Page 1
Direct payments workbook
1.
How to use this workbook
This work book forms part of the suite of learning materials that have been
developed to support the implementation of part one of the Care Act 2014. These
materials summarise and explain the ‘Care and Support Statutory Guidance’
(October 2014) [“the guidance”] and are designed to help those involved in care and
support services to understand and implement the Act.
The suite of learning materials contains workbooks, PowerPoint presentations and
other material for each of the following topic areas:
1. Introduction and overview
2. Information and advice
3. First contact and identifying needs, including assessment and eligibility, and
independent advocacy
4. Charging and financial assessment, including deferred payment agreements
5. Person centred care and support planning, including personal budgets, direct
payments and review
6. Transition to adulthood
7. Integration, cooperation and partnerships
This workbook is about the direct payments requirements of the Act and its statutory
guidance. It has been written for learning facilitators and includes exercises,
suggested group discussions, points of reflection and case studies that facilitators
can use either in their entirety or to pick and choose from as they see fit when
designing a learning programme based on the PowerPoint presentation.
The workbook can also be used by individuals who wish to learn more about this
topic area. You can watch the presentation, read the notes below, and undertake the
exercises at a pace and time to suit you.
As well as this workbook and PowerPoint presentation, there are also handouts and
a shorter, overview presentation on this topic area. Handouts provide easy to print
resources that summarise key factual information from the guidance.
Page 2
The implementation of the Act requires whole systems change and underpinning this
is a need for cultural change. These learning materials alone will not affect such
change, but they are one tool that can be used to support people along the journey.
In many instances, implementing the Act successfully will require those involved in
the care and support system to change the way they work i.e. behaviour change.
Research suggests that the way people behave is influenced by their knowledge,
skills and attitudes:
Knowledge
Skills
Behaviour
Attitudes
The PowerPoint presentation and handouts are designed to increase knowledge
about the Act or guidance. The questions and exercises in the workbook are
designed to spark conversations that encourage people to reflect on their own
attitudes and the attitudes of others. They aim to give learners the opportunity to
discuss the complexities of implementing the changes in practice, and/or provide a
safe way of challenging attitudes that go against good practice. The case studies
are designed to provide an opportunity for people to analyse and practice their skills.
Key learning point
These are used in the workbook as a way of highlighting changes that are likely to
have a significant impact on practice i.e. the major changes that the Act brings in.
The facilitators’ hints and tips in the workbook signpost facilitators to existing good
practice resources on this topic area and/or highlight key changes that are likely to
have the most significant impact on practice. The aim is to help facilitators to design
interactive learning programmes that are appropriate for their audience.
Page 3
Facilitator’s hints and tips
To successfully facilitate this module we suggest that you need to:

have read the relevant sections of the Act, regulations and guidance

have a good understanding of best practice in this topic area

remember that there are various modules available and you need to choose
the most suitable ones for your learning programme

also remember that you can pick and mix questions, exercises and case
studies from this workbook or from other topic areas

design your training session in a way that accounts for the learning pyramid
so as to maximize the experience and learning outcomes for your participants.
Average retention rates
Lecture
5%
Reading 10%
Passive teaching
methods
Audio visual 20%
Demonstration 30%
Discussion 50%
Participatory
teaching methods
Practice by doing 75%
Teach others 90%
Source: Adapted from National Training Laboratories, Bethel, Maine
Page 4
2.
Who is it for?
This workbook is about direct payments. It explores sections 31-33 of the Care Act
and chapter 12 of the statutory guidance. It is intended to be used to develop
learning programmes for:
 people who have a role in care and support planning and the administering
and monitoring of direct payments.
 staff employed by local authorities who are responsible for care and support
planning and the administration and monitoring of direct payments.
 managers of people undertaking care and support planning and the
deployment of personal budgets.
3. Contents
This workbook starts with an overview, which summaries the topic area, and
identifies relevant key words. It then contains the following sections that match the
slides in the PowerPoint presentation:












Introduction
Making direct payments available
Adults with and without capacity
Administering and monitoring direct payments
Payments and additional costs
Use of a direct payment
Monitoring usage of direct payments
Reviewing direct payments
Safeguarding through direct payments
Direct payments and hospital stays
Discontinuing direct payments
Summary
Appendices: links to key resources; handouts.
Page 5
4.
Overview
Direct payments, along with personal budgets and personalised care planning,
mandated for the first time in the Care Act, provide the platform from which to deliver
a modern personalised care and support system. People should be encouraged to
be involved in their care planning, and be free to choose how their needs are met,
whether through local authority or third-party provision, by direct payments, or a
combination of the three approaches. The guidance supersedes the 2009 guidance
on direct payments, and reflects the new legislative framework.
The local authority has a key role in ensuring that people are given relevant and
timely information about direct payments, so that they can make a decision whether
to request a payment, and, if doing so, are supported to use and manage the
payment appropriately. The route to a direct payment is for a person to request one,
but the local authority should support this request by providing the information and
advice.
The Care Act provides a power to enable direct payments to be made to the person
in need of care and support, or a nominated person acting on their behalf if agreed
by the person with care needs and the person with care needs has capacity. In
cases where the person in need of care and support has been assessed as lacking
capacity to request the direct payment, an authorised person can request the direct
payment.
