Direct payments Care Act 2014

Outline of content  Introduction Introduction  Making direct payments available Making direct payments available  Adults with and without capacity Adults with and without capacity  Administering and monitoring direct payments Administering and monitoring direct payments  Payment and additional costs Payment and additional costs  Use of a direct payment Use of a direct payment  Monitoring usage of direct payments Monitoring usage of direct payments  Reviewing direct payments Reviewing direct payments  Safeguarding through direct payments Safeguarding through direct payments  Direct paymentss and hospital stays Direct paymentss and hospital stays  Discontinuing direct payments Discontinuing direct payments  Summary Summary 2

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 3

Direct payments 4 The Care Act 2014 Direct Payments Regulations Health and Social Care Act Direct Payments Act

Number of people receiving direct payments 5 Client Group/Year 2008 / / / 2014 Physical Disability 24,89535,88537,015 Mental Health4,4508,2459,090 Learning Disability 11,95527,75531,210 Older People25,85043,26543,785 Source:

Care and support planning 6

Making direct payments available 7 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 8

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 9

Considering the request for a direct payment 10 Things to consider AppropriateManagementSupport A specialist assessor Quickly Interim arrangements

Refusing the request 11 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 12

Use of a direct payment 13 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

 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 14

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 15

Reviewing direct payments 16 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 17

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 18

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 19

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 20

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 21