Direct Payments

1. Introduction

Direct payments are payments made to individuals to meet some or all of their eligible care and support needs. They are the preferred means of providing personalised care and support.

They can provide independence, choice and control by enabling people to meet their eligible needs by commissioning their own care and support. Adults should be encouraged to take ownership of their care planning and should be free to choose how their needs are met, whether through direct payments, local authority managed or Individual Service Fund (ISF) provision or a combination of these approaches (see Personal Budgets).

Adults should be given relevant and timely information about direct payments so they can decide whether to request a payment and, if they do, so that they can be supported to use and manage the payment. People should not be forced to take a direct payment against their will, but should be informed of the choices available to them.

There are different criteria that have to be met for those who have mental capacity and those who do not (see Mental Capacity). The local authority will advise regarding these issues.

2. Consideration of the Request

The local authority will decide whether to provide a direct payment to the adult, based on the criteria. When the decision is taken to make a payment, it is recorded in the local authority’s care and support plan for the adult.

When the request is refused, the person making the request is provided with written reasons that explain the decision and made aware of how to appeal the decision through the local authority’s complaints process.

There may be cases where a direct payment is not appropriate to meet needs. Direct payments cannot be made to adults subject to a court order for a drug or alcohol treatment programme or similar schemes.

3. Administering and Reviewing Direct Payments

The direct payment has to be used to meet the care and support needs set out in the care and support plan and use of the direct payment must be monitored to ensure the money is being spent effectively.

Costs such as recruitment costs, employers’ National Insurance Contributions and any other costs incurred as a result of meeting the adult’s needs via a direct payment should be included in the personal budget (and thus in the direct payment) if it is appropriate for the adult to meet their needs in a way which incurs such costs.

Where a direct payment is used to employ a personal assistant or other staff, the local authority should ensure that clear plans are in place for how needs will be met in the event of the personal assistant being absent, for example, due to sickness, maternity leave or on holiday. These should be detailed in the care and support plan.

Direct payment holders who are employers are also required to comply with the duty to enrol eligible workers into a qualifying workplace pension scheme and to meet the minimum contributions required. They should also have plans in place for redundancy payments due to circumstances such as moving home, a change in care and support needs, or because of the death of the direct payment holder or care recipient. If the adult meets needs by directly employing someone, they are responsible for all employment costs including redundancy payments.

All adults receiving direct payments should be given information about having the correct insurance cover in place and should be supported to make these arrangements, so they understand the benefits that insurance cover can provide.

Consideration should be given to the integration of the direct payment with other forms of public funding, such as personal health budget direct payments.

4. Paying Family Members

Direct payments are designed to be used flexibly and innovatively and no unreasonable restriction should be placed on the use of a payment, as long as it is being used to meet eligible care and support needs.

The Care and Support (Direct Payments) Regulations (2014) exclude the direct payment from being used to pay for care from a close family member living in the same household, except where the local authority decides this is necessary.

These decisions should be recorded in the care plan and should include the amount of the payments, their frequency and the activities that are covered.

It is not appropriate to allow this where there is a risk that the direct payment may be abused or there are other sensitivities such as potential safeguarding issues (see Safeguarding Adults from Abuse and Neglect).

5. Short Term Stay in a Care Home

Direct payments cannot be used to pay for adults to live in long term care home placements. They can be made to enable adults to purchase short stays in care homes, however, provided that any stay does not exceed a period of four consecutive weeks in any 12 month period. This can be used to provide a respite break for a carer, for example.

The purpose of the time limit is to promote people’s independence and to encourage them to remain at home rather than moving into a long term care home placement. Where a person is constantly using the direct payment to pay for a short term care home stays, consideration should be given to whether to conduct a review in order to ensure that the care plan is still meeting the adult’s needs.

Adults can receive additional weeks in a care home once they have reached the four week maximum. They cannot purchase additional weeks using their direct payments, but if the local authority and the adult agree that a longer stay is needed, it can still arrange and fund stays for them.

6. Long Term Stay in a Care Home

Adults who are living in care homes may receive direct payments in relation to non-residential care services. For example, they may have temporary access to direct payments to try out independent living arrangements before making a commitment to moving out of a care home. Direct payments can also be used by adults living in care homes to take part in day time activities. This can be particularly valuable for young people in transition. Direct payments cannot be used at present for long term stays in a care home (although the government plans to introduce this in 2016).

7. Becoming an Employer

Clear advice should be given to people about their responsibilities when managing direct payments, and whether the person in receipt of direct payments needs to register with HM Revenue and Customs (HMRC) as an employer. This information should be provided by the local authority.

Where the person wishes to employ their own personal assistant directly, attention is paid to the guidance (Information Hub for Individual Employers and Personal Assistants (Skills for Care)) which details minimum levels of support for individual employers and personal assistants. This guidance recommends local authorities should provide ongoing support through access to training activities, promoting the Workforce Development Fund and encouraging apprenticeships for personal assistants.

8. Direct Payments and Hospital Stays: Person Receiving Care / Nominated Person

When direct payment holders are in hospital direct payments do not have to be suspended.

In such circumstances, the local authority should explore with the adult, their carer and the NHS the options to ensure that both the health and care and support needs of the adult are fully met in the best way possible. For example, they may prefer the personal assistant to visit hospital to help with their personal care, alongside health staff, especially where there has been a long relationship between the direct payment holder and the personal assistant.

In some cases, the nominated or authorised person managing the direct payment may be in hospital. An urgent review should be conducted to ensure that the person continues to receive care and support to meet their needs. This may be through a temporary nominated / authorised person or through short term care and support arranged by the local authority.

9. Terminating Direct Payments

Direct payments should only be terminated as a last resort or where there is clear and serious contradiction of the Regulations or where the conditions that need to be met no longer apply (except in cases of fluctuating capacity – see below).

All reasonable steps should be taken to address any situations arising without terminating the payment. Effective, but proportionate, monitoring processes should be routinely used to identify potential issues before a termination is necessary.

When a direct payment is terminated, there should be no gap in the provision of care support. Where a decision has been made to terminate a direct payment, the local authority’s care and support plan should be revised to ensure that the plan is appropriate to meet the needs in question.