Direct Payment Procedure

1. Using this Procedure

Sections 2, 3, 4 and 9 apply to all practitioners working across all areas of Adult Care and Support.

All other sections of the procedure should be used:

1. By frontline practitioners working in social work teams; when
2. A Care and Support Plan/Support Plan has been signed off; and
3. A Direct Payment is to be arranged; to
4. Understand and use the local process for arranging a Direct Payment; and
5. Work effectively alongside the Direct Payment team.

2. Promoting Direct Payments

The Care Act expects you to promote the use of Direct Payments. This means that whenever you identify that a Direct Payment may be an appropriate way to manage all (or part) of a personal budget you should discuss the benefits of doing so and support access to a Direct Payment.

This could apply:

1. When giving information and advice at any time;
2. During initial discussions about how eligible needs could be met;
3. When Care and Support Planning/Support Planning;
4. During statutory reviews; or
5. Throughout any process of monitoring.

3. Providing Information and Advice about Direct Payments

General information and advice

You are expected to be able to provide general information and advice about Direct Payments whenever:

1. A person/carer asks for it (reactive); or
2. You have identified a need for it (proactive).

The following is a list of all the information that you should be able to provide:

1. When a Direct Payment can/cannot be provided;
2. How a Direct Payment can/cannot be used;
3. Who can/cannot manage a Direct Payment;
4. The process of arranging a Direct Payment;
5. How often a Direct Payment is normally paid;
6. How any assessed financial contributions should be made;
7. Where prepaid cards are available, how they work; and
8. How Direct Payments are monitored and reviewed.

This procedure will support you to provide general information and advice about the process of arranging, monitoring and reviewing a Direct Payment.

Details about when a Direct Payment can/cannot legally be provided, and how it can be used is available within the 'Direct Payments' section of the Care Act resource, which can be accessed by clicking here.

If you require any further support you should:

1. Speak to your line manager; or
2. Contact a practitioner from the Direct Payments team.

E-mail: Directpayments@swindon.gov.uk
Tel: 01793 466883 or 01793 463914

Note: The Direct Payments Team is not a public facing team. As such, if people with Care and Support needs and carers with Support needs wish to access general information and advice about Direct Payments their contact details should not be provided. They should instead be directed to the Enham Trust:

E-mail: joseph.brown@enhamtrust.org.uk
Tel: 07710 092 056

Information and advice about employing a Personal Assistant

Although you are expected to provide general information and advice about Direct Payments you are not expected to be able to provide specific information or advice about employer liabilities and responsibilities where a person intends to employ a Personal Assistant.

Where such information or advice is required you must however take steps to ensure that the person/carer has access to it from the Enham Trust.

E-mail: joseph.brown@enhamtrust.org.uk
Tel: 07710 092 056

Consent

If you find yourself providing information and advice that is specific to the circumstances of a particular person/carer, you must consider who you are providing it to, and whether it is appropriate to provide it to them.

Normally it will only be appropriate to provide this information to:

1. The person/carer; or
2. Somebody else where clear consent of the person/carer has been given; or
3. Where the person lacks capacity, a Deputy appointed by the Court of Protection to make decisions about financial matters; or
4. Where the person lacks capacity, a Donee of a Lasting Power of Attorney who is authorised to make decisions about financial matters; or
5. Where the person lacks capacity, and there is no Deputy or Donee a person that you deem it in their Best Interests to provide the information to.

Accessibility

All information and advice that you provide must be given in a way that the person/carer receiving it will best be able to understand and use. This is a legal requirement of the Care Act.

Click here to read more about how to provide information in an accessible way under the Care Act.

If you provide information and advice but feel that person/carer for whom it is intended will need additional support to understand it then you should consider:

1. Whether the information can be provided in a different way;
2. Whether you can take any additional steps to support the person/carer to understand it (for example talking through the information on the telephone or in person);
3. Whether it would be appropriate to appoint an independent advocate to support the person/carer to understand and use the information.

4. Direct Payments and Mental Capacity

General guidance

A person who lacks capacity to request or manage a Direct Payment is still legally entitled to receive one as long as:

1. A legally authorised person has deemed it in their Best Interests (a Deputy or a Donee of a Lasting Power of Attorney); or
2. Where no legally authorised person exists, you deem it to be in their Best Interests; and
3. There is a suitable person available to receive and manage the Direct Payment.

