Report on the pa market and options paper V3

Directly Employed Personal Assistants in Bradford:
Market Analysis and Options for Development

1.Executive Summary......................................................................................................................4
2.Introduction...................................................................................................................................9
3.Personal Assistant Market Overview.........................................................................................10
3.1.National Perspective................................................................................................................................10
3.2.Bradford and District...............................................................................................................................12
4.Best Value and Personal Assistants............................................................................................20
5.Personal Assistant Market Barriers and Challenges................................................................21
6.Role of Local Authorities............................................................................................................25
7.Existing Personal Assistant and Employer Support in Bradford ...........................................26
8.Safeguarding Vulnerable Adults in an Unregulated Market...................................................28
9.Personal Assistant Accreditation and Registers........................................................................28
9.1.Overview..................................................................................................................................................28
9.2.Accreditation and PA Support Schemes – Legal Issues .........................................................................29
9.3.Accreditation and Register Options.........................................................................................................31
9.4.Function and Purpose of a Register.........................................................................................................31
9.5.Online and Electronic Register Service Providers...................................................................................33
10.Personal Assistant Project Recommendations........................................................................35
11.Appendices.................................................................................................................................41
11.1.Examples of PA Schemes......................................................................................................................41
11.2.Legal Advice on LA run PA Accreditation & Register.........................................................................43
11.3.Comparison of Online Solutions: Features & Cost...............................................................................45
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1. Executive Summary
1.1.In Bradford lives are changing as people begin to choose to use their
allocated public funds to arrange their own social care.
Direct Payments Recipient June 2010
“I used to have home care. It was ok, but they didn’t come early enough for
me and weren’t prepared to come earlier. Then I had [name of agency]. It
was a shambles. There were different people every time and I kept having
to explain everything.
I advertised in the paper for my staff. I guess I was just lucky with getting the
right people. My wife does the payments. The payroll system [Bradford CVS]
is excellent. My life is much better now. I have my own converted van. The
girls take me out and about, they even come on holiday with me. It’s worked
out really well. I wouldn’t change anything”.
1.2.Putting People First milestones sets a target for 30% of eligible service users
to take up self-directed support by April 2011. As a result it is expected that
more people will directly employ their own personal assistants for personal
care and also to achieve quality of life outcomes.
1.3.While flexibility of direct employment is clearly beneficial there is also
potential lowering of service costs compared to the more traditional home
care options. A model based on a 5% shift away from Council arranged
personal care to directly employed personal assistants shows a potential
saving of £211,000 per annum (comparing average hourly wages for 2009-
10, see 4.10). The difference is mostly due to the removal of third party costs
(for example, agency fees and on costs).
1.4.However, very little is known what capacity there is in Bradford and District for
the personal assistant market to achieve this level of change, which this
report aims to address. The Council’s role in stimulating the personal
assistant market’s capacity and quality is also discussed.
1.5.Demand Analysis – main findings
1.5.1. Up to 50% of people on direct payments employ a PA. However, the
majority are employing people known to them (friends and relatives). Few
are advertising for ‘career’ PAs who work independently.
1.5.2. In Bradford there is a downward trend in referrals to the Direct Payment
team, which has not increased as a result of the SDS process being
implemented. The indication is that most SDS recipients are referred to
the home care team and continue to have services arranged on their
behalf (in-house, locality contracts and All-Inclusive Rate spot
purchasing).
4

1.5.3. A number of structured interviews with direct payment recipient’s in
June 2010 found that insufficient information earlier on in the process
may be an issue. National surveys found that less than 8% of older
people knew anything about personal budgets. However, once explained
(options and support available as an employer) 44% said they would
consider employing a PA.
1.5.4. Based on the current trends the actual demand by people using cash to
directly employ personal assistants could remain low.
1.6.Supply Analysis – main findings
1.6.1. The supply of directly employed PAs (not agency care workers) is also
estimated to be low.
1.6.2. We judged that between 200 and 250 PAs are currently employed by
adult direct payment recipients in Bradford & District (the majority employ
someone already known to them and are unlikely to be ‘career’ PAs). The
rate of PAs to Direct Payment recipients is approximately 1to1, which is
lower than the national average of between 1.64 and 2.4 PAs to each
Direct Payment recipient.
1.6.3. A survey of people who previously replied to adverts for PAs work had
41 responses. 50% had no previous PA work experience. Of those with
some experience working as PA only 19% worked full time while 38%
worked between 2-4 days per week and 31% had no PA work at all.
Anecdotal evidence suggests that most career PAs get job satisfaction
but the infrequency of work and lack of employment security are major
barriers.
1.6.4. National surveys found 8% of employed PAs were on the minimum
wage, only 7% of employers arranged formal training and 40% had no
formal contract job description.
1.7.While demand remains low for career PAs, and the cash pool from direct
payments is modest, there is unlikely to be the incentive needed to grow the
PA market.
1.8.Safeguarding and PA registers
1.8.1. A concern exists among practitioners that abuse is more difficult to
detect with directly employed personal assistants in what is an
unregulated and potentially ‘grey market’.
1.8.2. One response to this has been for local authorities to consider
introducing some form of ‘approval’ or ‘accreditation register. However,
our research could only find one Local Authority that has a
comprehensive programme to ‘approve’ PAs (which by April 2010 had
only managed to train and approve only 12 PAs).
1.8.3. Most Councils have entered into a philosophical debate regarding the
tension between safeguarding and personalisation principles, not least
5

because 71% of SDS recipients say that is they who should decide and
some perceive that accreditation to be local authorities clawing back
control.
1.8.4. The model emerging acceptable to most people are externally hosted
registers that are not compulsory or exclude anyone although may
provide validation and credential checks (it is up to the employer to use
this information to make an informed choice).
1.8.5. The function of a register can be broader than safeguarding and
information. Some examples:
• Improve speed of access to the market by connecting people
looking for work with those seeking personal assistance.
• Create a ‘community’ for personal assistants and platform for
engaging the sector in workforce development and standards.
• Signpost PA employers and employees to where they may get
support resources.
• Opportunities for economy of scale benefits through organising the
sector in joint procurements (insurance, recruitment drives, training
etc.).
1.8.6. Some registers are using subscriptions as revenue for development.
However, this appears to be a very poor strategy and few employers are
signing up (PA Pool West Yorkshire 4 signed up; North West PA only 11
signed up). Registration fees may need to be free for a register to be
viable and have enough users to generate a market. Any safeguarding
function would be restricted by low service user participation offering little
incentive for PAs to join.
1.8.7. The cost of setting up a register varies widely. Higher end is over
£100,000 and a lower cost bespoke development, with external hosting,
had a one off cost of £15,000.
1.9.Holistic Approach
1.9.1. No compelling evidence was found in our research to support the view
that a register in itself will stimulate the market. A holistic approach is
required by the Council to prime pump the market through investment
and coordination:
• Inform – get information about direct payments and knowledge about
employment support out to service users very early on in the SDS
process and to increase recipients’ confidence to employ a PA.
• Develop - Shaping the market through workforce development,
partnerships and co-production of standards with service users and
PAs. The role of the Council is to support coordination of these
6

activities either directly or through investment in a non-profit voluntary
or User Led Organisation.
• Empower - Support service users and carers to take more direct
control of their own arrangement, such as having employment
‘toolkits’, and easy, quick to access PA registers in order to broker
these services for themselves.
1.9.2. A register needs to be embedded in a broader ongoing PA project that
drives this holistic approach.
• Coordination of stakeholders and partners to develop a systematic
policy approach that finds a balance between safeguarding
initiatives and principles of greater freedom of choice and control.
• Research and identify workforce issues
• Research, indentify and find solutions for barriers
• Produces a common induction and training standards for PAs
(employers taking a lead)
• A register maintained that is current, clear and with sufficient factual
information to promote informed decisions via different media
including print outs, telephone and internet. A system is put in place
to check the validity of the identity and credentials of PAs.
• A Code of Conduct for PAs is developed together with employers
and PAs.
• Coordinate recruitment drives.
• Create toolkits with guidance and resources for both employers and
PAs, including safeguarding information and advice.
1.9.3. A holistic PA project would require investment without which it is difficult
to see how this immature and unregulated market will consolidate.
However, given the low demand trend any development should be
scalable starting with a pilot. Demand and supply could be reviewed and
the project scaled up as required. We recommend (reasons described in
this report) an externally hosted project that prevents the boundary
between the Council’s role of providing information blurring with that of a
representative of PAs.
1.9.4. A register would be required as the backbone of a project. High cost PA
register solutions are not best value, as the current demand for a
registers is probably small. However, a useful system with demonstrable
benefits for PAs and Employers should generate interest and grow.
Therefore, a low cost register and additional investment for the broader
project developed (by a voluntary or ULO) is estimated to include a set-up
cost of £15,000 and a project management resource cost of
7

approximately £22,000 to £25,000 per annum, which initially could be pro
rata part-time while testing the market.
Russell Cox and Shona Grange
Commissioning Support - Market Development
15 June 2010
8

