"community and social care and use of direct payments"

About: Devon County Council Devon, Cornwall and Isles of Scilly

(as the patient),

It was suggested to me by my GP that I contacted care direct when I arrived home from hospital and was blacking out several times a day living on my own in considerable pain and struggling with day to day living…..The response was initially very sympathetic and there was an immediate desire to assess my needs and create a care plan until I revealed that I also had mental health difficulties…. Then I was told we are not trained to deal with "people like you. " Subsequently I have been told that direct payments for supported exercise for example are not available to me from the panel in charge of funding DP's for physical care because I receive direct payments for my mental health issues and its either/or. This seems to fly in the face of parity of treatment and accessibility of services to users with both kinds of disability! There has been much made of how people with mental health problems have a mortality rate of twenty years younger than those without mental health difficulties. I would like to know if this is an actual policy and if so is it legal…..or are services being parcelled up in line with the common prejudices against the mentally ill? ? ?

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Response from Peter Brain, Volunteer, Healthwatch Devon

Dear 'gianetti'

The comments received through 'Patient Opinion' are passed to us at Healthwatch.

This experience you describe was sadly not so unusual.

The mixture of provision of social care, mental health care and physical medical care is one which has been the subject of lots of discussion about the quality of provision and the funding; clearly the balance is not right.

The phrase 'people like you' is simply unacceptable.

The providers involved will respond to you on this web site and you may wish to comment further.


More generally, we are building a picture of the provision of services in Devon and these comments will help the NHS develop and improve its services.

If you wish to discuss any health or social care issues with us in confidence, including receiving advice or information about services, please call 0800 520 0640, or email info@healthwatchdevon.co.uk or go on-line to www.healthwatchdevon.co.uk.


Yours sincerely

Peter Brain


Healthwatch Devon is the consumer champion for Health and Social Care in Devon.

  • gianetti thinks this response is helpful
    {{helpful-1}} other {{helpful-1 == 1 ? "person thinks" : "people think"}} so too

Update posted by gianetti (the patient)


Prejudice hurts more

expecting kindness, connection

It then hurts the soul

Update posted by gianetti (the patient)

I have contacted our organisation. I would still like to know whether this is a written or unofficial policy and how to challenge it?

I have an update personally in that I have this morning been referred to complex care for a proper assessment of my needs….but its taken numerous requests from me, from my pain management consultant and from my recovery coordinator both in recent months and now I think about it going back years, all of us until today were blocked with this either official or unofficial policy of not doing a proper physical assessment of the needs of the mentally ill on the basis of the fact of mental illness and this "policy" still warrants investigation….I have only got this assessment because I have been relentless and desperate. The attitude and the "policy" need to be addressed for others as well as myself!

Response from Sam Holden, Patient Experience Lead, Patient Quality and Safety, South Devon and Torbay Clinical Commissioning Group

picture of Sam Holden

Dear Gianetti

I am really sorry for all the problems you have clearly had and that your experience has been so poor.

I appreciate that you feel that you haven’t been listened to before and that your concerns have not been taken seriously. I would very much like the opportunity to speak to you about your concerns in confidence. I work for the organisation that is responsible for buying mental health and other health services locally so we are removed from the organisations that provide the care.

I’d like to speak to you so that I can understand your concerns a bit better, help you with any questions that you might have and see if there is anything we can do that might be able to help you immediately. Some of the concerns you have raised sound really bad and so I’d like to check that you are ok and see if we can give you any other support you might need. if you like, we can also help you make a complaint if that’s what you’d like to do.

I appreciate you might not want to speak on the phone, so please do feel free to email me at patientfeedback.sdtccg@nhs.net or you can call me on 01803 652 578.

I really hope that I’ll be able to help you.

Best wishes


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Update posted by gianetti (the patient)

There is an update in that my complex care needs referral has been put on hold for a month because of the pressure on care services….and that is before I am given an appointment. I am planning to talk to Sam tomorrow and get more feedback on what may or may not be on offer. My physical and crisis care needs have increased and been met by duty social workers not calling me back and the crisis team referring me to the samaritans, I have had an increase in falls due to extreme pain and dizziness …I am feeling fearful now of my complex needs assessment coming too late to give me the support I need now.

Update posted by gianetti (the patient)

I have still not received a complex needs assessment and have been led to understand that even if I am assessed as having profound physical care needs these will be referred to the mental health panel who may deny me additional direct payments because of extreme scarcity of resources so the institutionalise prejudice can continue but with a policy that creates the illusion of parity of needs!

Update posted by gianetti (the patient)

Just to update this post and say that I have now at last had an assessment from an OT who could see the urgency of it on physical grounds! I am greatly appreciative of this although neither of us know the outcome because despite her identifying many physically based needs that are not currently met, the direct payments still need to be approved for by the mental health panel.

I understand now that direct payments needs are assessed by either a mental or physical health panel which is meant to take into account both physical and mental health needs. You are identified as being in one area or another which may be problematic as each budget is restricted and has been cut.

So despite the high aspirations of the social care act for wellbeing in both mental and physical health and assessments being needs and not budget based, ultimately what you receive will depend on budgetary considerations. These may not necessarily be appropriate to meet complex physical and mental health needs! Still I am hopeful that maybe I can get more support!