Support with Confidence schemes provide directories of accredited providers offering care and support services in a local area. Accreditation usually involves things like checking qualifications, asking for references and completing an enhanced Disclosure and Barring Certificate (DBS) check. Members of Support with Confidence schemes aren’t usually regulated by the Care Quality Commission, which has responsibility for inspecting services like home care and nursing homes. The accreditation process therefore provides important peace of mind for people when they are making choices about their services.
The first scheme was set up in 2009 by Oxfordshire County Council. The licence to run schemes under this name is now managed by Action for People and the Council pays a fee to them to operate the scheme in East Sussex. We set up our scheme in 2010 and it has been run by Adult Social Care and Health at the Council in partnership with our local Trading Standards.
There are a small number of other local authorities that were offering Support with Confidence schemes when this consultation launched. These were Bracknell Forest Council, Brighton & Hove City Council, Nottinghamshire County Council, West Berkshire Council and Wokingham Borough Council. We plan to contact these local authorities during the consultation to understand their plans, but any decision we make will be based on what’s best for East Sussex.
Residents of East Sussex could use the scheme to find help at home that they could trust. The directory was free to use and they knew that services listed in it would have been through an application process and be receiving ongoing training and support. The directory has nine categories covering a wide range of support and services:
|
Category |
Examples of types of support and services |
|
Support at home and personal care |
Personal assistants, home care, cleaning, live-in support, ironing and shopping assistance |
|
Home maintenance and gardening |
Decorators, handy people, plumbers and window cleaners |
|
Medical and therapeutic support |
Massage, occupational therapy and palliative care |
|
Specialist support |
Support to those with autism, dementia and visual impairments |
|
Personal development |
Learning support and peer support |
|
Financial, legal and secretarial support |
Financial advisors and secretarial support |
|
Social, physical and daytime activities |
Arts and crafts, personal trainers and social activities |
|
Pet care |
Pet boarding, sitting and walking |
|
Transport |
Community transport, personal assistant transport and taxis |
There have been two types of membership for the scheme: 1) Personal assistant membership; and 2) Business membership. Potential members paid an application fee and went through an accreditation process before they joined. If they were successful in their application there was an annual membership fee to pay. The amount members paid depended on the size of their business and the type of support offered.
Once an applicant was accepted to join the scheme, they were listed in the directory and they could use the Support with Confidence logo on their business paperwork and advertising.
In addition to the directory, the scheme also provided guidance, advice, training, newsletters, wellbeing support and help with complaints to all members. For personal assistant members there were two dedicated services offering referrals and contingency planning.
The referral service was used by Council staff to help our clients find support. The service helped match people with personal assistants who could help them at home and in the community with things like washing, dressing, cooking, medication and getting out and about.
The contingency planning service helped personal assistants to put a plan in place for when they were unable to do their job because they were ill or on holiday. This would include a referral service which helped find other personal assistants who could cover for them while they were off.
Our scheme had 349 accredited members and 55 applications in progress when it was paused in July. Self-employed personal assistants made up 85% of the membership and most of the new applications were in this category. The remaining 15% of members offered business services.
The main way that residents have found out about Support with Confidence services is through our online directory. Some visit it themselves, but others will have help from family, friends, adult social care staff, or organisations like Age UK or Age Concern. The directory has always been well used, with nearly 11,500 page views in May alone.
Residents who aren’t online could get in touch with the Support with Confidence team for help to access services. Between 1 March and 30 June, the team dealt with 196 enquiries about services from residents. They also had 373 personal assistant referrals from adult social care staff.
A report on the employment status of personal assistants was published in June by the National Direct Payments Forum. The report raised serious questions about how we were operating our Support with Confidence scheme at that point.
In summary, someone’s employment status will depend on how they are carrying out their work and will be determined for every individual working arrangement. This matters because self-employed workers are not paid through PAYE (Pay As You Earn) and they pay a different category of National Insurance to employees. They also do not have the rights and responsibilities of an employee, such as holiday or sick pay when they’re not working. There is no single test that decides if a person is employed or self-employed, or an agreed national position. This makes everything more complicated, as if someone’s employment status is found to be wrong, the worker and the individual or organisation that is found to be their employer may have to pay unpaid tax and penalties.
The majority of Support with Confidence members are self-employed personal assistants and they have been a big part of the success of the scheme. For this reason, we sought urgent legal advice on what we should do to address the issues raised in the report about the employment status of personal assistants and how they affect our scheme.