2. Introduction
2.1.The Putting People First policy aims to ensure that person-centred planning
and self-directed support becomes mainstream. Personal budgets or
individual accounts are envisaged to become the usual way for everyone who
is eligible for publically funded social care to achieve outcomes that meet their
individual needs and aspirations.
2.2.Bradford MDC has fully committed to the Putting People First personalisation
programme. Everyone eligible for publicly funded adult social care will have
the option to take up self-directed support (SDS) with the allocation of a
personal budget or individual accounts.
2.3.The SDS national indicator NI130 minimum target by the year 2010-11 is for
30% of people who have a community-based social care package in that year
having taken up SDS.
2.4.An anticipated result of increased uptake of self-directed support is more
people directly employing their own personal assistants.
2.5.Person-centred and more flexible support planning is likely to widen the role
and expectations of personal assistance from the traditional focus on
personal care to support accessing universal services.
2.6.A significant barrier to a mature and stable market of directly employed
personal assistant has been the relatively low uptake of direct payments.
Simply put, relatively few people on direct payments did not encourage many
career personal assistants to enter the market. However, the Putting People
First objectives have renewed the efforts to achieve better uptake of self-
directed support.
2.7.The flexibility of directly employed personal assistance has appeal to service
users who find traditional models of procurement not flexible enough for their
needs.
2.8.Personal assistance directly employed generally costs less than that procured
from a registered agency or an in-house homecare service.
2.9.However, these benefits are offset by concern that Personalisation could
unintentionally stimulate a ‘grey market’, where people employed directly as
personal assistants work unofficially with some not paying national insurance
or income tax, having few employment rights and do not meet any minimum
professional standards.
2.10. Currently there is no national regulatory system in place for Personal
Assistants. The General Social Care Council (GSCC) has indicated that a
national regulatory system for personal assistants is unlikely to be introduced.
2.11. Therefore, the flipside of the advantages and opportunities created by
personalisation policy is the potential for the growth of an unsupported
9

personal assistant market, where risks exist include exploitation of the
workforce and safeguarding concerns for the employers. This highlights a
tension between the personalisation and safeguarding agendas.
2.12. This report focuses on the role of the Local Authority in supporting the
development of the capacity and quality of the personal assistant market in
a way that achieves a balance between the benefits of SDS recipients being
direct employers and mitigating against the unintended consequences of an
unregulated market.
3. Personal Assistant Market Overview
3.1. National Perspective
Demand
3.1.1. The demand for PAs by people on SDS is expected to increase. UK
research of people opting for individual budgets suggests 50% will go on
to employ personal assistants1
although this may vary according across
user groups and nature of disability.
3.1.2. Research carried out by Demos from December 2008-July 2009 found
that found 62% of service users knew nothing at all and 20% knowing just
a little about direct payments of personal budgets.
3.1.3. Few older people (less than 8%) knew anything or very little about
personal budgets. However, once informed almost half said they would
change at least some things about their care package if they had a
personal budget. In particular, 44% saying they would want a PA if they
had a personal budget.
3.1.4. A 2008 Skills for Care workforce report found that the majority of direct
payment recipients are in the physically disabled adults and older people
categories. Combined they accounted for nearly two-thirds (62%) of direct
payments recipients, followed by carers receiving direct payments (16%
of users) and learning disabled adults (14%).
1
Priestley M et al. (2007) ‘Direct payments and disabled people in the UK: supply, demand and devolution’,
British Journal of Social Work, (October), vol 37, no 7, 1189–1204; Glendinning C., et al. (2008a) Evaluation
of the individual budgets pilot programme: summary report, York: Social Policy Research Unit, University of
York.
10

3.1.5. The trend was expected to continue with the older people becoming the
majority group of direct payment recipients from 2008 onwards.
3.1.6. With the emphasis on preventative and re-enablement services,
diverting older people away from residential care with greater numbers
remaining longer in their own home could significantly increase the
demand for personal assistance at home as more and more older people
get to know about and start to understand how personal budgets may
benefit them.
3.1.7. Demand for personal assistants is expected to be linked to the rate of
uptake of SDS. People gaining access to their own budgets through SDS
is forecast to rise from 114,000 in 2006 to 646,000 in 2025 (State of the
Adult Social Care Workforce in England 2008 study).
Supply
3.1.8. Research found that the supply of high-quality, trained and skilled
personal assistants is limited and this reduces choice for direct payment
employers. Supply shortages are greater in rural areas.
3.1.9. The Skills for Care England estimates that the number of personal
assistants employed by direct payment users would need to increase
nine-fold by 2025 to achieve maximum choice2
. However, this figure does
not take into account that many may choose to employ their previously
unpaid carer relatives instead of employing a career personal assistant.
3.1.10. Surveys conducted by Skills for Care of direct payment users
and their personal assistants estimate the number of personal assistants
per direct payment recipient at between 1.64 and 2.4 respectively3
.
3.1.11. However, of the Direct Payment recipients surveyed by the Skills
for Care, only 66% could find an appropriate personal assistant previously
unknown to them within a month and 36% said the process had been
difficult.
3.1.12. Expanding the market to meet the demand holds and
safeguarding risks associated with an essentially unregulated market
emerging with few quality checks, poor pay and transitory work force and
some PAs operating outside of employment law (the ‘grey market’).
3.1.13. While there is limited information in England it is expected that
the personal assistant/care support worker labour market is characterised
by migrant, mostly female workers with a high turnover. In Scotland
recent research of the PA market found the workforce was largely female,
white and on average over 40 years4
.
2
Eborall C., Griffiths D. (2008) The state of the adult social care workforce in England, 2008, Leeds: Skills for
Care.
3
Skills for Care Annual Workforce Report 2008, Skills for Care pp 46
4
Howie R et al (2010) Workforce and Employment Issues Surrounding Self-Directed Support. Social Research.
The Scottish Government
11

3.1.14. In the UK one in three PAs considered themselves underpaid;
with the average hourly wage in 2008 being £7.60 (£8.45 average
reported by the Scottish Government’s 2010 research) and 8% PAs were
on the minimum wage. It was also found that one third wanted training but
only 7% of employers arranged formal training5
. Two fifths of PAs had
received no formal contractual job description from their employer.
3.1.15. The PA workforce in the rest of the UK is likely to be similar to
the finding from Scotland having a low level of provision of sick pay
beyond Statutory Sick Pay, little if any pension provision and few PAs
belong to a trade union.
3.1.16. In conclusion, the directly employed PA market place as it exists
today is unprepared and ill equipped to meet the anticipated increase in
demand for good quality personal assistance.
3.2. Bradford and District
Demand
3.2.1. There should be a correlation between the demand for personal
assistants and the number of people receiving cash payments to
purchase directly their own support. Without this ‘cash’ market the
personal assistant market will not thrive. Therefore, it is important to
analyse the trend of self directed support in Bradford relative to the
number of people who are taking direct payments.
3.2.2. For the Mid-April 2010 return NI130 the number of adults in receipt of
direct payments or individual budgets was 610 (509 direct payments and
101 individual budgets). The figure includes one off payments. In June
2010 the number of people receiving regular direct payments was 467
with one off payments accounting for the remainder.
3.2.3. In April 2010 33% of people in receipt of a Direct Payment or Individual
Budget for Personal Assistance in Bradford & District were over 64 years,
which is similar to the National trend (see 3.1.4 above).
3.2.4. Mid-April 2010 of all direct payment and individual budget recipients
31% were adults 18 to 64 years with learning disabilities (higher than
average National prevalence) and 21% adults 18 to 64 years with
physical disabilities (lower than the average National prevalence).
3.2.5. Referrals to the Direct Payment Team from January 2009 to May 2009
suggest that the number of older people being referred is of similar
proportion to the existing recipient groupings (the majority of referrals
from the Adult Area Teams and hospital are older people – approximately
37%. However, referrals of people from the learning and physical
disabilities teams is lower while children make up a third of all referrals,
5
IFF Research (2008). Employment aspects and workforce implications of direct payments, Leeds: Skills for
Care.
12

