Background
Iriss recently published a report, Rest assured? A study of carers' experiences of short breaks, which was undertaken to improve our overall knowledge and understanding of short breaks provision in Scotland.
The findings from the national research highlighted that, despite the fact that less than one in every two carers (surveyed in the research) accessed short breaks, they were considered fundamental to help alleviate the physical and emotional demands of caring, to sustain the caring relationship and to prevent admission to residential care.
The research also uncovered carers views about how short breaks could be improved. Ideas included:
- breaks being provided as early intervention rather than at crisis point
- having increased choice, flexibility, frequency and length of short breaks
- an increase in appropriate and personalised short breaks, including those that are culturally suitable services for BME carers
- better planning processes including a single point of contact and dates for short breaks secured well in advance.
Falkirk Council Case Study
Local research often highlights similar findings. For example, in Falkirk Council, a pilot scheme was developed in response to:
- the low numbers of short breaks being accessed
- information contained in a local research report carried out by the Falkirk District Association for Mental Health Carers Group (September, 2005)
- the reluctance of people with mental health problems to access direct payments
In a bid to support people better, Falkirk Council embarked on a process of understanding how they could improve the short break experience. Feedback from people who use services indicated the desire to create a system that would limit the administration associated of taking control of a short break (often associated with a Direct Payment).
As such, a small-scale pilot scheme (six people involved in the pilot) involving the use of vouchers for short breaks was developed. The initiative was designed to support people to be more involved in determining the short break outcomes that they wanted and the package of support that would deliver these outcomes.
What were the vouchers like, and what was the process of using them?
The vouchers, and the process of using the vouchers, were designed with simplicity in mind. On the basis of assessed need, each person received a pack of vouches (which looked like a cheque book). These vouchers were averaged to a weekly amount and were exchanged for hours of support with a preferred provider. These providers were pre-determined through consultation. The packs of vouchers were issued quarterly, and the support was delivered.
In order to ensure that a dependency on the vouchers was not created, one of the key messages to participants in the scheme was that,
"if you don't use it, you don't lose it"
The vouchers themselves:
- were intended to be used for things out-with normal support
- were to be used flexibly - anything from one hour to lots of hours depending on what people wanted to do
- had no face value
- had an area for the provider to sign to indicate that the support had been delivered
- had a grid (optional) to help people record what they were using the breaks for
Margaret Petherbridge, Falkirk Council talks about how people used their vouchers
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How were the vouchers used, and what outcomes were achieved for people who use services?
After discussion with a range of practitioners instrumental in the implementation of the scheme, the most notable impact of the pilot has been the positive experiences of people using the vouchers. This was reiterated in a small-scale evaluation of the carers and people who use services.
Margaret Petherbridge details participant experiences of being involved in the scheme, and the outcomes that were achieved
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What did providers say?
Impact at an individual level
Involvement in the pilot seems to have had a positive effect on staff themselves. Many practitioners talked about how the process had reinforced the values of their job e.g.
"reinforced that people are experts in their own lives"
"Knowing the people you support and being able to offer different options helps you to make sure that they are in control. We need to keep trying different ways to engage with people - it won't be a 'one size fits all' - but I think more control helps to increase confidence"
Impact at an organisational level
From the organisation's point of view, many of the providers noted that the scheme had helped to fill the gaps between service provision. Providers appreciated that the scheme enabled individuals to have greater control over the support that they received. For instance, one provider was clear that the support that they normally provide (housing support) was not conducive to respite care and that the voucher scheme gave the individual they were supporting more flexibility and control (and the choice was was to choose the new service).
"It's given me another tool in my bag - helped me to get respite to hard to reach people."
What factors influenced the success of the pilot?
Charging policy
Falkirk Council have recently reintroduced their charging policy, which means that people have to put some money towards their break. Feedback from social work and providers suggests that this may discourage people from taking the support that they need.
Small scale
Providers were very enthusiastic about the scheme, however, they were clear that with an increase in scale, the ability to be as flexible as they were throughout the pilot may be difficult. In particular, providers noted that a need to employ more bank staff may emerge if the pilot was to be rolled out, which may then have a knock-on effect to the cost of the service overall.
Engagement from social work staff
The feedback suggests that although the voucher scheme has had lots of publicity from within the council, staff did not engage with the scheme as well as they might. Interviewees suggest that this may be due to increasingly high workloads, as well as the number of new initiatives that are currently being implemented. Some staff have suggested that greater publicity demonstrating the outcomes that have been achieved in the pilot may encourage others to introduce the vouchers to people that they support.
Using the vouchers for 'out of the ordinary' activities
Supporting people to have choice, if they haven't had it before, can be difficult. Both providers and people supported by services found it difficult, at times, to think about what the vouchers could be used for. There was consideration that providing tools or prompts to help both providers and people supported by services to think creatively about the support they might require would have been useful.
Tangible nature of the vouchers
People engaged in the pilot scheme thought that the vouchers were a useful tool and that their tangible nature was beneficial. There were some concerns, however, that in a roll out of the scheme, and in engaging with more mainstream providers, that the use of the vouchers might become stigmatising. This is an area the council are considering in the next steps of the scheme.
Key learning from Falkirk Council
- the vouchers provided a safe and reliable method for people to self-direct their support
- vouchers enabled people to take more control over how and when their support was delivered, and provided more flexibility over the type of support that was received
- vouchers allowed people who use services, carers and providers to engage more directly in determining how support is provided.