The direct payment must be sufficient to meet the person’s needs which the local
authority is under a duty to meet, or has exercised its power to do so. The direct
payment amount will reflect whether the person is required to make any financial
contributions, or is requesting a direct payment for only a part of their care and
support requirements.
5.
Key words
The suite of learning materials contains a glossary of key words used in the
statutory guidance. The following key words, which are defined in the glossary, are
relevant to this topic area: assessment, care and support plan, direct payment,
eligible needs, individual service fund, independent advocate, outcomes, personal
budget, reablement, support plan, top-up and wellbeing.
Page 6
6.
Introduction
Slide 1
Notes
1. This work book forms part of the suite of learning materials that have been
developed to support the implementation of part one of the Care Act 2014. These
materials summarise and explain the statutory guidance and are designed to help
those involved in care and support services to understand and implement the Act.
2. This presentation is about direct payments. It is intended for:
 people who have a role in care and support planning and the
administration and monitoring of direct payments
 staff employed by local authorities who are responsible for care and
support planning, administering and monitoring of direct payments
 managers of people undertaking care and support planning and the
administration and monitoring of direct payments.
3. The aim of the presentation is to help you reflect on the implications of the Act for
your role, so that you will know what you must do differently and what you may
need to do differently.
Slide 2
Page 7
Slide 3
Notes
1. Direct payments have been in use in adult care and support since the mid-1990s
and they remain the Government’s preferred mechanism for personalised care
and support. They provide independence, choice and control by enabling people
to commission their own care and support in order to meet their eligible needs.
2. Direct payments, along with personal budgets and personalised care planning,
mandated for the first time in the Care Act, provide the platform with which to
deliver a modern care and support system. People should be encouraged to be
involved in their care planning, and be free to choose how their needs are met,
whether through local authority or third-party provision, by direct payments, or a
combination of the three approaches. The guidance supersedes the 2009
guidance on direct payments, and reflects the new legislative framework.
3. For direct payments to have the maximum impact, the processes involved in
administering and monitoring the payment should incorporate the minimal
elements to allow the local authority to fulfill its statutory responsibilities. An
effective monitoring process should go beyond financial monitoring, because care
management responsibilities continue regardless of a person’s choice to take up
a direct payment, and it would include aspects such as identifying wider risks and
issues. For example non- payment of tax, appropriate employers’ liability
insurance and compliance with the rules regarding the checking of a person’s
right to work in this country, because all such concerns are lawfully relevant to
the authority’s management of risks to its own reputation and further liability.
4. The local authority also has a key role in ensuring that people are given relevant
and timely information about direct payments, so that they can make a decision
whether to request a payment, and, if doing so, are supported to use and
manage the payment appropriately. The route to a direct payment is for a person
to request one, but the local authority should support this request by providing the
information and advice as detailed above. People must not be forced to take a
Page 8
direct payment against their will, but instead be informed of the choices available
to them.
Slide 4
Notes
1. Direct payments were first introduced in 1997 under the Community Care (Direct
Payments) Act 1996. Initially, local authorities were given a power, rather than a
duty, to make payments for working age disabled adults. The Government
indicated that the user group for direct payments could be expanded without the
need for further legislation, should the system prove successful. The discretion
under the 1996 Act was extended to include older people in 2000, and further
legislation introduced in 2001 to include parents of disabled children and carers.
Carers and Disabled Children Act 2000 which inserted new section 17A into the
Children Act 1989.
2. A duty to provide direct payments was introduced in 2003 when regulations made
under Section 57 of the Health and Social Care Act 2001 made it mandatory for
councils to make direct payments to individuals who consented to, and were able
to manage them, with or without assistance. Community Care, Services for
Carers and Children’s Services (Direct Payments) (England) Regulations 2003
(SI 2003/762) since revoked and replaced by the Community Care, Services for
Carers and Children’s Services (Direct Payments) (England) Regulations 2009
(SI 2009/1887).
3. In 2009, provision was extended to persons appointed to receive direct payments
on behalf of individuals who lack mental capacity and to persons subject to
mental health legislation. Community Care, Services for Carers and Children’s
Services (Direct Payments) (England) Regulations 2009 (SI 2009/1887).
4. The Care Act 2014 confirms personal budgets in law for people with eligible
assessed needs and carers, including the right to direct payment. Care and
Support (Direct Payments) Regulations 2014.
Page 9
Slide 5
Notes
1. This data, drawn from the report on the social care activity of Councils with Adult
Social Services Responsibilities (CASSRs) in England, shows that there has
been an ongoing increase in the number of people aged over 18 who are
receiving self directed support (SDS) and/or direct payments provided or
commissioned by the CASSR.