Referrals to DPT Jan 2009 to May 2010 by Referee Group
31%
35%
6%
14%
8%
5%
1%
37%
Adult Area Teams Children &Young People Physical Disability Learning Disabilities
Mental Health Hospitals Sensory Needs
3.2.6. Of the 467 clients in May 2010 in receipt of a regular direct payment
219 (or 47%) employ at least one PA. The Direct Payment Team do not
think that there are many people with more than one PA, so the estimate
is 250 directly employed personal assistants, which is generally in line
with the national trend of 50% of direct payment recipients employing a
PA.
3.2.7. The overall trend of referrals to the Direct Payment Team would appear
to be declining since January 2009 (see chart below). This is more
pronounced for adults. This is counter intuitive in that one would expect
the referrals to rise with the promotion and increased take-up of self
directed support.
Referrals to Direct Payments Team Jan 2009 to May 2010
Trend Line over 17 Months
0
5
10
15
20
25
30
Jan-09
Feb-09
M
ar-09
A
pr-09
M
ay-09
Jun-09
Jul-09
A
ug-09
Sep-09
O
ct-09
N
ov-09
D
ec-09
Jan-10
Feb-10
M
ar-10
A
pr-10
M
ay-10
Month
NumberofReferrals
Adults Children Linear (Adults) Linear (Children)
13

Adult New DP Contracts by Month 2009-10
0
5
10
15
20
25
30
Apr-09
M
ay-09Jun-09
Jul-09
Aug-09
Sep-09O
ct-09
N
ov-09D
ec-09
Jan-10
Feb-10M
ar-10
NewContracts
Trendline
3.2.8. The RAS assessments were piloted in areas from around September
2009 and the process was fully rolled out to all areas by the end of
December 2009. This data shows that there has not been an increase in
Direct Payments as a result of the SDS process being implemented.
3.2.9. While further analysis is required to understand a downward trend the
reasons could include:
• Information about direct payments and option to employ own staff is
not fully understood by recipients early on in the process at the point
of the initial assessment.
• In the Self-Directed Support customer journey the majority of people
assessed are referred for re-enablement to the Home Care intake
team.
• There is a possibility that referrals to Direct Payment team could
increase post re-enablement although this is not yet showing up in
the current trends.
• People are continuing to choose services that are familiar to them
and the Council.
3.2.10. The average weekly hours and number of clients supported by
Home Care services has over 12 months remained relatively constant
without significant variations (see chart).
14

Home Care Average Weekly Hours & Clients 2009-10
15000
16000
17000
18000
19000
20000
21000
01-Apr-09
30-Jul-09
31-Aug-09
30-Sep-09
31-O
ct-09
30-N
ov-09
31-D
ec-09
31-Jan-10
28-Feb-10
31-M
ar-10
Hrs
1900
2000
2100
2200
2300
2400
2500
Clients
Hrs Clients
`
3.2.11. Using the number of recipients supported to place adverts for
PAs, as a proxy demand indicator for ‘career’ PAs, the number of people
employing PAs not previously known to them would seem to be quite low.
However, people may be placing adverts independent of support from the
Direct Payment team but this number is thought to be nominal. The
experienced Direct Payment officers believe that few PAs employed to
support children were previously not known to them or their families.
Number of Direct Payment Recipients Supported
to Advertise for Personal Assistants
20 23
14
3
0
5
10
15
20
25
2006 2007 2008 2009 2010
Year
Numberof
Recipients
Data for 2007 unavailable
3.2.12. The distribution of people who employ personal assistants do not
seem to be influenced by geographical or constituency factors and is
quite even with no noticeable patterns (such as clustering in certain
areas). Again, this may be indicative of employing personal assistants
known to them.
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3.2.13. The Putting People First milestone for April 2011 is for 30% of
eligible service users/carers to have a personal budget (referred to in
Bradford as an individual account). In Bradford this represents a target
number of 5000 people.
3.2.14. Based on the national trends of 50% this could potentially
represent 2500 people in Bradford wishing to employ a PA with their
individual account by April 2011.
3.2.15. However, the analysis above of both the up take of direct
payments (the cash needed to stimulate the PA market) and potential PA
pool in Bradford is comparatively low possibly because of a combination
of a number of factors:
• A high proportion of people taking up individual accounts may still
have the Council holding the money and arranging services on their
behalf most often as intake to the Home Care services.
• Safeguarding concerns may influence how these arrangements are
made when care managers perceive that abuse by personal
16

assistants is less likely to be detected than abuse of people in more
traditional services6
• Further, at least initially the demand by older people for employing
PAs themselves will be less (see 3.1.3 above).
• A significant proportion of people recorded in the NI130 return will
be those receiving vouchers (7%) or winter warmth payments
(19%), as found in the March 2010 returns.
• Many people will seek to employ someone that they already know
and trust. In many cases this will not be a career PA who they have
no previous acquaintance.
Supply
3.2.16. The actual number of directly employed PAs in Bradford and
District is difficult to estimate. We can only estimate the supply relative to
the number of SUs in receipt of direct payments and individual budgets
who employ a PA. However, the number of personal assistants employed
by self-funders is not known.
3.2.17. For June 2010 there were 219 people who employed at least
one personal assistant.
3.2.18. Using the national estimate for the number of personal
assistants per direct payment recipient ranges between 1.64 and 2.4. If in
Bradford there is a similar rate then the number of directly employed
personal assistants by direct payment or individual budget recipients is
between 360 and 525.
3.2.19. However, the view of the Direct Payment Team is that in
Bradford the majority of people only have only one Personal Assistant
and would estimate the true number of personal assistants between 220
and 250 (most are likely to be someone known to the employer and not a
career PA).
3.2.20. Therefore, the initial indication is that the number of personal
assistants per direct payment recipient is less than the national average.
3.2.21. One reason for this may be that there has not been enough local
demand to stimulate the PA market. Historically the uptake of direct
payments in Bradford has been below the national average of the
percentage of Social Care Clients receiving Self Directed Support
(Bradford 3.1% compared to 5% comparator average and 6.9% National
Average for 2008-09).
3.2.22. A list held by the Direct Payments team has a further 385 names
of people who at some time have responded to adverts for personal
6
CSCI (2008) Safeguarding adults: A study of the effectiveness of arrangements to safeguard adults from abuse
17

assistants but were not employed. It is thought unlikely that many of these
individuals will be working as individual career personal assistants.
3.2.23. A survey of personal assistants working in Bradford and district
was undertaken in June 2010 targeting two distinct groups. First a group
of 219 adult direct payment recipients, known to currently be employing a
PA, were asked to forward the survey to their employees. The second
group was a list held by the Direct Payment Team of people who have at
some time responded to adverts for personal assistants (340 surveys
sent out as 45 names removed, as known to be unsuitable).
3.2.24. In total 47 completed survey forms were returned. The response
rate for both groups was very low but particularly poor for the first group
(only 3%). For the second group the response rate was slightly better at
10%.
3.2.25. Although limited the survey does provide some initial
understanding in particular of the people responding to adverts for PA
employment. The charts below show the key results.
Respondents with Previous PA Work Experience
40%
58%
2%
No Previous PA
Experience
Previous PA Experience
(blank)
PA Employment Status
39%
29%
25%
7%
PA is Main Employment
PA Supplements Main
Employment
PA not main Employment
Not Stated
Primary Employer
12%
40%
12%
12%
8%
4%
12%
36%
Agency Only
Direct Payment Recipient
Only
DP & Agency
DP & Self-Funder
Mix of All
Other
Self-Funder Only
Frequency of PA Work
19%
38%
12%
31%
Full-Time
2-4 Days
Less than 2 days
Not at All
3.2.26. In summary the following observations can be made:
• A high proportion of respondents had no previous experience
of working as PAs (40%). Of the respondents on the Direct
Payment List 50% had no prior experience (possibly replying
to adverts out of interest).
18