Fluctuating capacity

If a person has fluctuating capacity a suitable person must be appointed to receive and manage the Direct Payment but:

1. The suitable person must agree to the person with Care and Support needs  making decisions about how the Direct Payment is used during periods where they have capacity to do so; and
2. You must be satisfied that this is going to be the case before arranging the Direct Payment.

Monitoring a suitable person

You must make appropriate and proportionate arrangements to monitor the Direct Payment when you have concerns that a suitable person:

1. May not be able to manage the Direct Payment; and/or
2. May not arrange support and services that are in the Best Interests of the person; and/or
3. Where the person has fluctuating capacity, may not permit them to make their own decisions about how the Direct Payment is used when they have capacity to do so.

Click here to access the procedure for monitoring a Direct Payment.

5. Before Arranging a Direct Payment

In all circumstances

Before arranging a Direct Payment you must be satisfied that all of the following apply:

1. The person with Care and Support needs is not excluded from receiving a Direct Payment under the Care Act; and
2. Where the person receiving or managing the Direct Payment is the person with Care and Support needs, they are capable of managing it (with or without support); or
3. Where the person receiving or managing the Direct Payment is not the person with Care and Support needs, they are willing and capable of managing it; and
4. Where the person with Care and Support needs lacks capacity, the Direct Payment will be used by the suitable person to arrange services that are in their Best Interests; and
5. The Direct Payment is the most appropriate way of arranging the required support or services; and
6. If the Direct Payment will be used to employ a Personal Assistant, that employer related costs have been taken into account; and
7. If being used to pay for respite in a care home, no more than 4 weeks of this will be taken consecutively in any 12 month period; and
8. The Direct Payment will not be used to pay for Care and Support provided by a relative living in the same household; unless
9. This has been agreed through the Care and Support Plan sign-off process.

Note: For guidance about the 4 consecutive weeks in a care home rule see 'Needs that May Not Be Met by a Direct Payment'.

If you have any doubts about any of the above conditions you should:

1. Seek the support and advice of your manager; and
2. Consider the need to apply or recommend that conditions are placed on the Direct Payment; or
3. Consider the need to make appropriate and proportionate arrangements to monitor the Direct Payment.

Click here to access the procedure for monitoring a Direct Payment.

Direct Payments to purchase Section 117 After-Care

If a person is to be provided with Section 117 After-Care under the Mental Health Act 1983 they are legally entitled to receive a Direct Payment, and to use the Direct Payment to purchase After-Care so long as all of the above conditions apply.

Direct Payments if the person already has a Health Direct Payment

If the person with Care and Support needs already has a Health Direct Payment you should:

1. Speak to your manager; and
2. Explore whether the two Direct Payment's can be provided as a single payment; and
3. If so, follow any local processes for arranging this; but
4. If not, arrange for a separate Local Authority Direct Payment in the normal way.

6. Arranging a Direct Payment

When to use this section of the procedure

This section of the procedure should be used when:

1. A person or carer has requested a Direct Payment; or
2. You have deemed it to be in their Best Interests; and
3. You are satisfied that there is no reason why the person, their nominated representative or a suitable person (if they lack capacity) should not receive a Direct Payment; and
4. The Care and Support Plan/Support Plan has been signed off.

Applying and recommending conditions

The Local Authority is legally permitted to place conditions on a Direct Payment if it feels it necessary and appropriate to do so. These include:

1. Prohibiting a named individual from providing care; and
2. That certain information must be provided to enable effective monitoring.

Indicators that conditions may be required include concerns about:

1. A person's ability to receive or manage the Direct Payment (even with support);
2. The ability of the person's nominated representative or a suitable person (if they lack capacity) to manage the Direct Payment;
3. Whether the suitable person will arrange services based on what is in the person's Best Interests;
4. If the person has fluctuating capacity, whether the suitable person will permit them to manage the Direct Payment when they have capacity to do so; and
5. The Direct Payment being used to purchase care from a family member living in the same household (without agreement to do so).