2. The figures below indicate the increase in take up and offer of the number of
people with self directed support, including direct payments, over a three year
period for people aged 18 and over:
 in 2011-12 the total number of people All ages (18 and over) was: 527,020
 in 2012-13 the total number of people all ages (18 and over) was: 611,115
 in 2013-14 the total number of people all ages (18 and over) was: 648,380
3. This is mirrored by the increase in number of carers receiving self-directed
support and/or direct payments provided or commissioned by the CASSR during
the same period
 in 2011-12 the total number of carers all ages (under 18 and over) was:
78,405.
 in 2012-13 the total number of carers all ages (under 18 and over) was:
103,340
 in 2013-14 the total number of carers all ages (under 18 and over) was:
110,915
4. The majority of the carers receiving self directed support and/or direct payments
are aged between 18-64 (60,890), those under the age of 18 years old numbered
1,535 and the remaining are aged 65 and over 1. In addition, the proportion of
1
http://www.hscic.gov.uk/catalogue/PUB14397/comm-care-stat-act-eng-2013-14-prov-anxe.xls
Page 10
expenditure on direct payments reported by CASSRs in England has continued
to rise, accounting for eight per cent in 2013-14, compared to seven per cent in
2012-13 and four per cent in 2008-09. In 2013-14 £1.4 billion of expenditure was
on direct payments compared to £1.2 billion in 2012-13; an increase of ten per
cent in cash terms and eight per cent in real terms.
5. Over the five year period from 2008-09 when the figure was £610 million,
expenditure on direct payments increased by 125% in cash terms and 103% in
real terms.2
6. However, it is clear from the table below that take up of direct payments
specifically (rather than SDS more broadly) has plateaued in recent years.
Number of people receiving direct payments
2008 / 2009
Physical Disability
24,895
Mental Health
4,450
Learning Disability
11,955
Older People
25,850
2012 / 2013
2013 / 2014
35,885
37,015
8,245
9,090
27,755
31,210
43,265
43,785
Source: www.hscic.gov.uk
7. The Personal Budgets Outcomes and Evaluation Tool (POET) Survey for
personal budget holders and for carers of personal budget holders provides an
opportunity for people to report their experiences of personal budgets and the
ways of managing these including direct payments. See personal budget
workbook.
8. In total, 2,022 personal budget holders and 1,386 carers completed the 2013
POET survey. Of these:
 just under half (47%) reported managing their personal budgets through direct
payments paid to them
 followed by direct payments looked after by someone else (26%), councilmanaged personal budgets (11%)
 and individual service funds (7%).
2
http://www.hscic.gov.uk/article/2021/Websitesearch?productid=15453&q=direct+payments&sort=Relevance&size=10&page=1&area=both#top
Page 11
9. However, within these overall figures there were substantial differences across
social care need groups with:
 working age adults with mental health problems or physical disabilities more
likely than older people and working age people with learning disabilities to
hold a personal budget in the form of a direct payment paid to them
 working age adults with learning disabilities more likely than other groups to
hold a personal budget in the form of a direct payment looked after by
someone else
 working age adults with mental health problems more likely than other groups
to hold a personal budget in the form of an individual service fund
 older people more likely than other groups (particularly working age people
with mental health problems) to hold a council-managed personal budget.
10. The POET survey asked people whether their personal budgets had made a
difference to 14 aspects of their lives, and if so whether this difference has been
positive or negative. The results indicated that the majority of respondents
reported that holding both types of direct payment had made a positive impact on
the following areas:
 physical health
 mental wellbeing
 control over life
 being as independent as you want to be
 control over support
 getting the support that you need
 being supported with dignity
 feeling safe
 improved relationships with paid supporters.
11. The POET survey also revealed that holding personal budgets, including both
types of direct payments, had made no significant difference to the following
aspects of people's lives:
 choosing where they lived and who to live with
 getting and keeping a paid job
 volunteering
 relationships with family (although there was a trend for people holding direct
payments to be more likely to report a positive impact on family relationships
than other forms of budget types)

3
relationships with friends3
http://www.thinklocalactpersonal.org.uk/_library/POETNationalReportFINAL.pdf
Page 12
Making it Real - Direct Payments
The number of people who are receiving self-directed support (SDS)and/or direct
payments provided or commissioned by the CASSR primary by client type and
extended age group
Total number of people receiving SDS
Period 2013-14
and/or direct payments
People aged 18 to 64
217,785
People with a Physical Disability
91,615
People with Mental Health needs
33,725
People with a Learning Disability
88,445
People with Substance Misuse
issues
960
Other Vulnerable People
2,890
People aged 65 or over
430,595
People aged 65 to 74
79,165
People aged 75 to 84
153,540
People aged 85 and over
197,885
Facilitator’s hints and tips
You may want to gather information directly from the local authority or via the
www.hscic.gov.uk or https://nascis.hscic.gov.uk/ websites to understand what the
figures look like for the local area and how this compare with the national average.
It might then be useful to discuss the differences and the potential reasons for them.
Page 13
Slide 6
Notes
1. This diagram illustrates the main elements of the care and support planning
process.
2. If the local authority has a duty to meet a person’s needs (because it is required
to or decides to meet needs) it must help the person decide how their needs are
to be met, through the preparation of a care and support plan for those with
ongoing needs or support plan for carers. The plan must describe what needs
the person has, and which needs the local authority is to meet.
3. Everybody whose needs are met by the local authority will have a personal
budget as part of the care and support plan/support plan that identifies the cost
of their care and support and the amount that the local authority will make
available.
4. When someone has a personal budget they can take some or all of the budget as
a direct payment (as long as they meet the conditions in the Act and
Regulations), i.e. people can chose how much control they wish to take over the
arrangement of their care or support. During the care planning stage local
authorities must inform the person of the needs that could be met via direct
payments.
5. The local authority is under an ongoing duty to keep the person’s plan and
personal budget under review, to ensure that their needs continue to be met;
they will review the plan periodically, involving the person and agreeing any
necessary changes.