• Of those that do have previous experience 39% stated this to
be their main occupation while only 19% worked full time as a
PA. The majority (38%) only worked 2 to 4 days a week and
31% were currently not employed as a PA.
• While 40% stated that their primary employer was a direct
payment recipient the rest are finding employment from a mix
of employers including agencies, self-funders and direct-
payment respondents.
• The particularly low return of surveys by Direct Payment PA
employees may be on account of the higher proportion being
people previously known to the recipient and not a career
personal assistant.
• Despite the above stated limitations of this survey the
findings suggests that there may be a very small and
predominately part-time pool of career personal assistants.
Supply & Demand Gap
3.2.27. For reasons already noted the future demand for PAs is difficult
to predict and the trend between the uptake of SDS and those wanting to
directly employ a PA is unlikely to be linear.
3.2.28. Early indication is that the number of intakes to the Direct Team
is modest relative to the increase in the overall SDS uptake.
3.2.29. A chicken and egg relationship exists where the demand for
PA’s will be determined by how well organised and dependable the PA
market is perceived. However, a critical mass of demand is necessary
before a viable market can flourish and thrive to meet these expectations.
3.2.30. However, for illustration purposes if the current demand for PAs
(see 3.2.6 above) doubled by April 2010 there could be approximately
500 people wishing to use their individual account or direct payment for
directly employing a PA.
3.2.31. Assuming the national prevalence of a minimum of 1.64 PAs to
each individual budget or direct payment recipient then the gap would be
in the region of at least 460 PAs. However, the majority of PAs will
already be known to recipient so the gap for career PAs is likely to be
much less.
3.2.32. The early indications are that the majority of people who do not
already know someone, to employ as a personal assistant, may continue
to use agency and home care team services.
3.2.33. However, an investment to develop a directly employed PA
marketplace could result agency workers switching to this way of working
19

should there be more cash reaching the market from self directed
support.
4. Best Value and Personal Assistants
4.1.The development of a personal assistant market of people recruited and
employed directly by a SDS recipient has potential to deliver services at a
lower unit cost than if arranged or provided by Bradford MD Council.
4.2.In theory the growth of the personal assistant market operating independently
of an agency or the local authority would redistribute demand by reducing
reliance on higher cost suppliers.
4.3.In Bradford the majority of personal assistance (personal care) is provided by
in-house, locality contracts and AIR or All-Inclusive Rate (domiciliary care
agency approved provider list) services.
4.4.The locality contracts do not have a minimum guaranteed hours requirement
so a reduction in use would not result in any penalties and there is also no tie
in with the AIR agencies. Therefore, there is no apparent contractual barrier
to commissioning directly employed PAs as an alternative to traditional home
care.
4.5. As discussed in 4.1.14 above the hourly wage for directly employed Personal
Assistants vary greatly and the national average in 2008 was £7.60. In
Bradford the current average hourly wage (direct cost) is £7.50 per hour and
approximately an average of £2 paid from the direct payment to cover
employment costs (for example holiday pay, insurance, payroll costs).
Therefore, together this works out to an average £9.50 per hour.
4.6.People on SDS determine what rate they are prepared to pay for a personal
assistant. The Direct Payment Team state that recipients may choose to pay
more for fewer hours of good quality service than having more time receiving
a lesser service.
4.7.Where people get PAs from an agency the rate would depend on the costs of
agencies in their geographical area.
4.8.Bradford MDC retains £13.75 per hour from a person’s agreed budget if the
Council were asked to continue to provide or purchase personal care, and
represents the Council’s calculation of the average cost per hour to the
Council of procuring such services.
4.9.In comparison with home-care services the delivery of personal assistance by
directly employed PAs will be on average more cost efficient. For example
this year to date average cost of in-house home care provision (includes
intake) is £21.38 per hour (including management and running costs) or
£15.45 per hour as direct cost only. The average hourly rate for Locality
Contracts is £13.36 per hour and All-Inclusive Spot contracts this is £13.62
per hour.
20

4.10. The example in the table below models the potential lower cost where
service users directly employ individual PAs that are not arranged through an
agency or the Council’s home care service. The calculation assumes a 5%
reduction in home care commissioned services and is based on the average
gross cost (direct and employment costs) of £9.50 per hour for directly
employed PAs by direct payments or individual account.
(A)
Average
Overall
Weekly
Hours
(B)
5% of
(A)
(C)
Average
Hourly
Rate
(D)
Cost Difference
= £8 - (A)
(PA national
average rate)
(E)
Estimated
Annual Cost
Difference
=(B)x(D)x52
Locality Contract 5447 272 £13.36 £3.86 £54,596
All Inclusive Spot 4223 211 £13.62 £4.12 £45,205
In-House
(including intake)
7221 361 £15.45 £5.95 £111,693
Total 16891 844 £211,494
Based on year to date averages 31 March 2010
4.11. With only a 5% shift of hours away from Council procured personal
assistance this example suggests an annual reduction in the cost of personal
assistance by £211,000. Further, this does not include any efficiency savings
that may result from reduced management and running costs of the home
care service.
4.12. While this is a crude analysis, and the actual saving would be
influenced by fluctuations in needs and the actual (but still unknown) average
hourly rate of the PA market in Bradford, it is highly probable that a robust
and organised independent PA market has the potential to provide an
alternative and more cost efficient choice for service user employers.
4.13. An inherent risk is for these potential financial savings to influence
commissioning patterns without investment in the quality and standards of the
independent Personal Assistant Market.
4.14. Individual transaction costs will be higher and will not benefit from other
economies of scale. A consequence of this is that personal investment in
training and other practice support could be neglected by employers.
4.15. A strategy for developing the market needs to therefore address the
quality of directly employed PAs and address the potential risks of under
investment and support.
5. Personal Assistant Market Barriers and Challenges
5.1.The history of direct payments has shown that three main factors have
hindered progress with up-take of SDS:
• concern about managing direct payments amongst service users and
carers;
• staff resistance;
21

• difficulties regarding the supply of personal assistants7
.
Below are a few examples of common barriers and challenges to the expansion
and quality of the PA market:
Employers
5.2. While a national survey found that 79% of employers were satisfied with their
current PA a third found it difficult to cope with the administration of being an
employer and had difficulties recruiting an appropriate worker.
5.3.Concerns about lack of understanding and experience of managing the
business, such as administration and paperwork, payroll and pensions,
insurance and other employer’s responsibilities).
5.4.Difficulty arranging emergency cover (i.e. unplanned absences of PA).
5.5.Limited choice of PAs (more pronounced in rural communities).
5.6.Most local authorities allocate service users less money to buy their own
services than would have been allocated if the councils arranged the care
themselves8
.
5.7.Employers are generally unwilling to fund training for their employees citing
costs – only 7% have arranged or paid for PA training and many feel it is not
their responsibility.
5.8.Initial feedback from Bradford care managers identified that Service Users are
interested in having a PA but stated a reluctance to become and employer
and concern about the length of time to employ the right person.
5.9. In June 2010 twenty structured interviews were conducted with direct
payment recipients in Bradford to learn about the opportunities and
challenges of self directed support and employing a personal assistant. The
common themes included:
• Most people had been told about direct payments by their social
worker but sometimes only after their care packages had gone wrong.
• Compared to making their own arrangements most direct payment
respondents were dissatisfied with services arranged by the Council on
their behalf.
• Everyone liked having their own budget because of the flexibility and
the choices it gave them.
7
ESRC (2006) Disabled People and Direct Payments: A UK Comparative Study
8
Davey, V et al (2007) Direct Payments: A national survey of direct payments policy and practice
22

• However, managing accounts and administration is sometimes both
difficult and complex. While a payroll system helped it did not alleviate
all the difficulties of administration.
• The majority chose to use agencies or to employ people they already
knew. Only two people had advertised for a PA with mixed success.
Getting the right PA through advertising was regarded as ‘luck’ and
repeated advertising proved expensive and unreliable.
• Those using PAs for personal care reported being content with the
service they received. In respect of support by PAs to assist inclusion
activities the main concern expressed was difficulty getting to know
about what was available and a lack of suitable places to go for outings
and activities.
Quotes from Interviewed Direct Payment Recipients – June 2010
“I spoke to the members of my group. None of them had heard about direct payments.
Nobody had told them even though they had problems with their support. I told them they
could do this much better.”
“I use an agency. Why? Can you really employ people yourself?”
“Mum used to refuse services sometimes. She doesn’t like them to give her a bath, so I
end up doing it. The flexibility of payments has been good for us though, because now I
get a break while mum goes shopping with her PA, so I don’t mind. It works out well
because we’ve timed it to fit in with the access bus. That way she keeps her
independence; she collects her own pension and she likes to browse and choose her own
things. The staff are so patient and I know she is safe.
“The only downside has been the accounts. I would say people need to fully understand
what they are taking on. I’ve been doing it since 2004, but lately it has got so much
easier since we started using the Community payroll. Mum doesn’t want to be bothered
with stuff like that- she just wants to know where she is going that day!”
“There were times we couldn’t get any support and as a result we had money left in the
bank and we had to pay it back. But she pays £160 per month towards her support and
we didn’t get any of that back. They said ‘tell us which days she got no support and we’ll
try to sort it out’, but I couldn’t remember which days. It seemed so complicated I said,
‘don’t bother’.”
“There’s direct payments and ILF, plus her own money. You never get the same story
twice about who should be paying for what and every four weeks you have to send money
back because we don’t use all of it if she’s been unwell or at appointments.”
“Finding out information like services, changes to benefits, legislation, things like that
can be hard. We’re not on the internet, but we get a newsletter from Carers Connection.
It’s very good. Perhaps information about using direct payments well could be put in
there?”
23

