Direct payments
Care Act 2014
Outline of content
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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
The Care
Act 2014
Direct
Payments
Regulations
Health and
Social
Care Act
Direct
Payments
Act
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Number of people receiving direct
payments
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
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Care and support planning
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Making direct payments available
someone who agrees to
manage a direct payment for a
person who lacks capacity
someone who agrees to manage a
direct payment on behalf of the
person with care needs
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
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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
Appropriate
Interim
arrangements
Management
Things
to
consider
Quickly
Support
A specialist
assessor
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Refusing the request
Accessible
Format
Which
conditions not
met and why
What to do in
the future
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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
Short-term
care in a care
home
Nonresidential
care in a care
home
Paying family
members to
manage the
DP
Pre-payment
cards
Services from
‘another’
local
authority
Flexibly and
innovatively no
unreasonable
restrictions
Becoming an
employer
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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
• Direct payments must be reviewed within the first six
months of making the first payment
Review • It is a light touch review as part of the initial review of the
care and support plan
• The management and use of the direct payment
• Any long-term support arrangements
Consider • Whether the individual is fulfilling their responsibilities as an
employer
• Direct payments must then be reviewed annually
Ongoing • Incorporating the views of all relevant parties and recorded
Review
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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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