If you feel that it is necessary and appropriate for a condition to be placed on a Direct Payment you should:

1. Seek the advice of your manager; and
2. If they are in agreement, advise the Direct Payments team of the condition that has been applied; and
3. Make appropriate arrangements to monitor that the condition is met; or
4. If the condition relates to the provision of information to the Direct Payments team, recommend that the Direct Payment team monitor the condition.

Arranging the Direct Payment

Making a Referral to the Enham Trust

A referral should be made to the Enham Trust for every Direct Payment, regardless of whether it is going to be a managed account or not.

Enham will undertake a visit to the service user to advise them of what a Direct Payment is and how it works. Enham will also assist with helping the person source a personal assistance and explain employment responsibilities. Enham also offer a facility for a person to have a payroll maned facility if they do not wish to have a full managed account.

For information about making a referral see the Local Resources area.

Making a Referral to the Direct Payments Team

When the Care Assessment is uploaded and authorised on Eclipse it will send an automatic notification to the Direct Payment Team.

The assessment should clearly identify:-

1. Any special requirements for the Direct Payment or agreed exemptions from normal process with evidenced justification.
2. If the person has capacity so the correct contract can be sent.
3. The total weekly Direct Payment.
4. The hours required per week.
5. Whether the person is going to employ an agency or personal assistance for their Direct Payment or requires Supported Living Rates.
6. The rate payable per hour, allowing for different hourly rate if a P/A is required and any night rates.
7. The hourly rates are to be taken from the Fees and Charges sheet which is cascaded to the ASC Team.
8. If a respite payment is to be made as part of the Direct Payment, for how much and for how long.

Financial Assessment

If a financial assessment/reassessment has not yet been requested you should do so.

You should also explain to the person that any contribution will be deducted from the Direct Payment so will affect the amount paid. You should also explain that the person will need to make arrangements to pay their financial contribution into the Direct Payment account to ensure that monies are sufficient to pay for their services.

7. Delays

Delays in arranging the Direct Payment

Delays in arranging the Direct Payment must not lead to delays in the meeting eligible needs.

If a delay in arranging the Direct Payment occurs you must:

1. Seek the support and advice of a manager as required; and
2. With the agreement of the person (or in their Best Interests if they lack capacity) refer to the relevant sections of the Commissioning, Contracting and Brokerage procedure; to
3. Arrange any interim services that are required, ensuring that the statutory obligations of the Local Authority are met.

Delays in employing a Personal Assistant or arranging services

The duty to meet eligible needs is not discharged until:

1. The Direct Payment is being provided; and
2. Services and support to meet eligible needs is in place.

If there are delays in employing a Personal Assistant or arranging the required service you should consider whether:

1. You are able to support in the arrangement of a service; or
2. Other support can be provided (for example an advocate); or
3. An independent person or organisation can support in the recruitment of a Personal Assistant.

If a delay persists you must:

1. Seek the support and advice of a manager as required; and
2. With the agreement of the person (or in their Best Interests if they lack capacity) refer to the relevant sections of the Commissioning, Contracting and Brokerage procedure; to
3. Arrange any interim services that are required, ensuring that the statutory obligations of the Local Authority are met.

8. Monitoring how a Direct Payment is used

When monitoring may be needed

Appropriate and proportionate arrangements to monitor how the Direct Payment is being used should be considered when:

1. A one-off Direct Payment has been provided to make a specific single purchase; or
2. Conditions have been placed on the Direct Payment; or there are concerns about
3. Delays in arranging services and support to meet eligible needs; or
4. A person's ability to receive or manage the Direct Payment (even with support);
5. The ability of the person's nominated representative or a suitable person (if they lack capacity) to manage the Direct Payment;
6. Whether the suitable person will arrange services based on what is in the person's Best Interests;
7. If the person has fluctuating capacity, whether the suitable person will permit them to make their own decisions about how to use the Direct Payment when they have capacity to do so; and
8. The Direct Payment being used to purchase care from a family member living in the same household (without agreement to do so).

Agreeing your role

Your role in monitoring the Direct Payment should be agreed by your manager and clearly recorded.

