can
pay them a competitive wage”.
“I have an improved state of mind as I am not so isolated and
have support with health problems”.

                                  How has it improved your life?


                                                      Buying the
                       Conven ience

                                                                   break from
                                       Control over

                                                      services I

                                                                    Takin g a
          Choice of







                       of care


When asked if the decision to use Direct Payments was the right
one, 94% agreed that it was the right decision and the following
comments highlight this.

“My son was on the waiting list of kids through Social
Services for 5 years. By accessing Direct Payments I received
support and respite immediately”.
“Definitely changed my life”.
“Difficult to set up but it does improve”.

              Do you feel that you made the right decision to use Direct
                   Payments and would you recommend them?

                                                                          Did you make the right decision
                                                                          to use Direct Payments?
                                                                          Would you recommend Direct
                 Yes                  No                 Unsure

However, despite agreeing that it was the right decision, the
following comments were also made highlighting that some
recipients were not altogether happy with the decision.

“It was the only choice as there were no other choices
“Forced by circumstances to have Direct Payments so that I
could keep the support”.
“Too much paperwork”
“The down side has been selection recruitment and retention
of staff, particularly as they have to work with other
employers to make up their wage”.
“It is difficult to co-ordinate should I need any extra support
due to unforeseen circumstances e.g. extra personal care”.

Again 94% of recipients stated that they would recommend Direct
Payments to someone else; however, the comments highlighted a
mixed response. Here are a few of the comments that encapsulate

“It is an easier and more efficient way to get services”
“More control, you‟re the boss and I have recommended it to
many others”.
“I would recommend it despite the form filling being so
“It can facilitate an independent and fulfilled life”.
“I would recommend reservedly as I feel dictated to and have
very limited control on how you use the money for care”.
“It‟s a feasible means of supporting people in the community
and helps relieve the pressures of everyday life”.

“Plymouth City Council could do more to publicise Direct

Of those receiving Direct Payments, only 33% felt that they have
experienced difficulties with using it. Overall, the completion of the
monitoring forms and the recruitment of personal assistants were
highlighted as being the most difficult. Also, finding the right
services was another factor that was mentioned, however, most
agreed that support was available from Leonard Cheshire and the
Direct Payments Team to resolve these issues.

Of all the recipients that took part in this survey, 39% felt that
Direct Payments had been more demanding than they originally
thought it would be. Most of the comments made were about the
complexity and amount of paperwork that needed to be completed.
Here are a few comments that highlight this.

“It would have helped to know about all of the admin at the
“The paperwork can be a pain”.
“The paperwork is quite complex with having to balance the
monthly and quarterly returns with the bank statements”.
“Receiving payments is fine, but it‟s the paperwork that
comes with it that makes Direct Payments complicated”.

Of those asked whether they receive on-going support from
Leonard Cheshire Support service, 75% said they did still receive
some support and the graph below shows how the 75% said that
they rated that support.

               How do you rate the on-going support from the Leonard
                            Cheshire Support Service?

                                                                  Excellent        74%
                                                                  Good             21%
                                                                  Satisfactory       3%
                                                                  Poor               2%

73% agreed that the support that they received had made it easier
to manage their direct Payments, however, there were no
comments made on how Leonard Cheshire could do things

               Has this support made it easier to manage your Direct

  40                                                                             Series1
           Yes     73%            No   25%            Unsure 2%

The question ‘Has Direct Payments been more demanding than
you initially thought it would be?’ revealed that 39% thought it had
been. Although 28% of recipients felt that it had not been more
demanding and 25% felt that it was as they had expected, 8% did
not answer this question.

              Has Direct payments been more demanding than you

       Yes        39%   No           As I expected      Not answered
                             28%           25%                8%

Out of the 51 responses, 53% said that they had not received a
copy of Plymouth’s ‘Financial Records-Information to Help You
Manage Your Direct Payments, 2006’. Although 35% said they
had received it, 12% did not answer this question. This graph
shows how the 35% that did receive a copy of it, felt about its

             For those who received a copy of the Financial
               Records-Information, how did you find it?

                                                     Easy to understand
                                                     Neither easy or diffcult
                                                     Difficult to understand
                                                     Did not read
                                                     Did not answer

        For those who started Direct Payments after December 2006,
                  how did you find the service agreement?

                                                     Easy to understand           6%

                                                     Neither easy or difficult    16%

                                                     Difficult to understand      0%

                                                     Did not read                  4%

                                                     Did not answer

Some of the comments made about the service agreement were: -
“My advocate explained it to me”
“I found it useful”
“I am not aware of any service agreement”
“The agreement I have is dated July 2004”.
Those who employ staff would have been given an employment
pack with information about advertising, interviewing etc to help
with the recruitment of staff. 55% said that they had read through
this pack, however 31% did not use it and 4% were unsure if they
had received or read it. The following graph illustrates how easy or
how difficult the information was to understand within this pack.

        How did you find the information that Leonard Cheshire left in
                           the employment pack?

                                                      Easy to understand          53%
                                                      Neither easy or difficult   29%
                                                      Difficult to understand     7%
                                                      Did not answer              11%

When asked whether the recipient knew how to make a complaint
about Plymouth city Council, 53% stated that they did, however,
45% stated that they did not know how to make a complaint. There
were 2% that did not answer this question. The graph below shows
how those recipients who had made a complaint, felt about the
way it was dealt with. It must be noted that only 4 recipients had
made a complaint.

                  How do you rate how your complaint was dealt with?




 30                                                                              Series1



      Excellent     Good      Satisfactory   Poor        N/A         No answer
          2%            0%         2%               4%         43%       49%

At the end of the survey, the recipients were given the opportunity
to make any further comments that they felt would help to improve
their lives and here are a few of the final comments made by the
Direct Payments recipients.

“To have known about Leonard Cheshire would have been a
great help in the beginning and more re-assuring for myself
and other carers on the support available”.
“They need more user friendly literature and maybe do a
leaflet drop at special schools to get the message across”

“Could Leonard Cheshire create a post or signpost to an
assured auditor to help with monthly and quarterly audits”
“More choice and services for teenagers on the autistic
spectrum disorder”
“It would be very helpful to have a list of private homes and
people who provide respite care”
“There needs to be more support to train people as there can
be a delay for getting carers on the relevant courses”
“It would be better to introduce 6 month contracts so that it
would be easier to get rid of my PA if it goes pear-shaped”

We would like to take this opportunity to thank all those recipients
who participated in the survey in order for us to produce this
report. We would also like to thank the Leonard Cheshire Support
Service and Plymouth City Council Direct Payments Team for their
help and support during our Community Development Project.

Alison, Emily and Lisa


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