The legal advice was clear that there were two elements of the scheme as it was running then that should be permanently stopped. These were the personal assistant referral service and the contingency planning support. This is because supporting referrals and helping people to find personal assistants through the directory could be classed as providing unregulated introductions and a ‘matching’ service. In a similar way, helping with contingency planning could potentially count as operating as an unregulated care agency. Neither of these types of activity are appropriate for us to be doing as a local authority and they bring legal risks that we are not willing to accept.
We know that these aspects of Support with Confidence are particularly valued by members. Because of this we decided to pause any new activity relating to the scheme while we decided what to do next. This includes activity for all members, both personal assistants and businesses, even though business members aren’t directly affected by these issues.
The Support with Confidence scheme has been widely used by the department’s staff to help people eligible for support from us – our clients - to find services. We would like to reassure clients who have already used the scheme to find a personal assistant that there are no plans at this stage to review your existing arrangements. If that changes in future, we will be in touch to discuss what needs to happen. Business services are not affected by the issues raised in this consultation, so there will definitely be no need to review your use of these services.
There is more information on how clients already using services are affected in our ‘frequently asked questions’ on the consultation webpage. You are also welcome to discuss your current arrangements at any point with our contracted direct payment support providers (visit our website for their contact details or get in touch with us to find out more).
The issues raised in the report are national and don’t just affect East Sussex. At the time of starting this consultation there is no indication that there will be any more information available soon from national organisations. We don’t think it’s fair to keep the scheme paused for a long period of time. That means we need to decide what is best for East Sussex based on the information already available to us and what we learn through the consultation.
The consultation is about our proposal to stop offering the Support with Confidence scheme and about what support we might provide instead. We want to hear from residents, scheme members and applicants, and those who have referred to the scheme in the past, about what would be important to them for new support.
As we have already said, we will not be offering a referral service or supporting personal assistants with contingency planning in the future. This is due to the legal risks of continuing to provide this sort of support. For this reason, we are not consulting on the decision to stop offering this support.
We feel there are two main options for what we do next:
With option one, the scheme could continue to offer an accreditation service and online directory, as originally intended, but would not provide the referral service or help personal assistants with contingency planning. This would allow us to keep the scheme logo and directory. The issue is that the elements of the service that would stop are the ones that members particularly value. This is likely to mean that some personal assistants decide to stop being members. If enough members left this would make the scheme less useful to residents and less viable to run.
With option two, the support would focus on elements of the existing scheme that people value and could include things like accreditation, DBS checks and training. The benefit of this approach is that we would have the opportunity to offer something based on people’s needs and what would make the most difference to them. While the level of support wouldn’t be the same as now, we would still be offering support to personal assistants and businesses, and residents looking to engage their services. To get an idea of the types of support we may be able to offer in future please see the survey.
We’ve had lots of discussion internally about what is best to do next. Our feeling at this stage is that a fresh start would be better in the long run. This is mainly because the elements that we have been legally advised to stop offering are an integral part of how Support with Confidence was working locally. Continuing the scheme without the referral service and contingency planning doesn’t feel viable.
For this reason, we are proposing to go ahead with option two. This would see us stop offering the Support with Confidence scheme and offer support to residents and members in a different way based on what was most important to them. This might include directing people to services run by other organisations.
We know that the referral service has been popular with adult social care clients and helped many people find a personal assistant to meet their needs. Based on legal advice, the service in its current form won’t be able to restart. We are planning to explore what we could do instead, but it’s still early days in our thinking on this.
It should also be noted that other information may come to light during the consultation that may change our thinking on the options. This is because the National Direct Payment Forum is planning a conference on the topic and Action for People is in the process of revising the Support with Confidence licence.
Whatever we decide at the end of this process will be based on ensuring we are safeguarding our residents as best we can. We would also like to emphasise that we are committed to working with those affected by any change to manage the transition to whatever comes next.
We know that the Support with Confidence scheme in its current form is highly valued by members and residents. For this reason, we really want to hear from those who will be affected by the pausing of the scheme and whatever happens next.
The consultation is your chance to share your views, concerns, and ideas. What you tell us will help make our decision making as robust as it can be. We are keen to hear from:
The consultation closes at the end of the day on 5 December 2023. What you tell us will be summarised in a consultation report and will inform the Equality Impact Assessment (EqIA). An EqIA is a tool we use to understand how particular groups and communities would be affected by a proposed change. Both reports will be published on our main website and we’ll let you know when they are available by updating our consultation webpage.
A final decision on what happens next will be made by the Lead Cabinet Member for Adult Social Care & Health in February 2024. Lead cabinet members are authorised by Cabinet to make certain decisions within their areas of special responsibility.