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4.1.3 Direct Payments

RELATED GUIDANCE

Care and Support Statutory Guidance (GOV.UK)

AMENDMENT

In August 2016, a new Section 7, Hospital Stays was added.


Contents

  1. What are Direct Payments?
  2. Who can get Direct Payments?
  3. How Often are Direct Payments Made?
  4. What is the Process?
  5. Direct Payments Can be Spent on Employing a Personal Assistant (PA)
  6. Direct Payments Can also be Spent On
  7. Hospital Stays
  8. Direct Payments Can Not be Spent On
  9. What are the Benefits of Direct Payments?
  10. Decisions Not to Make Direct Payments
  11. Monitoring and Review of Direct Payments
  12. Reducing the Amount of Direct Payments
  13. Repayment and Recovery of Direct Payments
  14. Ceasing Direct Payments

    Appendix 1: Direct Payments Personal Budget Agreement

    Appendix 2: Direct Payments Flowchart


1. What are Direct Payments?

A Direct Payment is money given to children aged 16 yrs or over who have a disability and to parents or carers, aged 16 or over of young people, by the authority to enable them to buy in support that is assessed as being needed, instead of the authority providing that support through their own services. Direct Payments do not affect benefits.

Direct Payments can be made for special educational provision, health care and social care provision.

Local authorities must offer the option of Direct Payments in place of Services currently being received. For both Education and Social Care the Local Authority must be satisfied that the person who receives the Direct Payments is able to manage the direct payments either by themselves or with whatever help the authority thinks the applicant or nominated person will be able to access will use them in an appropriate way to meet the needs in question and that they will act in the best interests of the child or young person.

Regulations governing the use of Direct Payments for special educational provision place a number of additional requirements on both local authorities and parents before a Direct Payment can be agreed. These include requirements to consider the impact on other service users and value for money and to seek agreement from educational establishments where a service funded by a Direct Payment is delivered on their premises.

Direct Payments for health require the agreement of a Care Plan between the Clinical Commissioning Group and the recipient.


2. Who can get Direct Payments?

Those who have been assessed as meeting the criteria for disabled children's services aged 16 or over and are children and young people who have Education, Health and Care Plans and their parents have the right to request a Personal Budget, which may contain elements of education, social care and health funding, and may be delivered by way of Direct Payments. Under the Children and Families Act 2014, this covers those aged 0-25 having special educational needs and disabilities. Direct payments are available if a child or young person is disabled and aged 16 or over or is a carer or parent aged 16 or over for a child with disabilities. No-one can be forced to have a direct.

Direct payments can also be made to a willing and appropriate person on a disabled person’s behalf if they lack the mental capacity to agree to and manage direct payments themselves.

Direct payments cannot be used to pay for services from a spouse, partner or a close relative living in the household unless the local authority consider it is necessary to do so. However, a direct payment can be used to employ a relative if they are not living in the household.


3. How Often are Direct Payments Made?

Direct Payments are paid in advance into a bank or building society account specifically set up for this purpose, as a one off payment or on a weekly basis. If the direct payment is assessed as being needed at key times e.g. school holidays, then payment will be made accordingly. The typical payment process is on a 4 weekly basis.


4. What is the Process?

The arrangements for Direct Payments will be included in the child’s/young person’s Education, Health and Care Plan, following an Education, Health and Care Needs Assessment. See Children and Young People Aged 0-25 with Special Educational Needs and Disabilities Procedure.

See Appendix 2: Direct Payments Flowchart.


5. Direct Payments Can be Spent on Employing a Personal Assistant (PA)

  • To take the young person/child into the community to access an activity, support inclusion, going to a club etc;
  • To work with the child directly within the home, to give parents and siblings a break;
  • To stay overnight to give respite to parents;
  • Or a registered childminder or child home carer (for children aged under 8).


