Direct Payments in Black, Asian and Minority Ethnic Communities
Direct payments are a cash sum given to people to help them to arrange and personalise their own support and services. They are used by various city councils as a way for those in adult social care to access the individual support that they need in the way that best suits them.
IMPACT worked with Leicester City Council from June 2022 to June 2023. The Council had identified that some community members did not access direct payments. In particular, this included individuals from the Black, Asian, and Minority Ethnic (BAME) communities. The Council wanted to understand the reasons behind this, and how to better meet their individual needs.
The Council recognises the term BAME includes a diverse range of different communities and cultures with different needs. Therefore, when we use the term we are speaking about these collective communities – not as a replacement for individual or specific references.
Pre-project Evidence on Direct Payments
Published research on personalisation is growing. However, the research rarely focuses in much detail on the experiences of people from different community groups. The minimal evidence suggests that individuals from Black, Asian, and Minority Ethnic communities are generally willing to try direct payments once they know how they work.
There were two key points that needed to be considered. You can learn more about these by clicking on the titles.
Direct payments provide empowerment to those with social care needs. They allow them to purchase social care services that are individualised. For example, arranging services that align with their ethnic, religious, and cultural values and preferences. This might mean choosing a personal assistant from the same cultural background or enlisting a close family member.
The evidence found limited information about personalisation and how direct payments work. Where information was available, it was not in an accessible format. One reason for this was language differences between communities that were not always catered for. This meant that in most cases where information was available, individuals from Black, Asian, and Minority Ethnic communities could not always understand it.
The Facilitator model reviewed all the steps involved in accessing direct payments. The aim of the review was to identify barriers that prevented those from Black, Asian, and Minority Ethnic communities from accessing direct payments and create a strategy to overcome them. This included understanding why some individuals preferred direct payments to commissioned care and why this may be. Rather than setting targets for engagement, the Council placed more importance on the meaningful value of people’s lived experience and overall greater choice and control.
The Facilitator did the following to understand the experiences of individuals and communities:
Throughout this process Leicester City Council was committed to the Facilitator project, and instrumental in setting up the main activities.
The biggest challenges were engagement and co-production. This was mainly because of the time and availability of staff and those with lived experience. It is recognised that the relatively small number of perspectives heard may not be representative of all views and experiences. Going forward, the Council aspires to co-produce changes to mainstream services and this may feature within their overall engagement plan.
Learnings about Direct Payments
The Facilitator found that, in line with the evidence, Direct Payments gave Black, Asian, and Minority Ethnic individuals greater choice and control. However, it was also confirmed through conversations that this was not always explained. As a result, one carer had assumed they had no choice until a new social worker supported them to choose a new carer agency and carers.
The Somali community and those in the Asian or Asian British – Indian community were particularly unaware of the availability of direct payments. The Somali community members explained they are an oral community, preferring talking leaflets over the written word. They recommended this as a way to reach their community members.
Some people were ‘scared’ to use the direct payment allowance because they were confused about what direct payments could be used to purchase.
The Council provided information in English, but interpretation or translation to any other language was only considered on a case-by-case basis. The Council offers a translation service, but none of the individuals we spoke to mentioned using this service.
The importance of the spoken rather than written word was highlighted within the project and may open the door to different ways of communicating in the future.
Support agencies highlighted difficulties in recruiting personal assistants of the same ethnicity and people receiving direct payments. This was mainly due to social care staff shortages and retention issues. Other difficulties included:
- Some people thought they could not hire family members who lived at another address as their personal assistants. Part of the confusion was because they had learned that family members who live at the same address can only be employed under exceptional circumstances.
- Recruitment can be a lengthy process, which can put pressure on agencies.
- There is a lack of information about the personal assistant market.
Several people explained that support plans were not always appropriate. For example, 30 minutes for meal preparation was not always enough time to prepare culturally appropriate meals.
We uncovered equality, diversity, and inclusion issues within mainstream services.
For example, we found some providers assumed caring needs would be met by the individual’s family. However, in these situations, family members were not in a position to offer the level of care needed.
The council will be using the evidence shared to:
- Commission actioning the changes identified by the Facilitator project.
- Develop staff training on the creativity and flexibility of direct payments
In 2023, Leicester City Council developed a database to capture personal assistant data. This may help the council better understand how people can personalise their care/support via their choice of a personal assistant.