If monitoring only involves reviewing information provided to the Direct Payments team, it may be more appropriate for the Direct Payments Team to carry out monitoring.

Depending on the nature of what is being monitored, it may be more appropriate for monitoring activity to be completed by the Direct Payments Team.

Recording monitoring activity

Any monitoring activity that you carry out should be clearly recorded. In particular you should record:

1. Whether any specific item to be purchased with a one-off Direct Payment has been purchased as intended;
2. Whether concerns remain/exist;
3. Whether on-going monitoring activity is required;
4. Whether the on-going Direct Payment remains appropriate.

9. Concerns about an Existing Direct Payment

The following are some of the concerns that could exist regarding a Direct Payment:

1. The person does not appear to be able to receive or manage the Direct Payment appropriately (even with support);
2. The person's nominated representative or a suitable person (if they lack capacity) does not appear able to manage the Direct Payment;
3. The suitable person is not arranging services based on what is in the person's Best Interests;
4. If the person has fluctuating capacity, the suitable person is not permitting them to make their own decisions about how to use the Direct Payment when they have capacity to do so; or
5. The Direct Payment is being used to purchase care from a family member living in the same household (without agreement to do so).

Concerns about an existing Direct Payment can arise at any time and, if you are working with a person who is using a Direct Payment you should:

1. Have conversations about how the Direct Payment is working as and when you feel they are required (not just during statutory reviews); and
2. Be vigilant to some of the possible concerns that could arise; and
3. Ensure that they are reported to the person best placed to respond (if this is not you).

Concerns can also be identified and raised by:

1. The person with Care and Support needs;
2. The person receiving or managing the Direct Payment (if not the person with Care and Support needs);
3. The Direct Payments team;
4. A healthcare professional (e.g. a community or district nurse);
5. Another social care professional or practitioner (for example an Occupational Therapist or reablement worker);

If you identify, or become aware of any concerns you must:

1. Record the concerns and the evidence for them;
2. Seek the support and advice of your line manager as required;
3. Take steps to resolve any issues that you are able to resolve;
4. Notify your line manager of the concerns and action taken (if not already done so when first identified).

Appropriate action could include:

1. Placing a condition on the Direct Payment;
2. Increased monitoring activity;
3. Variation of the Direct Payment;
4. Suspension of the Direct Payment; or
5. Withdrawing the Direct Payment.

10. Reviewing a Direct Payment

Using this section of the procedure

This section of the procedure should be used when carrying out the statutory review of:

1. An on-going Direct Payment made to a person with Care and Support needs (or a carer with Support needs); or
2. A one-off Direct Payment being used across the year (rather than to purchase a specific item).

If a one-off Direct Payment has been provided to purchase a specific item appropriate arrangements should be made to monitor whether the item has been purchased as intended soon after the payment was provided.

The timing of a Direct Payment Review

Initial reviews of a Direct Payment must take place no later than 6 months after the first payment is made.

Further reviews must take place no less than every 12 months after that.

It is prudent to carry out more frequent reviews when:

1. There are conditions placed on the Direct Payment; or
2. The Direct Payment is being monitored because there are concerns.

Combining a Direct Payment Review with another review

If you are carrying out the Direct Payment review you should make arrangements to do so alongside any other statutory review that is taking place at that time, unless there is a valid reason not to do so.

This includes the review of:

1. A Care and Support Plan;
2. A Support Plan; or
3. An Education, Health and Care Plan (EHC Plan).

The purpose of a Direct Payment review

The purpose of the review is to:

1. Reflect on what is working and not working about the Direct Payment;
2. Consider what may need to change about the Direct Payment;
3. Make sure the Direct Payment remains the most appropriate way to provide the required services; and
4. Make sure the Direct Payment is supporting the person/carer to meet their outcomes as intended.

In order to achieve its purpose the following must all be reviewed:

1. How well the process of receiving payments is working;
2. How well the Direct Payment is being managed;
3. Whether records required by the Local Authority are being maintained by the person receiving/managing the Direct Payment;
4. Whether information is being provided to the Local Authority as required;
5. Whether the Direct Payment is being used as anticipated;
6. Whether the Direct Payment is supporting the person/carer to meet the outcomes in their Care and Support Plan/Support Plan.