6. Direct Payments Can also be Spent On

  • The Direct Payment is for you to buy the services as detailed in your support/care plan. This plan is flexible and you should contact your Social Worker/Child Support Officer and agent/chosen decision maker if you wish to change anything;
  • Whilst we or an agent may assist you to buy the support you need you will be responsible for the day to day management of the support including employing workers and/or entering into contracts with providers. If you employ any workers to provide support to you, you will be responsible for complying with all relevant legal requirements including but not limited to requirements relating to taxation, health and safety, equal opportunities, insurance, employment law and any other relevant legislation;
  • We recommend that you use providers that we have approved from our Domiciliary Framework of providers;
  • Should you choose to use other providers who are not on this list;
  • You are responsible for ensuring that they can provide the support;
  • You require, and we insist that you purchase care from a provider;
  • Who is registered with the Care Quality Commission or Ofsted;
  • Registered to ensue that the standards of care provided;
  • If you wish to employ someone privately you will have to have a new “Data Barring Service” (DBS) check or Enhanced DBS check if appropriate. We will obtain the appropriate level of check for you. We will pay for obtaining the appropriate level of DBS check;
  • Children’s Services insist that a DBS check is carried out for all Personal Assistants working with young people under 18 years old;
  • By agreement with the Team Manager for direct payments, any service which meets your assessed need for a short break;
  • Special educational provision specified in an Education, Health and Care Plan.


7. Hospital Stays

When a child or young person under 16 yrs needs to go into hospital, the parent, carer or the person managing the Direct Payment, should advise the local authority straight away to discuss the continuation of the payment.

It is possible that the payment will continue for a time-limited period, if only to allow for the person managing the Direct Payment to ensure that any contractual obligations around termination of the support can be met. However, there might also an issue of continuity of care post-discharge to consider in some instances.

Where a Young Person is 16 yrs or older and in receipt of Direct Payments, hospitalisation may not necessarily mean that the Direct Payments should cease. Guidance advises that consideration should be given by the local authority, the carer, the holder and NHS Trust to as to how the payments might be used to meet non-health needs or to ensure that the employment arrangements can be maintained. For example, the holder may prefer some personal care tasks to be undertaken by the carer rather than hospital staff. However, the personal care and medical input need to be tailored so as not to interfere with the medical treatment. (Terminating or suspending the carer's employment may lead to a delay of continuity of care and a delay in discharge).

In instances where the authorised or nominated person requires hospital treatment, the local authority must conduct an urgent review to ensure the holder continues to receive the care and support they need. This might include the duties to be carried out by a temporary nominated person, or through short-term authority arranged care/support.


8. Direct Payments Can Not be Spent On

  • Employing someone without DBS and CPR checks or references;
  • Permanent residential accommodation, though they can be used for occasional short breaks, if the local authority agrees, for up to 120 days in any 12 month period. (Note: where two periods of short – term care are 4 weeks or less apart, then the cumulative total of the stays should be added and not exceed 4 weeks if the stay is to be funded by Direct Payments).
  • Within Children’s Services, Direct Payments cannot be used to fund a family holiday. Carer/PA support can be funded but the holiday cannot be funded using your Direct Payment;
  • The Local Authority does not permit within Children’s Services, the use of your budget to fund expenses or mileage. As the child or young person is under 18 years of age, it remains Parental Responsibility to support the child or carer’s expenses for outings or meals, and any travel costs incurred. Should the budget be used for this purpose, the Local Authority will request that the person with parental responsibility for the child or young person will reimburse this unauthorised expenditure.


9. What are the Benefits of Direct Payments?

Direct Payments allow parents and young people greater choice flexibility and control, to employ their own workers at times convenient to them and in the way they wish, to provide an individual service to meet their needs. Payments made do not affect welfare benefits.

The aim of Direct Payments is to give the family greater control and choice, adopting a personalised approach to receiving support and who provides this support.


10. Decisions Not to Make Direct Payments

Where the local authority decides not to make Direct Payments it must inform in writing the child’s parent or the young person of its decision and reasons in a format that is accessible to them and in line with the Data Protection Act. It must also advise of their right to request a review of the decision.