6. It is expected that most requests to receive direct payments will occur during the
care planning stage as this is when authorities must inform the person of the
needs that could be met via direct payments. But local authorities must consider
requests for direct payments made at any time, and have clear and swift
Page 14
processes in place to respond to the requests. In practice, it may be convenient
to consider the request at the same time as a review of the care plan. In these
cases, the review should be brought forward so as not to delay the consideration
of the direct payment request.
7.
Making direct payments available
Slide 7
Notes
1. The availability of direct payments should be included in the universal information
service that all local authorities are required to provide. This will allow people to
be fully aware what direct payments are and whether they are something that are
of interest. Note that there is a module on information and advice for more detail
on this. The information service should set out:
 what direct payments are
 how to request one including the use of nominated and authorised persons to
manage the payment
 an explanation of the direct payment agreement. Note that a nominated
person is anyone who agrees to manage a direct payment on behalf of the
person with care needs, when the person with care needs has capacity. An
authorised person is someone who agrees to manage a direct payment for a
person who lacks capacity according to the Mental Capacity Act 2005
 the responsibilities involved in managing a direct payment and being an
employer
 making arrangements with social care providers
 signposting to local organisations and the local authority’s own internal
support, who offer support to direct payment holders, and information on local
providers
 case studies and evidence on how direct payments can be used locally to
innovatively meet needs.
Page 15
2. Local authorities have a crucial role to play in promoting the use of direct
payments, and enabling people to make requests to receive direct payments in
an efficient way. However, the gateway to receiving a direct payment MUST
always be through the request from the person, or where the person has been
assessed as lacking capacity an authorised person can request the direct
payment on their behalf.
3. Local authorities must not force people to take a direct payment against their will,
or allow people to be placed in a situation where the direct payment is the only
way to receive personalised care and support. However, local authorities are
encouraged to prompt people to consider direct payments and how they could be
used to meet needs.
4. The steps to follow after receiving a request for a direct payment will depend on
whether the person has been assessed as having capacity to make a decision
about direct payments or not.
5. Assessments of capacity must always be made on a case-by-case basis, in
relation to the specific decision to be made. Assumptions should not be made
due to the existence of a particular condition, nor on whole groups of people.
Consideration should also be given to whether capacity is constant or likely to
fluctuate. Where it is clear that fluctuating capacity is a known issue, or likely to
be, this should be covered in the care plan which details the steps to take where
capacity fluctuates.
6. See Handout: Nominated and Authorised Persons.
Key learning point
The availability of direct payments should be included in the local information and
advice service.
Facilitator’s hints and tips
Increasing the take-up of direct payments requires the right support, the right tools,
the right systems and the right attitudes. Thinking about the right support, a key
issue is the need to improve the quality and consistency of the support required to
encourage people to take up direct payments. There tend to be three types of
organisations that provide support:
 council’s own in-house support services
 small specialist local services often delivered by user-led organisations
 larger national or regional organisations that offer support to councils across
the country
Page 16
It might be useful to discuss with participants what support is currently offered in their
local area. Think Local Act Personal (TLAP) resource Best practice in direct
payments support – a guide for commissioners might help you to prepare for and
structure this discussion.
Questions
 What percentage of people that the local authority funds are in receipt of
direct payments?
 Is the percentage of people continuing to grow? What are barriers to giving
more people direct payments?
 What information do you currently provide? Does it cover the elements
outlined above?
 What measures have you taken to ensure that the information about direct
payments is accessible to people with varying needs?
Example
Abdul is a deafblind man; to communicate he prefers to use Braille, Deafblind
Manual and email. He directly employs several staff through direct payments. He
receives payroll support from his local direct payments support service. Abdul
suggested ways to make direct payments management accessible to him. He
communicates with the support service mainly via email but they also use Text
Relay.
At the end of the month, Abdul emails the support service with details of the hours
that his staff have worked. The support service work out any deductions from pay
(such as National Insurance and Income Tax) and email him to tell him how much he
should pay the staff via cheque. They then send him pay slips to be given to staff.
The envelope that the payslips are sent in has two staples in the corner so that he
knows who the letter is from. The payslips themselves are labelled in Braille so that
he knows which staff to give them to.
Each quarter, the support service tells him how much he needs to pay on behalf of
his employees in National Insurance and Income Tax. The service also fills in
quarterly Inland Revenue paperwork. At the end of the year, the support service
sends relevant information to the council, so that they are aware of how the direct
payments are being spent.
Page 17
Abdul has taken on only some of the responsibilities of employing people; he has
delegated some tasks to the support service. Control still remains with Abdul and
confidentiality is maintained by using accessible labelling.
Questions
 What measures do you currently take to make direct payments accessible to
people with various needs?
 What else could you do?
8.
Adults with and without capacity
Slide 8
Notes
1. Where the local authority is satisfied that the person has capacity to make a
request for direct payments to cover some or all of their care needs, it must
consider each of the four conditions in clause 31 of the Care Act. These
conditions need to be met in their entirety; a failure in one would result in the
request to receive a direct payment being declined:
 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 by Regulations under section 33 from
meeting the adult’s needs by making direct payments to the adult or
nominated person (see Schedule 1 of the Direct Payment Regulations)
Page 18


the local authority is satisfied that the adult or nominated person is capable of
managing direct payments either by himself or herself, or with whatever help
the authority thinks the adult or nominated person will be able to access
the local authority is satisfied that making direct payments to the adult or
nominated person is an appropriate way to meet the needs in question.
