Direct payments

Care Act 2014

Outline of content

Introduction Making direct payments available Adults with and without capacity Administering and monitoring direct payments Payment and additional costs Use of a direct payment Monitoring usage of direct payments Reviewing direct payments Safeguarding through direct payments Direct paymentss and hospital stays Discontinuing direct payments Summary

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Introduction

Direct payments (DPs) are monetary payments made to individuals who request to receive one to meet some or all of their eligible care and support needs

Administering and monitoring DPs must not restrict choice or stifle innovation, and must not place undue burdens on people to provide information to the local authority

The local authority must ensure that people are given relevant and timely information about direct payments and supported to use and manage the payment appropriately

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Direct payments

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The Care Act 2014

Direct Payments

Regulations

Health and Social

Care Act

Direct Payments

Act

Number of people receiving direct payments

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Client Group/Year

2008 / 2009 2012 / 2013 2013 / 2014

Physical Disability

24,895 35,885 37,015

Mental Health 4,450 8,245 9,090

Learning Disability

11,955 27,755 31,210

Older People 25,850 43,265 43,785

Source: www.hscic.gov.uk

Care and support planning

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Making direct payments available

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The availability of direct payments should be included in the local

information and advice service, and should set out:

What direct payments are How to request one including the use of nominated and

authorised persons to manage the payment Explanation of the direct payment agreement The responsibilities involved in managing a direct payment Making arrangements with social care providers Signposting to local organisations that can help

someone who agrees to manage a direct payment on behalf of the person with care needs

someone who agrees to manage a direct payment for a person who lacks capacity

Adults with capacity

The local authority must consider each of these four conditions – and all four must be met: The adult has capacity to make the request, and where there is a

nominated person, that person agrees to receive the payments The local authority is not prohibited from meeting the adult’s needs

by making direct payments to the adult or nominated person The adult or nominated person is capable of managing direct

payments It is an appropriate way to meet the needs in question

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Adults lacking capacity

An authorised person can request the direct payment on the person’s behalf if all of these five conditions are met: where the authorised person is not authorised under the Mental

Capacity Act 2005, a person who is so authorised supports the authorised person’s request

The local authority is not prohibited from meeting the adult’s needs by making direct payments to the adult or nominated person (see Schedule 1 of the Direct Payment Regulations)

The authorised person will act in the adult’s best interests The authorised person is capable of managing a direct payment Making direct payments to the authorised person is an appropriate

way to meet the needs in question

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Considering the request for a direct payment

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Things to

consider

Appropriate

Management

Support

A specialist assessor

Quickly

Interim arrangements

Refusing the request

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Accessible Format

Which conditions not met and why

What to do in the future

Payment and additional costs

The direct payment must be sufficient to meet needs which the local authority has a duty to meet

The amount will reflect: the financial contributions the person is required to make whether it is for part or all of the care and support requirements any other direct payments from partner organisations, such as

personal health budgets Any ‘on-costs’ as result of a direct payment should be incorporated into

the personal budget amount Local authorities still have a duty to ensure needs are being met, so

contingencies may be needed

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Use of a direct payment

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Flexibly and innovatively -

no unreasonable

restrictions

Pre-payment cards

Paying family members to manage the

DP

Short-term care in a care

home

Non-residential

care in a care home

Services from ‘another’

local authority

Becoming an employer

Becoming an employer

People need clear advice and support as to their responsibilities when managing direct payments, in particular:

Whether the person in receipt of direct payments needs to register with HM Revenue & Customs (HMRC) as an employer

The difference between a regulated and unregulated provider

Monitoring should check PAYE income tax and National Insurance contributions and that payments conform to the national minimum wage using the Working Time Directive

Alternative arrangements should be put in place if the direct payment recipient is failing to meet their obligations as an employer

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Monitoring usage of direct payments

Key features of systems to monitor direct payment usage:

They must not place a disproportionate reporting burden upon the individual

They must enable greater autonomy, flexibility and innovation They should be proportionate to the needs to be met and the care

package Lowering monitoring requirements should be considered for people

that have been managing direct payments without issues for a long period

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Reviewing direct payments

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Review

• Direct payments must be reviewed within the first six months of making the first payment

• It is a light touch review as part of the initial review of the care and support plan

Consider

• The management and use of the direct payment • Any long-term support arrangements • Whether the individual is fulfilling their responsibilities as an

employer

Ongoing Review

• Direct payments must then be reviewed annually• Incorporating the views of all relevant parties and recorded

Safeguarding through direct payments

Personalisation and safeguarding are two sides of the same coin Increased freedom to choose and arrange your own care brings

concerns about risk of exploitation Well designed self-directed support packages should be unique to the

individual and have checks and balances built in Overprotective approaches can in themselves put people at risk Direct payment holders employing personal assistants may be reluctant

to disclose problems of harm or neglect

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Direct payments and hospital stays

When direct payment holders require a stay in hospital, this should not mean that the direct payment must be suspended while the individual is in hospital

Where the nominated or authorised person managing the direct payment requires a hospital stay, there must be an urgent review to ensure that the person continues to receive care and support to meet their needs

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Discontinuing direct payments

A recipient of direct payments may decide at any time that they no longer wish to continue receiving them

Direct payments should only be terminated by the local authority as a last resort

The local authority must ensure there is no gap in the provision of care and support, and revise the plan

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When a person loses capacity or regains capacity to consent

Where someone with capacity loses that capacity to consent, the local authority should:

discontinue direct payments to that person

consider making payments to an authorised person instead

in the interim make alternative arrangements to ensure continuity of support for the person concerned

When a person regains capacity to consent direct payments must be discontinued to the authorised person but not before beginning to make payments to the person themselves

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Summary

Administering and monitoring DPs must not restrict choice or stifle innovation, and must not place undue burdens on people to provide information to the local authority

The local authority must ensure that people are given relevant and timely information about direct payments and supported to use and manage the payment appropriately

The DP must be sufficient to meet needs which the local authority has a duty to meet

DPs must be reviewed annually

If a decision is made to discontinue DPs then the local authority must ensure that there is no gap in the provision of care and support, and revise the plan

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