“I advertised in the paper for my staff. I guess I was just lucky with getting the right
people”
“Finding a PA can be hard. Because it’s only 8 hours, nobody is going to do this as a
permanent job. The DP team were very helpful, but advertising through the paper has
cost £400! The person we picked only stayed 8 months because they didn’t hit it off.
There has to be a better way”
“Maybe my PA could meet up once a month with others to find out about what’s going
on and how other people use their budgets and what services and equipment you can
get”.
Personal Assistants
5.10. Take up of direct payments has historically been insufficient to create a
sustainable market of personal assistants and the specific services that
payment holders require.
5.11. Little or no dedicated support for PAs (compared to employers who
may get support from Direct Payment teams).
5.12. Barriers can include difficulty in finding out about becoming a PA,
unable to find the right opportunities and isolation in marketing and promoting
their services.
5.13. Terms and conditions of employment may be unattractive (low wages,
limited sick pay or pension contributions etc.) and not conducive to stimulating
a skilled and stable PA workforce.
5.14. Lack of awareness or understanding of employment rights. Research
nationally has found that two fifths had no formal contractual job description.
5.15. Employers not supporting training or difficulty identifying and accessing
suitable training.
5.16. Poor job security because there may be only one employer who is
totally dependent on Local Authority funding. If assessed needs change there
is a risk of loss of funding.
5.17. Lack of status associated with low pay, unsociable hours, limited career
progression and training opportunities.
5.18. Respondents to a survey conducted June 2010 of Personal Assistants
in Bradford found half had none or limited previous experience of working as
personal assistants.
5.19. While limited the initial comments from personal assistants working in
the Bradford region cite training, qualifications and not enough hours of work
as principle barriers.
24

5.20. Most respondents indicted that they would be very interested in support
for a range of needs including:
• Receiving news and information relevant to working as a Personal
Assistant; support that promotes career development (such as training
opportunities) and help to source work (rated on average 9 out of 10 in
importance)
• Contact with other personal assistants (peer support) & advice about
employment rights (rated on average 8 out of 10 in importance)
5.21. A number of respondents commented that they would like information
to support there employers to access resources and help when problems
arise.
Quote from Personal Assistants in Bradford June 2010
“How to get around the qualifications or training! Most employers want one or both before
they take you on, but how are you supposed to get trained if no-one will [train you]!?!”
“I fill in many forms leaving my contacts for PA employment but always seem to be chasing
work. I see many jobs advertised but when I send in application process takes a long time”.
“Am waiting for my CRB to come through. I've got a job with a 12 year old boy but at the
moment it's only 2 days a week. My car is also insured for business use. I would like more
hours”.
Would like “Info for things to do to get out and about to aid the people I care for, i.e.
sightseeing, places of interest and discount tickets etc for things like national Trust, Cinema,
parks etc”.
Would like a “Newsletter on a regular basis ….. Where to seek advice for clients re any
problems etc”
6. Role of Local Authorities
6.1.The role of local authorities in developing and supporting the PA market is
varied with most doing so by collating and providing information.
6.2.The LAs role may include, for example:
• Provide information and advice including factsheets for both PAs and
Employers
• Ensuring safeguarding and quality concerns awareness
• Investing in community organisations that will develop a PA support
service.
• Publicising PA support services and coordinating recruitment campaigns
25

• Policy decisions such as creating flexibility in assessed need payment
rates so that PAs fees can match complexity of needs
• Establishing fair charging policies for any PA support services and support
brokerage services.
• Subsidise or pay for CRB checks and training.
• Promote the development of a personal assistant list or register.
6.3.In the case of PA registers these tend to be external and independent (with
branding distinct from that of the LA). Appendix 11.1 provides example of PA
Schemes including some with registers. The only examples we found of
Authorities that do host registers are Merton and Wigan & Leigh.
6.4.Our research did not find any ‘accreditation schemes’ for PAs run by a local
authority. Only one LA has a comprehensive programme of ‘approved’ PAs
(Oxfordshire) which is run in conjunction with Trading Standards ‘Buying with
Confidence’ scheme. The Council trains, complete checks, and ensures
signing up to a code of conduct before ‘approving’ PAs although they still
recommend that the service-user, as an employer, also completes their own
checks. The scheme went operational in January 2010 but by April 2010 had
only trained and approved 12 PAs.
6.5.Councils do not in the main offer any specific training or approval checks for
PAs. However, most do offer a support service to the service users in terms
of advertising for a PA, help with the recruitment process and to offer services
such as a Box number and interviewing space away from the employer’s
home.
7. Existing Personal Assistant and Employer Support in Bradford
Bradford MD Council
7.1.Bradford Council does not provide any specific support or training for PAs.
Enquiries about training for PAs are signposted to external providers to give
advice.
7.2.However, Bradford MDC Workforce Development Unit undertakes training for
Council staff in Common Induction Training. A whole time equivalent post
exists to support external market development and it is feasible for this to
include directly employed PAs. There is capacity to train additional groups of
20-25 people approximately four times a year.
7.3.The Council’s Direct Payment team assist service-users with assessed need
to find and employ a personal assistant. Support includes help to advertise
and recruit (supply application forms, help with short-listing, interviewing and
information packs). The Direct Payment team does not approve or
recommend PAs and the onus is on SUs to complete checks, including CRBs
(although helped in doing so) at their own expense.
26

7.4.The Direct Payment team is currently running a capacity of 4 direct payment
officers to 187 direct payment recipients.
Other Local Resources
7.5.Some CQC registered domiciliary care agency providers in Bradford area are
offering services that resemble the work practice of a PA (carer workers who
work exclusively for specific service users) although the PA is still employed
by the agency and not the service-user.
7.6.Bradnet’s Independent Living Service, their CQC registered domiciliary care
agency, operates a PA register and has a rolling programme of training.
Support includes matching disabled people with PAs across the whole of
Bradford and Keighley. They undertake references, CRB checks and provide
support for supervision and review. They also complete assessments where
no statutory assessment has been made (e.g. self-funders). Bradnet are the
employers and not the service-user.
7.7.Other registered domiciliary care agencies providing this type of flexibility
include St Anne's, Supported Lives, Active, and Able Community Care. These
agencies have historically worked with service-users with learning disabilities,
physical disabilities, and those who require someone to live-in.
7.8.Older people's care has tended to centre around block contracts based on
geographical area and typically traditional service offerings focused on
personal care needs using rotas, where a variety of carers could call at a time
that suits the agency.
7.9.However with the introduction of Individual Accounts, there is now scope for
older people to choose an agency that offers PAs. Service providers should
be encouraged to develop further opportunities and choice for personal
assistance.
7.10. Age Concern Bradford & District already has trade registers including
‘personal care’ listings9
. Currently they have only domiciliary care agencies
registered. They do not do not advertise or solicit traders to come on to the
register. A documentation vetting and checking process is undertaken based
on an application for registration process before the information is made
available to clients. The demand for registration has been low from agencies
and currently only three are registered. Career PAs would be able to apply to
register (free) but are required to pay for an enhanced CRB. They would have
to produce three references, public liability insurance and evidence of any
professional membership before the PAs details are included on the register.
Essentially this is an approved list but cannot be accessed online by PA
employers (they need to telephone and are given 3 names from the list). The
scheme may therefore have some limitations in facilitating easy access.
9
http://www.ageconcernbradford.org.uk/services/home_services
27