Example
Sahil has a diagnosis of bi-polar disorder and has had a number of admissions to
hospital over the last ten years. During his last admission, he acknowledged that his
social isolation and a lack of activity during the day has a detrimental impact upon
his mental health and is keen to find meaningful and enjoyable activities to maintain
his improved mental health and wellbeing.
During a care and support planning review meeting he requests a direct payment as
part of this personal budget so that he can employ someone to help him meet his
need to reduce his social isolation which will be directed by him at his own time and
place. He has ongoing support from his care coordinator within the local support and
recovery team.
He is assessed as having capacity to make the request, is capable of managing the
direct payments and it is agreed that the direct payment is an appropriate way to
meet these needs.
Facilitator’s hints and tips
The POET survey found that if the processes involved in setting up a personal
budget are complex and poorly communicated this creates inefficiencies and has a
major impact on people’s experiences. It also found that most councils do not make
the process easy for people and that this was the single biggest factor impacting on
their outcomes. Places that are making good progress with personal budgets and a
personalised approach are also making good progress with direct payments.
It might be useful to have a discussion based around the following statement from a
TLAP study Trust is the key: Increasing the take-up of direct payments:
“The research shows that staff members are less likely to promote direct payments if
they see them as causing more work, or being too risky and that users are less likely
to take up direct payments if there are long delays in sorting them out.”
Page 19
Slide 9
Notes
1. In cases where the person in need of care and support has been assessed as
lacking capacity to request the direct payment, an authorised person can request
the direct payment on the person’s behalf. In these cases, the local authority
must satisfy itself that the person meets the five conditions as set out in section
32 of the Care Act. As with direct payments for people with capacity, each of
these conditions must be met in their entirety. Failure to meet any of the
conditions would result in the request being declined
2. An authorised person can request the direct payment on the person’s behalf, and
for this to be agreed all of these five conditions must be 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 by Regulations under section 33 from
meeting the adult’s needs by making direct payments to the authorised
person.
 the local authority is satisfied that the authorised person will act in the adult’s
best interests in arranging for the provision of the care and support for which
the direct payments under this section would be used
 the local authority is satisfied that the authorised person is capable of
managing direct payment by himself or herself, or with whatever help the
authority thinks the authorised person will be able to access
 the local authority is satisfied that making direct payments to the authorised
person is an appropriate way to meet the needs in question.
Page 20
Facilitator’s hints and tips
There is evidence that local authorities have not been enabling suitable people to
manage direct payments on behalf of users who lack capacity by restricting this only
to people appointed by the Court of Protection.
One of the biggest barriers is a culture of risk aversion and a failure to trust both
user-led support and user-directed solutions. You may want to use the selfassessment tool in the TLAP resource A Positive Approach to Risk &
Personalisation: A Framework to inform a discussion around developing a culture of
positive risk taking.
9.
Administering and monitoring direct payments
Slide10
Notes
1. The Care Act defines one of the conditions to be met is that the direct payment is
an appropriate way to meet the needs in question (or, in respect of after-care
services, an appropriate way to discharge its duty under section 117 of the 1983
Act). Local authorities must not use this condition to arbitrarily decline a request
for a direct payment. For example there may be instances where a person is
obliged to receive services as a condition of mental health legislation (including a
community treatment order, guardianship or leave of absence from hospital under
the Mental Health Act) In these circumstances it may still be appropriate to give
the person the responsibility of meeting their needs via a direct payment although
the person is being obliged to receive the services and not choosing to do so.
2. Appropriateness is for local authorities to determine, although it is expected that
in general, direct payments are an appropriate way to meet most care and
support needs. NB: The Regulations set out that direct payments cannot be
made to people subject to a court order for a drug or alcohol treatment
programme or similar schemes (see Schedule 1 of the Care and Support (Direct
Payments) Regulations 2014).
Page 21
3. In satisfying itself that the person, or nominated or authorised person is capable
of managing direct payments, the local authority is expected to take all
reasonable steps to provide support to people who may require it, and this
condition should not be used to deny a person from receiving a direct payment
without consideration of support needs. In taking reasonable steps to provide this
support to people who may require it many local authorities have contracts with
voluntary or user-led organisations that provide support and advice to direct
payment holders, or to people interested in receiving direct payments and some
put extra funds into the direct payment to give people choice and control if they
have nobody in their circle able or willing to help.
4. Consideration of a specialist assessor in determination of support requirements is
particularly relevant if one was used earlier in the care and support process (such
as assessment).
5. The consideration stage should be performed as quickly as is reasonably
practicable, and the local authority must provide interim arrangements to meet
care and support needs to cover the period in question.
Questions
 Using your own experience can you think of any cases where it has not been
deemed appropriate for a person to receive direct payments? What were the
barriers?
 On reflection is there anything that could have been done differently that
might have enabled the person to receive direct payments?
Page 22
Slide 11
Notes
1. The person making the request should be provided with written reasons that
explain the decision, and be made aware of how to appeal the decision through
the local complaints process.