Who must be involved

There is a legal requirement to involve the following people in a Direct Payment review:

1. The person receiving Care and Support; or
2. The carer receiving Support;
3. Any carer the person has;
4. The person to whom the payments are being made (if this is not the person receiving Care and Support or the carer);
5. Any person who is providing administrative or management support;
6. Anybody the person asks the Local Authority to involve;
7. In the case of a person who lacks capacity, anybody authorised by the Mental Capacity Act to make decisions about Care and Support provided to the person (a Deputy of Power of Attorney); or
8. Where no authorised person exists, anybody the Local Authority deems to be interested in their welfare.

The role of the Direct Payments team

The Direct Payments Team should be consulted prior to review to establish:

1. Whether records required by the Local Authority are being maintained by the person receiving/managing the Direct Payment; and
2. Whether information is being provided to the Local Authority as required.

They may also have been involved in monitoring existing concerns, or have gathered other information that may be prudent to any decision about the on-going appropriateness of the Direct Payment.

Light touch reviews

It is possible to carry out a light touch review of the Direct Payment (even if any other review is not light touch), so long as:

1. The person (or their representative) is happy to continue using and managing the Direct Payment;
2. The Direct Payment remains an appropriate way to meet the eligible needs identified in the Care and Support Plan; and
3. The Local Authority has no concerns about how the Direct Payment is being managed or used.

In order for the outcome of a light touch Direct Payment review to be sufficient you must be satisfied that the Direct Payment is:

1. Appropriate to meet the needs set out in the Care and Support Plan;
2. Being well managed;
3. Being used appropriately to meet the needs and outcomes identified in the Care and Support Plan.

Using the Care and Support Plan/Support Plan review procedures

You should refer to the Care and Support Plan/Support Plan review procedures in your team's area of this site for general advice about:

1. Arranging reviews;
2. Gathering and using information;
3. Using advocacy;
4. Deciding the method of review;
5. Having effective review conversations; and
6. To ensure that all requirements of any other statutory review being carried out at the same time are met.

Deciding the outcome of the review

Possible outcomes

There are 4 possible outcomes following a Direct Payment review:

1. No changes required to the Direct Payment;
2. Changes to one or more element of the Direct Payment;
3. Suspension of the Direct Payment; or
4. Termination of the Direct Payment.

Deciding the outcome

Throughout the process of review you should talk to the person (or their representative)/ carer and others involved about the likely outcome of the review, endeavouring to reach an agreement about this as the process progresses.

The Local Authority is however responsible for making the final decision about the outcome of the review. This is a decision that you should always make with regard for:

1. The views of the person/carer about the outcome;
2. The impact of the outcome on the person/carer's Wellbeing; and
3. The views of anyone else consulted in the process.

The decision that you make about the outcome of the review must be evidence based and robust. This means you must be able to demonstrate the information that you have used to reach a decision if challenged.

Managing disagreement about the outcome

There may be times when the person/ carer, their representative or another person disagrees with the decision that has been made about the outcome of the review.

In this situation you should be open to reviewing the available evidence to ensure that the decision is robust. You should be open and transparent about the evidence sources you have used and take steps to try and support the person/carer to understand the decision you have made.

Where ongoing disagreement persists you should you must make the person (or their representative)/ carer aware of their right to complain about the decision that has been made.

Making a formal record of the review

Wherever possible, you should make a formal record of the review as part of the formal record of any other statutory review that is taking place at that time, unless there is a valid reason not to do so.

This includes the review of:

1. A Care and Support Plan;
2. A Support Plan; or
3. An Education, Health and Care Plan (EHC Plan).

You are responsible for establishing:

1. The current review framework used by your team for recording purposes; and
2. The timeframe for making a formal record; and
3. Any particular local requirements for recording a Direct Payment review.

If you are unclear you should speak to your line manager before proceeding to make a formal record of the review.