8. Safeguarding Vulnerable Adults in an Unregulated Market
8.1.A concern regarding directly employed personal assistants is that if
employment checks are voluntary, people with criminal records may be able
to persuade the person employing them that checks are not necessary.
8.2.The future role of regulation in relation to self-directed services is not clear.
How best to protect people directing their own support from abuse has to be
balanced with people having control and choice over their own support.
8.3.Innovations by Councils to address these concerns while also promoting the
principles of personalisation will reflect organisational culture and attitude
towards risk and risk taking.
8.4.In November 2008 no Council receiving a service inspection had a systematic
approach in place to address the balance choice-control and safeguarding10
.
8.5.CSCI (now CQC) found examples of Councils offering options to people that
help to prevent abuse and minimise risk without undermining choice and
independence, tailoring arrangements to individual circumstances. These
options included:
• Good information on safeguarding in card form
• Obtaining CRB and career history checks and references for personal
assistants
• Recruitment support from a third party
• Training and support on financial and employment issues and potential
abuses for people directing their own support
• Routine council checks on progress through care plan reviews
• Organising forums of people directing their own support to share
experience and good practice.
9. Personal Assistant Accreditation and Registers
9.1. Overview
9.1.1. An emerging response by Councils to safeguarding concerns is to
promote a register of personal assistants that allows employers to have
more detailed information about potential employees enabling better
informed choices based on the character and competency of the people
offering services as personal assistants.
9.1.2. A secondary function of registers is to stimulate and promote the
personal assistant market. The potential for this will depend on the nature
10
CSCI (November 2008) Safeguarding adults: A study of the effectiveness of arrangements to safeguard adults
from abuse
28

of the system put in place although the aspiration is that a well run
register could possibly:
• Consolidate and promote the visibility of the local market for
personal assistants
• Increase confidence of employers to employ PAs previously not
known to them
• Promote work opportunities with increased volume providing job
market stability needed to attract more PAs to enter the directly
employed market.
• Have secondary gains by strengthening both employer and
employee communities where sharing of support (including
workforce development and standards) can be organised in a
coordinated way.
9.1.3. A policy decision that the Council needs to address is its role in putting
in place a system of accreditation or approval of personal assistants that
promotes safeguarding, while at the same time is flexible enough to meet
the diverse nature of peoples’ wishes given the increased choice they will
enjoy controlling their own funding.
9.1.4. A Council accreditation or Approved list would by definition exclude a
sector of the market place that does not meet the set criteria for inclusion
on a list.
9.1.5. The support for a compulsory register by employers is mixed. The Skills
for Care survey found that 58% of employers felt that having an official
register would be useful although half wanted it to be voluntary and the
other half compulsory. However, 71% stated that they wanted to retain
the right to choose their own personal assistant including someone who is
not registered.
9.1.6. There is a view held by some service users and disability groups that
accreditation or other approved lists is actually a backdoor to restrict their
freedom of choice and decrease the power they have in employing who
ever they wish.
9.1.7. Therefore, introduction of a compulsory accreditation or approval list
would potentially be a politically sensitive development.
9.2. Accreditation and PA Support Schemes – Legal Issues
9.2.1. A concern by some Local Authorities is that the development of an
accreditation process, led by a Council, could potentially blur the line
between the Council’s role in providing information to promote choices
and its role as an employer (since the Council may be seen as
introducing, training, vetting and giving approval/accreditation. This is
29

compounded by the fact that the source of money for pay comes from the
Council).
9.2.2. Bradford MDC Corporate Law Team has been consulted regarding this
concern. The legal view is that, “It is difficult to see how this arrangement
could result in the inference of an employment relationship”. The full
response is included in appendix 11.2. However, the main points include:
• This arrangement appears to be similar to that provided by some
children services in local authorities in relation to registered
childminders.
• Ultimately the service user dictates how the service is provided
while input from the Council concerns safety and standards. The
key decisions affecting the employment relationship will continue to
be determined between the service user and the personal assistant.
• An appropriate disclaimer by the Council should reinforce that the
employment decision is that of the direct payment recipient and they
need to carry out their own checks, using the list as a source of
information only. For example,
Wiltshire Direct Payment Support Service operate this register to assist disabled
people living in Wiltshire in finding Personal Assistants (PAs). This in no way acts
as a recommendation of any PA and we do not CRB check PAs or carry out any
other suitability checks prior to entry on the register. It is therefore important that
the potential employer carries out any checks they feel necessary before
employing anyone.
9.2.3. The key questions for deciding the extent of the role of the local
authority in supporting a registration list and personal assistant support
scheme are:
• Do direct payment recipients in Bradford want an ‘approved’ list and
is this compatible with the aims of personalisation?
• Or is an inclusive register (providing information about the skills,
CRB status and other attributes but is not a closed list) more
appropriate to allow greater choice while also sharing information
about standards and quality?
• Can the Council take a leading role in supporting personal
assistants while having a paramount duty of care to service users or
does this present a potential conflict of interest?
• Who keeps (hosts) and maintains the register, as this may reflect
the degree to which the recipients of direct payments or individual
accounts perceive they have control over the resource?
30

9.3. Accreditation and Register Options
9.3.1. The key decisions about the above will be based on a policy or
philosophical considerations rather than legal principles.
9.3.2. A register can validate credentials and the PAs qualifications / skills
without endorsing or recommending the registered personal assistants.
In contrast an accreditation or approved register or list restricts
membership to those PAs who have met certain minimum criteria.
9.3.3. The principle of Personalisation is to allow maximum choice to service-
users. There are advantages to having some form of approval or
accreditation scheme for PAs to allow peace of mind. However, because
people employ PAs for a wide variety of tasks it would not be beneficial to
insist that everyone needs the same training, or even any formal training
at all. Equally, although it is universally recommended that checks are
carried out, this isn’t always welcomed, particularly when family or friends
will be employed.
9.3.4. The options are set out in the diagram below:
9.3.5. From our research the majority of councils appear to have opted for
registration system that are voluntary and provides information to support
informed choice and are not approved lists of PAs. (See appendix 11.1
for more detail of various schemes).
9.4. Function and Purpose of a Register
9.4.1. The primary purpose of a register is to facilitate and energise the
marketplace of long term, regular Personal Assistants who are directly
employed (‘career’ personal assistants).
9.4.2. The register also could function as a source of short term cover by
personal assistants that are CRB checked and able to respond quickly
(this may include people employed by an agency or working
independently who are willing to respond at short notice).
Accreditation or Approved
List Hosted & Managed by
Council e.g. only one
example found - Oxfordshire
CC support with confidence
scheme
Accreditation or Approved
List Hosted & Managed by
VCS. No examples found
Register Hosted & Managed
by ULO e.g. Essex Coalition
of Disabled People; NW-PA
(Age Concern & Cheshire
CIL coalition).
Register Hosted and
Managed by VCS or
Council e.g. Compass
Disability Services, Wilts;
Merton Council; Wigan and
Leigh
31

9.4.3. An option for the register is to provide a link with domiciliary care
agency workers where care is organised in line with a personal assistant
model including support for inclusion (however, this is likely to be at a
higher cost).
9.4.4. Potential uses of a register are:
• Provide a platform for a visible personal assistant
marketplace that is updated and current.
• Improves speed of access and connects people looking for
work with those seeking personal assistance.
• Good information facilitates informed choice by service users
by giving details, skills and credentials of people on the list.
• Create a ‘community’ for personal assistants where
information that supports their career development can be
developed and shared.
• Provides signposting to impartial and reliable information for
both PA employers and employees (for example, the
Personal Assistant Network at www.panet.org.uk).
9.4.5. Potential users of a register:
• People in receipt of direct payments or individual accounts
• Relatives and friends supporting a service user
• Professional brokers / care managers
• Self-funders
9.4.6. Consultation in the West-Midlands found that what people want:
• Employers recruiting PAs want to get the service at the right
price and quickly
• For PAs it is having sufficient employment to make it viable
and to not keep filling in application forms.
9.4.7. A Personal Assistant register could be electronic or paper based or
both. However, the organisation and resourcing of the register will need to
be dynamic otherwise it would soon become out of date and not useful to
the end users.
9.4.8. As noted earlier Bradford MDC Direct Payment Team already has a
‘list’ with 385 names of people who have responded to PA adverts.
However, very few on this list are actually known to be regular PAs and
32