2. Where the decision has been refused, the person in need of care and support,
and any other person involved in the request (i.e. the nominated or authorised
person) should receive the reasons in a format that is accessible to them.
3. It should set out:
 which of the conditions in the Care Act have not been met
 the reasons as to why they have not been met
 what the person may need to do in the future to obtain a positive decision.
4. The local authority should continue the care planning process so that it can agree
with the person how best to meet the needs, without the use of direct payments.
5. The consideration stage should be performed as quickly as is reasonably
practicable, and the local authority must provide interim arrangements to meet
care and support needs to cover the period in question
Example
Eleanor is a 92 year old widow who lives alone in a three-bedroom bungalow. She
has had Parkinson's disease for many years which limits her mobility and her ability
to carry out some of her basic care needs without assistance.
During the assessment of her care and support needs it was agreed that she needed
support to maintain her personal hygiene, get up and get dressed and prepare her
meals. Eleanor requested a direct payment be considered as part of her agreed
personal budget as she wants to employ her neighbour to meet her needs on an
ongoing basis. She knows her neighbour well and trusts her. This was agreed as
Eleanor was assessed as having capacity, is capable of managing the direct
payment, and the direct payment is an appropriate way to meet these needs.
Page 23
Example
Benjamin is subject to a court order for a community drug treatment programme, his
request for a direct payment was refused as payments cannot be made for people
with these issues or for these schemes. Note: see Schedule 1 of the Care and
Support (Direct Payments) Regulations 2014.
10. Payment and additional costs
Slide 12
Notes
1. The amount of the direct payment is derived from the personal budget as set out
in the care and support plan, or support plan and must be sufficient to meet the
person’s needs which the local authority is under a duty to meet, or has exercised
its power to do so. Please refer to the personal budget workbook which covers
sufficiency and resource allocation in more detail.
2. The direct payment amount will reflect whether the person is required to make
any financial contributions, or is requesting a direct payment for only a part of
their care and support requirements.
3. Where it is in the person’s interest to combine the plan and personal budget with
another form of state support, such as personal health budgets; and the person
agrees that plans should be combined, attempts should be made to harmonise all
direct payments so that the person does not have multiple payments each with
their own monitoring regime.
4. It is ultimately for authorities to decide whether payments are made on a gross or
net basis, in consultation with appropriate stakeholders. Gross payments are for
the full direct payment amount, and the local authority then recovers any
applicable charges from the person.
Page 24
5. A net direct payment is allocated after any appropriate charges have been
subtracted, and is generally seen as the easiest way to administer direct
payments. Net payments should be encouraged as the default method for
paying direct payments.
6. Where use of a direct payment will result in any ‘on-costs’ (e.g. recruitment costs
or employers National Insurance contributions), these costs should be
incorporated into the personal budget amount. To address ‘on-costs’ some local
authorities include one-off payments within the direct payment to cover these
factors. In addition, other authorities have commissioned support services such
as brokerage, and payroll and employment advice.
7. Local authorities still have a duty to ensure needs are being met, even if the
person makes their own arrangements via the direct payment, so contingencies
may be needed. For example in case of sickness where personal assistants are
employed.
8. If the person meets needs by directly employing someone, they will be
responsible for all costs of employment including redundancy payments and this
should be made clear to people as part of the information and advice process
before a decision is made whether to request direct payments. The local authority
must ensure that the direct payment is sufficient to meet these costs.
9. Local authorities should also consider how to recover unspent direct payments if
the recipient dies. For example, if someone wishes to pay an agency in advance
for its services, the council should bear in mind that it may be difficult to recover
money paid for services that were not in fact delivered. Councils should also
consider, if the direct payment recipient does leave unspent funds to be
recovered, that before their death the direct payment recipient may have incurred
liabilities that should legitimately be paid for using the direct payments (for
example, they received services for which payment had not been made at the
time of death).
10. Local authorities should ensure all direct payment recipients are supported and
given information in regards to having the correct insurance cover in place.
Page 25
11. Use of a direct payment
Slide 13
Notes
1. Direct payments are designed to be used flexibly and innovatively and there
should be no unreasonable restriction placed on their use, as long as it is being
used to meet eligible care and support needs.
2. For example, many local authorities have been developing the use of pre-paid
cards as a mechanism to allow direct payments without the need for a separate
bank account, or to ease the financial management of the payment. Whilst these
can be useful, they should not be provided as the only option to take a direct
payment, the offer of a cash payment should always be available if this is what
the person requests. It is also important that where a pre-paid card system is
used, the person is still free to exercise choice and control. For example, they
must not be linked solely to an online market-place that only contains selected
providers from which to choose. Local authorities should give consideration to
how they develop card systems that encourage flexibility and innovation.
3. The previous 2009 Direct Payment Regulations excluded the direct payment
from being used to pay for care from a close family member living in the same
household, unless the authority thought it was necessary.
Page 26
Example
David has been using direct payments to meet his needs for some time, and has
used private agencies to provide payroll and administration support, funded by a
one-off annual payment as part of his personal budget allocation.
David’s wife, Gill provides care for him and is increasingly becoming more hands-on
in arranging multiple PAs to visit and other administrative tasks as David’s care
needs have begun to fluctuate.
They jointly approach the local authority to request that Gill undertake the
administration support instead of the agency as they want to take complete control of
the payment and care arrangements so that they can best meet David’s fluctuating
needs and ensure that appropriate care is organised.