The following information about the Direct Payment should be clearly but proportionately recorded:

1. Any issues or concerns about how the processes of receiving and managing payments is working;
2. Whether records required by the Local Authority are being maintained by the person receiving/managing the Direct Payment;
3. Whether information is being provided to the Local Authority as required;
4. Whether the Direct Payment is being used as anticipated;
5. Whether the Direct Payment is supporting the person/carer to meet the outcomes in their Care and Support Plan/Support Plan;
6. Whether the Direct Payment is still the most appropriate way to meet the person/carer's eligible needs;
7. Whether any changes are required to the Direct Payment; and
8. Whether the Direct Payment will continue;
9. The views of the person/carer and the person receiving/managing the Direct Payment about all of the above.

The person/carer and anybody responsible for receiving or managing the Direct Payment must be provided with a copy of the formal record.

Actions following the review

Deciding the timeframe for the next review

If the Direct Payment is to continue the next statutory review must be carried out within 12 months. However, the date can be earlier and decisions about the timeframe must consider:

1. The need to monitor any aspect of the Direct Payment;
2. When other statutory reviews are scheduled to take place (as a combined review should be arranged wherever possible);
3. Whether the Care and Support Plan/Support Plan is stable.

The agreed timeframe for the next review should be clearly recorded on the formal review record and any Care and Support Plan/Support Plan.

If you are unclear about an appropriate timeframe for review you should seek the advice of your line manager.

11. Varying, Suspending or Ending a Direct Payment

Varying a Direct Payment

Variations to a Direct Payment include:

1. The addition or removal of a condition;
2. An increase in the Direct Payment paid;
3. A decrease in the Direct payment paid;
4. A change to the person receiving or managing the Direct Payment.

You should refer to available local processes and guidance to vary a Direct Payment.

Suspending a Direct Payment

A Direct Payment may be suspended when there are concerns about:

1. A person's ability to receive or manage the Direct Payment (even with support); or
2. The ability of the person's nominated representative or a suitable person (if they lack capacity) to manage the Direct Payment; or
3. Whether the suitable person will arrange services based on what is in the person's Best Interests; or
4. If the person has fluctuating capacity, whether the suitable person will permit them to manage the Direct Payment when they have capacity to do so; or
5. The Direct Payment being used to purchase care from a family member living in the same household (without agreement to do so); but
6. It is felt that with some support the issues can be resolved and the Direct Payment resumed.

The following must be clearly recorded:

1. The reason that the Direct Payment has been suspended;
2. How long the Direct Payment is likely to be suspended for; and
3. How the situation will be monitored or reviewed.

If a Direct Payment is suspended the duty to meet eligible needs for Care and Support/Support still applies. This means you must:

1. Seek the support and advice of a manager as required; and
2. Refer to the relevant sections of the Commissioning, Contracting and Brokerage procedure; to
3. Arrange any interim services that are required, ensuring that the statutory obligations of the Local Authority are met.

Ending a Direct Payment

The Direct Payment must be ended if:

1. The person/carer no longer wishes to revive the Direct Payment (when it is being paid to them and they have capacity to make this decision); or
2. The person/carer becomes subject to a requirement, license or order to undergo drug or alcohol rehabilitation, behaviour therapy or testing; or
3. A person with Care and Support needs moves into a care home; or
4. The carer is no longer a carer as defined in the Care Act.

The Direct Payment must also be ended if any of the following situations apply and no resolution to continue the Direct Payment can be found:

1. The person managing the Direct Payment has breached a condition of the Direct Payment Agreement;
2. The person managing the Direct Payment has not been using the Direct Payment to meet eligible needs;
3. The person with Care and Support needs has become permanently incapacitated and there is no suitable person to manage the Direct Payment;
4. The Direct Payment is being used to pay for a family member living in the same household as the young adult to provide care without prior agreement;
5. A Direct Payment is no longer deemed the most effective way to meet the person/carer's needs.

You should refer to available local processes and guidance to end a Direct Payment.

If a Direct Payment is suspended the duty to meet eligible needs for Care and Support/Support still applies. This means you must:

1. Seek the support and advice of a manager as required; and
2. Undertake further Care and Support Planning/Support Planning as required; and
3. Refer to the relevant sections of the Commissioning, Contracting and Brokerage procedure; to
4. Arrange any alternative services that are required, ensuring that the statutory obligations of the Local Authority are met.