their credentials have either not been checked or updated. As a result the
usefulness of the list is limited.
9.4.9. Therefore, for a register to be relevant it needs to hold information
about PA credentials, price and availability, as well as information that will
help in skill matching (such as a PA profile of interests and personal
attributes). For the PA it should provide a means of reducing form filling
and marketing their services directly to service users (such as through a
secure gateway where the identity of the service user is protected until
they choose to make contact).
9.5. Online and Electronic Register Service Providers
9.5.1. Four online service providers were identified offering solutions
dedicated to a personal assistant register. Other E-shop solutions have
the potential for including personal assistants. Appendix 11.3 provides a
more detailed comparison of features and cost.
9.5.2. There are a number of common characteristics:
• None independently provide a vetting or checking feature and
where these checks exist it is the responsibility of the local
authority or an agency.
• All have a secure online account registration system.
• Most offer an inbox system for employer and PAs to
communicate (although restricted by some for safeguarding
reasons – i.e. PAs cannot see details of employers).
• Very little direct support for PAs is offered through these
services (for example none offer support for training although
PA Pool is considering developing a PA support service
including training, advice, payroll and CRB checks via
partnering organisations).
9.5.3. For comparison PA Pool and the NW-PA model (determined by Age
Concern and not Adomedia) impose subscription charges on service
users ranging between £52 and £58.70 for 90 days respectively.
Registration of PAs is usually free.
9.5.4. Slivers-of-Time is a form of agency working for anyone with spare
hours to sell to local employers. Agencies operate the marketplaces for
Slivers-of-Time. They vet the participants and see them into the market.
The agencies’ payroll / invoicing systems take over once a timesheet for a
booking is completed. A subscription fee is required for employers.
9.5.5. PA Pool is a “non profit distributing” company and user-led
organisation building a UK-wide hub for PA recruitment. It offers a
dedicated website for disabled people looking to employ a PA (PA
Employers) and for PAs looking for work. PA Pool offers members the
33

opportunity to interactively manage their own recruitment or employment.
Members manage their own profile content and members can view
profiles containing information about a person and what they are looking
for - whether they are looking for a PA or a PA job. They can search the
database using specific criteria, and PA users only pay a subscription fee
when they are actively looking for a PA and wish to contact a potential
candidate.
9.5.6. Adomedia NW-PA has designed a website (North West PA Register,
formerly known as Cheshire PA Register) to bring together people
seeking employment as a Personal Assistant (PA), and Employers
looking for potential PAs allowing access to information about people who
want to be a PA or vacancies for PAs in an area. Employers and PAs
register an account (registration is free only for PAs and employers pay a
subscription).
9.5.7. Historically Opportunity Links has developed child minder registers
with local authorities in East of England. However, the Company is
excepting from July to create a register for PAs but also other people who
would undertake activities in people's homes (trades people etc). PAs
and service users will be able to register online but goes through back
office vetting system, (managed by staff of the local authority). For
safeguarding reasons they opted not to include service-user details for
matching. SUs can select searched based on their requirements and
online bookings are in real-time.
9.5.8. The cost of the registers varies widely from approximately £0 (PA Pool
– national site already exists) to £106,000 (Slivers of Time) for set up. In
respect of per annum charges these also range widely from between
£330 per annum (Adomedia hosting fee) to over £24,000 per annum (PA
Pool for licence option paid by LA per 200 users).
9.5.9. Initial indications are that the demand for these services by
employers has not been significant. For example see tables next page:
34

PA Pool May 2010 registration statistics for Yorkshire:
Region Registered Employers Registered PAs
NW-PA June 2010 registration statistics:
Region Registered
Employers
Registered
PAs
9.5.10. PA Pool and NW-PA are established services. Possible reasons
for the poor uptake by employers and PAs could be:
• Both charge a high subscription to the service user, which
may be a disincentive to register.
• Without a dedicated PA support the services may not be
achieving a potential or meeting a need beyond a place to
advertise. In other words a register in itself is not addressing
the barriers for entering and remaining in the PA market.
10.Personal Assistant Project Recommendations
10.1. A Holistic Systems Approach
10.1.1. The analysis suggests that both the demand and supply for and
of personal assistants is low in Bradford (although some demand may be
delayed because of the re-enablement process).
10.1.2. There is little evidence that a register or list alone is effective in
increasing both demand and supply. Rather a holistic model needs to
address any barriers that may exist that are unintentionally restricting the
uptake of direct payments to buy personal care (as apposed to continued
use of traditional channels of care).
35

10.1.3. Without sufficient cash entering the market to provide
sustainable income opportunities few career personal assistants will enter
the marketplace.
10.1.4. An ongoing PA project is required that takes a systems approach
that covers three key areas – inform, develop and empower.
10.2. PA Project Framework Partnership Approach
10.2.1. There is a good rationale to delineate in the roles of the
supporting Personal Assistants and employers. The in-house options are
considered below:
Personal Assistants - Home Care Team
• There is some capacity for the homecare team to absorb a register
within the Time Out service. A management structure is already in
place that could support PAs.
• However, there are a number of problems associated with such a
model:
o Potential liability to the local authority, as may be viewed as
being an agency requiring registration with CQC.
o Blurring of boundary with other homecare services may
leave the authority obliged to offer back-up cover.
o Through association may reinforce continued reliance on
traditional practices in delivering personal assistance.
Inform
EmpowerDevelop
Early access to
advice about
using direct
payments to
employ a PA
Shaping the
market through
investment,
workforce
development,
partnerships,
co-production of
standards etc.
Support service
users and
carers to take
more direct
control of their
own solutions
(i.e. an online a
PA register)
36

o An in-house support scheme for personal assistants is
unlikely to achieve the empowerment and control outcomes
to the same extent as an independent, external host or
provider such as schemes promoted by User Led
Organisations or VCS services.
Employers – Direct Payment Team
• The Direct Payment Team already provides a service to support
people who wish to directly employ personal assistants. While
there are examples of such schemes being managed outside of
the local authority there are no particular disadvantages in having
an in-house service.
• The direct payment recipients interviewed were happy with this
service although most expressed that it would have been helpful to
have accessed or known about the service earlier. The indication
is that people who are assessed as eligible for social services do
not always understand the option for using direct payments to
directly employ their own PAs or the extent of the support they
could receive from the Direct Payments Team. Better information
and understanding of support offered earlier may increase the take
up of direct payments to purchase directly their own personal
assistance.
• The Direct Payment officers are best equipped to provide this
information. While information in leaflets and guides are useful
face to face interaction is likely to be more effective in the initial
stages.
• The Council should consider an in-reach for Direct Payment
officers earlier on in the customer journey (perhaps initially
together with practitioners at the initial visit and assessment stage).
This could be monitored to see if there is a resultant increase
uptake for using cash to directly employing a personal assistant.
10.3. Personal Assistant Project.
10.3.1. Recommend that support for employers remains with the Direct
Payment Team and capacity increases to support a proactive role in
providing information and advice earlier on in the customer journey. This
is key because without a better use of SDS money to directly purchase
personal assistant the PA market will not expand. While options for
support in the role of employer are not known or understood many people
will not opt for direct payments.
10.3.2. Recommend that support to Personal Assistants is hosted
external of the Council and developed in co-production with the Council,
service users and their carers or advocates or other appropriate voluntary
community service stakeholders. Existing initiatives, such as Age
37

Concern Bradford and District‘s trading register may be a potential bolt on
for a PA register.
10.3.3. Hosting of the project for-profit provider (such as a domiciliary
care agency that has a PA register) is not recommended because of the
potential monopoly over the PA market by a single provider. A register
hosted by a voluntary service would allow agencies to register employees
that work flexibly as PA.
10.3.4. Further, non-restrictive Payment and Charging Policies (free for
both PAs and Employers) are recommended, as it is likely that
subscriptions are a disincentive to registration. The Council could support
through investment so that the project does not need to find revenue from
PAs or service users
10.3.5. The register needs to be part of a wider PA Support scheme.
Therefore a holistic PA Support project could offer the following initiatives
to support the development of both the capacity and quality of PAs:
• Identifies workforce development issues and produces a common
induction framework for PAs together with employers.
• Provides an administration resource to validate the identify of the
PA and the credentials, such as qualifications, that they provide in
their listings (for example, a visual check of CRB or clearance of
Vetting and Barring process11
where stated).
• A register that is not an approved list but presents clear and factual
information about a range of service providers.
• Allows access to a register via different media including print outs,
telephone and internet.
• A Code of Conduct for PAs is developed together with employers
and PAs. PAs using the register would indicate that they have
understood and will abide by the Code of Practice.
• Coordinate recruitment drives for personal assistants and
communication about the role and responsibilities.
• The online register is developed to have content features with
guidance and resources for both employers and PAs. For PAs this
may include:
o Opportunities for free or reduced training costs by through
volume bookings.
o Updates on employment law and rights.
11
This is being introduced in England by the Independent Safeguard Authority (voluntary from July 2010,
mandatory from Nov 2010) Total cost will be £64 and includes CRB and one off registration of £28). Benefit of
this scheme is that the employer is notified if change to CRB status between annual renewals.
38