The local authority considers that Gill would be able to manage this aspect of the
payment, and jointly revises the care plan to detail the aspects of the payment, and
what services Gill will undertake to the agreement of all concerned. The personal
budget is also revised accordingly.
The family now has complete control of the payment, Gill is reimbursed for her time
in supporting David with his direct payment, and the local authority are able to make
a saving in the one-off support allocation as there are no provider overheads to pay.
Facilitator’s hints and tips
One of the key issues to draw out here is the need to expand the scope of support
that people use direct payments to purchase other than employing staff directly. Too
often users or staff are worried that being innovative and flexible will be frowned on
as not being good use of public money. If the care and support plan is truly
personalised and outcome focused, flexibility should not be difficult.
Who
Judy is a 78
year old lady
with dementia.
She lives with
her husband
Tony.
Desired
outcome
Judy would
like to
continue to
live at
home with
Tony.
The challenge
Use of direct payment
Judy keeps leaving the
house without Tony
realising. Judy is very
vulnerable on her own in
the community as she no
longer has any road
safety awareness and
their home is on a busy
main road.
The direct payment
has been used to
purchase some
assistive technology
so that Tony is alerted
when Judy leaves the
house.
Page 27
Ravi is 62 and
has been left
with physical
disabilities after
suffering a
major stroke.
Ravi would
like to
continue to
live on his
own.
Dave is a 28
year old man
who is suffering
from early onset
MS. He has
been feeling
down and is
becoming
increasingly
isolated.
Dave
would like
to attend
art classes
as this is
something
he used to
do.
Ravi is unable to prepare
or cook meals. He has
been losing weight
because he does not like
the English style food
provided by the ‘meals on
wheels’ service.
The nearest class is in
the next village and using
public transport is not
feasible.
Ravi uses part of his
direct payment to pay
his neighbour Vindra,
to cook the West
Indian style food they
both like.
Dave uses part of his
direct payment to pay
a local taxi company
to drive him there and
back every week.
You may want to ask participants to read the examples above and think of other
examples they know of where direct payments have been used creatively.
Alternatively you may want to give participants the information about the people in
the examples but not tell them how the direct payment was used. Instead you could
ask them to think about how a direct payment could be used to solve the challenge
and achieve the outcome.
4. While the Care and Support (Direct Payments) Regulations 2014 maintain this
provision regarding paying a family member living in the same household for
care, it also provides a distinction between ‘care’ and ‘administration/
management’ of the direct payment. This allows people to pay a close family
member living in the same household to provide management and/or
administrative support to the direct payment holder in cases where the local
authority determines this to be necessary. This is intended to reflect the fact that
in some cases, especially where there are multiple complex needs, the direct
payment amount may be substantial. The management and administration of a
large payment, along with organising care and support can be a complex and
time-consuming task.
5. This is not intended to be income replacement and the local authority should be
satisfied that that it is necessary to make the payment and that it will only be used
for administration and management. The activities, frequency and amount of
Page 28
payment should be recorded in the care plan and be taken into account during
allocation of the personal budget.
6. Local authorities will need to have in place agreement between all parties about
what steps need to be taken in case of a dispute regarding the management of
the payment by a household family member
Example
James has severe learning difficulties as well as various physical disabilities. He has
serious trust issues and a unique way of communicating that only his family, through
years of care as a child, can understand. The local authority agrees that using a
direct payment to pay for care from his parents is necessary as it is the best way to
meet James’ needs and outcomes.
7. Direct payments can be made to enable people to purchase for themselves a
short stay in residential care, provided that the stay does not exceed a period
of four consecutive weeks in any 12-month period. See Section 12.39-44 of the
Statutory Guidance for more details on the relevant Regulations.
8. Direct payments cannot currently be used to pay for people to live in long-term
residential care. However, people living in care homes may receive direct
payments in relation to non-residential care services, for example:
 to try out independent living arrangements before making a commitment to
moving out of their care home, which could be particularly empowering for
young people in transition
 to take part in day-time activities if assessed as additional to the provision
contractually agreed by the care home.
9. Note that using direct payments to secure long-term care in care homes is being
tested, with the aim of introducing it to all Local Authorities in 2016.
10. Direct payments may be used to pay for care and support from their ‘home’ local
authority services; however where a person wishes to do so it may be easier and
less burdensome to provide the service direct to the person. Even so, there may
be cases where the ‘home’ local authority exercises discretion, for example this
could be where a person wants to make a one-off purchase from the local
authority such as a place in day care.
11. Direct payments can also be used to purchase services from a different local
authority; for example, a person may live close to authority boundaries and
another local authority could provide a particular service that their ‘home’
authority does not provide.
Page 29
12. The benefits of using pre-paid cards include:
 their availability to all
 flexibility and choice for the individual
 development and promotion of life skills particularly for people without access
to a bank account
 access to services at a lower price
 quicker access to funds
 easier to monitor and replace.
Questions
 Does this raise any issues concerning safeguarding for you?
 What could you do to limit any safeguarding concerns you may have?
 What are the advantages and disadvantages to the local authority and direct
payment holder of using pre-paid cards for direct payments?
Example
Alan has Parkinson’s Disease resulting in fluctuations in his ability to move. Alan
lives at home with his wife Sheena who assists him with most of his personal care.