11. Monitoring and Review of Direct Payments

The local authority must financially monitor and review the use of Direct Payments by the recipient at least once within the first three months of Direct Payments being made, and when conducting a review or a re-assessment of an Education, Health and Care Plan. In addition, a recipient may make a request for the local authority to review the making and use of Direct Payments and the local authority must then consider whether to carry out a review.

This is the statutory review of your child’s eligible needs which will help you to look back over the past six months at what you have achieved. It will also include a review of your Personal Budget and a decision will be made informing you if your allocation will remain the same based on you and your child’s needs. The Child in Need Review (CIN) will take place 6 monthly under Government Guidelines and will be chaired by a Team Manager from the Disability Service.

When carrying out a review, the local authority must consider whether:

  • It should continue to secure the agreed provision by means of Direct Payments;
  • The Direct Payments have been used effectively;
  • The amount of direct payments continues to be sufficient to secure the agreed provision;
  • The recipient has complied with their obligations on the use of the Direct Payment.

Following a review the local authority may:

  • Substitute the person receiving the Direct Payments with a nominee, the child’s parent or the young person, as appropriate;
  • Increase, maintain or reduce the amount of Direct Payments;
  • Require the recipient to comply with either or both of the following conditions:
    • Not to secure a service from a particular person;
    • To provide such information as the local authority considers necessary.
  • Stop making Direct Payments.

(See also Section 7, Hospital Stays).


12. Reducing the Amount of Direct Payments

Where the local authority decides to reduce the amount of Direct Payments, it must provide reasonable notice to the recipient, and must set out in the notice the reasons for its decision.

The local authority must reconsider its decision, where requested to do so by the recipient, but is not required to undertake more than one reconsideration of a decision. When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child’s parent or the young person) and must then provide written reasons to the recipient (and to the child’s parent or young person, where the recipient is a nominee) of its decision following the reconsideration. The local authority may reduce Direct Payments following reasonable notice despite the fact that a request for reconsideration has been made.


13. Repayment and Recovery of Direct Payments

The local authority may require the recipient to repay part or all of the direct payments, where:

  • The circumstances of the child or young person have changed in a manner which has an impact on the appropriateness of the agreed provision;
  • All or part of the Direct Payments have not been used to secure the agreed provision;
  • Theft, fraud or another offence may have occurred in connection with the Direct Payments;
  • The child or young person has died;
  • If you do not use the money in accordance with your agreed support/care plan or if you do not comply with the requirements set out in this agreement we may require you to repay some or all of the money paid to you. We will also reclaim any surplus monies in the account.

It must give notice in writing to the recipient, setting out the reasons for the decision, the amount to be repaid and a reasonable timescale within which the amount must be repaid.

The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child’s parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child’s parent or young person, where the recipient is a nominee).

The local authority may only seek repayment of any portion of the Direct Payments that has not already been spent on the agreed provision.


14. Ceasing Direct Payments

The local authority must stop making Direct Payments if:

  • The recipient has notified the local authority in writing that he or she no longer consents to receive the Direct Payments;
  • The recipient ceases to be a person to whom a Direct Payments may be made;
  • Following a review, it appears to the local authority that:
    • The recipient is not using the payment to secure the agreed provision;
    • The agreed provision can no longer be secured by means of Direct Payments.
  • At any point the local authority becomes aware that the making of Direct Payments is:
    • Having an adverse impact on other services which the local authority provides or arranges for children and young people with an Education, Health and Care Plan which the authority maintains; or
    • No longer compatible with the authority’s efficient use of its resources.
  • It has taken reasonable steps to ascertain whether the young person consents to Direct Payments and the young person has not notified the local authority of their consent.

Where the local authority decides to stop making Direct Payments, the local authority must first give notice in writing to the recipient setting out the reasons for its decision.

The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child’s parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child’s parent or young person, where the recipient is a nominee).


Appendices

Click here to view Appendix 1: Direct Payments Personal Budget Agreement

Click here to view Appendix 2: Direct Payments Flowchart.

End