o Information about standards and good practice.
o Forum for sharing good practice and knowledge.
o Guides or ‘toolkits’ for employing and becoming a PA.
o Links to Payroll and other Human Resource supports.
o Information on safeguarding and how to identify/report abuse.
10.4. Project Costs
10.4.1. The Council should be cautious in investing in expensive
technical solutions when the demand for online register is not fully
understood and where projects have been established these seem to be
poorly supported by employers (possible reasons described above).
10.4.2. However, given a ‘free’ registration service and dedicated
promotion usage may improve. A register embedded in a wider support
project (whole systems approach) would contribute to consolidating the
PA market and provide a visible presence.
10.4.3. The core costs of a project include:
• Development of an online register to be hosted by a non-profit
organisation that is not also a provider of personal care.
• Project coordinator / administrator or equivalent providing support to
the registration process and developing knowledge and information
resources (toolkits for PAs)
• Increased capacity of the Direct Payment Team to improve earlier
access to direct payment support, information and signposting to
employment resources, such as payroll services.
10.4.4. The following is an illustration of a base cost for development of
the PA register including a resource manager:
• One off cost of £15,000 for a bespoke development of a register
with both online and offline (printed) capabilities. For example based
on the Adomedia model but without subscriptions. Approximately
£500 per annum for hosting fees.
• Resource coordinator at senior administrator level or equivalent
(based on posts held in similar PA projects this would be equivalent
to rates of pay at upper Scale 5 £21,519 to Scale 6 £22,221.
10.4.5. The project can be scaled up should demand increase and
operating cost off-set by the expected reduction in reliance on more
expensive, traditional forms of provision.
39

11.Appendices
11.1. Examples of PA Schemes
Organisation Register updated accredit
ation
CRB Employ
ment
support
Training
Essex PASS Essex coalition of disabled people.
http://www.ecdp.org.uk/personalassistantvacancies/
Manually-
PA must
contact
None- Recomme
nded
SU
funded
Yes-su no
PApool.co.uk Web based
www.papool.co.uk
By PA
online
none No no no
Wiltshire-
Compassdisability.org.uk
Web based and searchable online
http://www.selfdirectedcare.org.uk/wdpss/PA_reg/pa_reg_main.
htm
Online but
cleared by
staff
none no no no
Derbyshire with Centre for
Indep. Living
no n/a none none Yes-su For
service
user
Dorking- Lifetrain trust no n/a Open
college
network
Accredite
d
training
no no For PAs
And Sus
Merton council Council website on-line
http://www.merton.gov.uk/living/care/directpayments/personal-
assistant-database.htm
manually no no Sample
letters,
forum
no
Manchester no n/a no no informati
on
no
41

Organisation Register updated accredit
ation
CRB Employ
ment
support
Training
Doncaster with South
Yorkshire centre for
inclusive living
no n/a no Advice
only
Induction
pack
Disability
equality
and
moving
and
handling
Paid for
by SU
Lancashire Yes- linked to national site
http://www.lancs-pa.org/index8.php
? no no Yes, to
SU
no
Oxfordshire with trading
standards
Yes
http://www.takingcontroloxon.org.uk/wps/wcm/connect/occ/Takin
g+control/Home/
? ‘Approve
d’
Yes, plus
risk asst
by OCC
HR and
trading
standards
yes Yes, 7
days
NVQ
standard-
in house
Wigan and Leigh- PASS
personal assistant support
scheme
Yes
http://www.wigan.gov.uk/Services/HealthSocialCare/DirectPaym
ents/PASS.htm
? no no Yes Advice
where to
access
Dorset, Nottingham,
Solihull, Staffs
Warwickshire: all with
Rowan organisation
no n/a no Expect LA
to do but
if not will
do
yes no
NW-PA http://www.nw-pa.org
42

11.2. Legal Advice on LA run PA Accreditation & Register
From: Marcia McFarlane
Sent: 02 June 2010 15:00
To: Shona Grange
Cc: Kerry Mosley
Subject: Employing personal assistants
Dear Shona,
Please find below a summary of my thoughts on this matter-
I understand the query is as follows:
The council is in the early stages of scoping a possible approved/accredited personal
assistant 'list'. This will be held by the Authority for 'customers' with direct
payments/individual budgets. One arrangement is for the local authority to provide
training and bench-marking, CRB and ISA checks, alternatively recognised training plus
CRB and ISA checks. Either will be accessible to the public as a service so that service
users are assisted in determining carers that are better suited to their needs.
I understand there are concerns that this assistance might result in blurring of the lines
between the Local Authority as a provider of information service as opposed to the Local
Authority as an employer since the council may be seen as introducing, training, vetting
and giving approval/accreditation. This is compounded by the fact that the source of
money for pay comes from the council.
On first glance the proposed arrangement appears to be similar to that provided by some
children services in local authorities in relation to registered childminders (i.e details of the
childminders available on a list from which the parent can select ( some lists carry more
information than others). It is difficult to see how this arrangement could result in the
inference of an employment relationship. I expect that the Local Authority will not
determine who is appointed to a particular service user, instead the service user
ultimately selects the worker (keeping in mind that the service user may choose someone
not on the list). The service user will dictate how the service is to be provided, when
holidays should be taken, hours of work, when the contract should end and how it ends. I
would expect that if there are any negotiations on pay the service user will do this. In
short the key decisions affecting the employment relationship will be determined by the
service user and the worker, while decisions affecting standards and safety will have
some input from the council. The service user provides the work and the worker provides
the personal services, so if any employment relationship is to be implied it is most likely to
arise between the worker and the service user. The fact that the council funds the
arrangement will not necessarily result in an inference of a contract and provided we can
explain any council involvement in terms of our obligations to assist and support
vulnerable adults then the prospects of resisting an inference of an employment contract
is better. I describe this arrangement as the council in the role of facilitator or information
provider.
The best reassurance I can offer is the suggestion that the list carries an appropriate
disclaimer e.g ' The council has collated this information in order to provide assistance to
those members of the public who are considering engaging personal assistants to provide
support with personal care. Please note that you are not obliged to only consider the
persons on this list. Most of the information in this document has been provided by the
individuals and therefore the council does not give any warranty as to the accuracy of the
information in this document. The public are therefore encouraged to take reasonable
steps to confirm the information in this document and must make their own determination
43

on suitability. It is not the council's intention that any legal relationship be created or
inferred from the provision of this information.'
If this does not deal adequately with your question then please give me a quick call and I
will look at the matter again in light of our discussions
Marcia McFarlane
Senior Solicitor
Corporate Law Team
44

11.3. Comparison of Online Solutions: Features & Cost
Features
Supplier
Slivers of Time PA Pool Adomedia (Age
Concern NW-PA)
Opportunity
Links
Approves Entries
LA or purchasing
agency needs to
set approval
protocols.
Approved on face
value only &
content moderation
only.
The local authority
or host organisation
staff approve the
PA account details
The local
authority or host
organisation staff
approve the PA
account details
Vetting (i.e., CRBs,
checking
qualifications)
LA agrees
safeguarding
framework and
criteria.
No validation or
documentation
checks
No validation or
documentation
checks (unless LA
or host organisation
undertakes checks)
No validation or
documentation
checks
Database
Maintenance
Yes
maintains the
database and
provides local area
Yes Yes
Matching Service No No No
Do not hold SU
details for
safeguarding
reasons
Online Availability
Time table
Yes Yes Yes Yes
Bookings Online Yes
Yes but PAs and
employers can
communicate using
an inbox system
No but PAs and
employers can
communicate using
an inbox system
Yes, in realtime
Statistics Yes Local areas specific Yes No
PA Training &
Practice Support
No
Plan to develop
training, advice,
information, payroll
and CRB checks by
partnering with
organisations who
are experts in these
fields.
No No
Web development
Cost
£30k +vat
None – nationally
hosted register
already exists
IRO £10-15K for
bespoke
development for
Bradford
£15K
Subscription Costs
Monthly licence
fee of £5k + vat
pcm or if turnover
is more than
£250K per
calendar pcm
then
2.5% service
charge on each
transactions
PA employer
subscribes
3 days - £5
1 month - £20
3 months - £52
6 months - £98
1 year - £188
However, Local
Authority can buy a
license that gives
service users free
access(i.e. £24k pa
for 200)
Not required by
Adomedia although
client can set
subscription policy.
None
Hosting Fee None £281 plus VAT £2.5k p.a.
Estimated Total
Cost to LA per
annum
£70.5K per annum
inclusive (£105,750
first years with
start-up)
None if relies on
SU subscriptions;
or estimated
minimum £24K per
annum (limited to
200 SU or £120 per
service user)
Initially £15k then
£330 per annum
(incl. vat). Separate
contract required
for hosting agency
to manage the
register
Set-up £15K then
£2.5 per annum
45

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