However, when Alan is experiencing an episode of decreased mobility, Sheena
needs help to meet her husband’s personal care needs. Alan receives a direct
payment and he uses part of it to access support from a local home care agency as
and when he needs it.
Page 30
Slide 14
Notes
1. Local authorities should give people clear advice 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
 explaining the difference between a regulated and unregulated provider
 Pension arrangements.
2. As part of the monitoring of the direct payment arrangement, local authorities
should check, if appropriate:
 to make sure any PAYE income tax and National Insurance contributions
deducted from an employee’s pay is in turn paid over to HMRC
 employment payments conform to the national minimum wage counted using
the Working Time Directive.
3. The direct payment scheme should be reviewed and consideration given to
alternative arrangements that result in the direct payment recipient no longer
acting as the employer need to be made, where it is clear that:
 payments, or returns detailing employee information deductions, have not
been made
 the individual is failing to meet their obligations as an employer generally.
4. Many local authorities have commissioned voluntary and charity organisations to
provide support to direct payment holders.
5. The local authority should have regard to the guidance published by Skills for
Care detailing minimum levels of support for individual employers and PAs. The
Skills for Care guidance recommends local authorities should provide on-going
support through access to training activities in a variety of ways and promote the
Workforce Development Fund. It also proposes that local authorities promote
apprenticeships for PAs.
Page 31
Facilitator’s hints and tips
Problems in recruiting, employing, retaining and developing personal assistants and
assuring their quality can be a disincentive to taking up direct payments. One way to
overcome this is through the use of a personal assistant register. A register enables
individual employers to search for personal assistants in a specific geographical
area, skill level, experience and availability. In some places simple registers have
been expanded into full employment services.
You may want to ask participants whether this exists in their local area and if so what
the strengths and weaknesses of it are.
You may want to provide some good practice examples such as
www.people4people.org.uk
Page 32
12. Monitoring usage of direct payments
Slide 15
Notes
1. The local authority must be satisfied that the direct payment is being used to
meet eligible care and support needs, and should therefore have systems in
place to proportionately monitor direct payment usage.
2. The Care and Support (Direct Payments) Regulations 2014 set out that the local
authority must not require information to be provided more often and in more
detail than is reasonably required to satisfy themselves the direct payment is
being used appropriately.
3. Key features of systems:
 they must not place a disproportionate reporting burden upon the individual
 the reporting system should not clash with the policy intention of direct
payments to encourage greater autonomy, flexibility and innovation
 monitoring 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.
4. The local authority must review the making of direct payments initially within six
months, and thereafter every 12 months. NB: The six month initial review only
applies to direct payments issued under the Act, and not to existing direct
payments.
5. Where there is integration with personal health budget direct payments, the local
authority could agree with the NHS that the social care and health direct
payments be combined and that the monitoring is performed solely by the local
authority, reporting to health professionals as appropriate.
Page 33
Example
Mr G has a stable condition and has been successfully managing his direct payment
for over two years. The local authority therefore decides to monitor the payment by
exception. Notwithstanding the required review in the Act and Regulations, Mr G is
now considered to have the skills and experience to manage on his own unless the
local authority request otherwise or information suggesting otherwise comes to the
attention of the local authority.
Facilitator’s hints and tips
Good practice guidance in Best practice in direct payments support – A guide for
commissioners suggests that personal budget holders find the following things
useful:
 Clear guidance about what is expected in terms of records and paperwork
 Examples of systems other personal budget holders have found helpful
 Optional training on managing your personal budget and/or direct payment
 A nominated link person in the local authority who can be contacted in the
event of difficulty
 Not having to keep receipts for small items of expenditure
 Clear information on how under-spends will be dealt with
 For those who require a full audit – different options such as home visits.
It might be useful to get participants to think through the degree to which they
currently do these things.
Questions
 Thinking about some of the people you know who are in receipt of direct
payments, are there cases where it would be appropriate to reduce the
monitoring?
 What do you think might be the impact of reducing monitoring in these cases?
 How might you balance proportionate monitoring with ensuring the direct
payment is being used to meet needs?
Page 34
Facilitator’s hints and tips
Moving to a more empowering and flexible system demands a significant change in
culture and thinking. Unfortunately some elements of bad practice have become
commonplace and it might be useful to discuss whether any of the things listed
below are common practice in the organisations your participants work in.
 It is bad practice to limit expenditure to certain kinds of services – people are
entitled to their budget because of their need for support in achieving
independent living – there is no reason why that budget cannot be spent on
whatever best meets that goal
 It is bad practice to limit expenditure to items previously specified in a support
plan – plans are projections, they should not limit how budgets are used. The
budget-holder should be able to use their discretion and change how they
spend their budget in the light of current circumstances
 It is bad practice to claw back money that is unspent at the end of a year – a
good budget-holder will vary the pattern of expenditure over time and should
not be penalised for holding back money from one year to the next. In fact,
clawing money back is most likely to encourage wasteful expenditure and will
make support arrangements less robust
 It is bad practice to demand itemised accounts of expenditure – the budgetholder may need to keep appropriate records, however these records are their
own and there is no need or value in receipts being passed on to the public
body. This is a wasteful and ineffective control system.
13. Reviewing direct payments
Slide 16
Notes
1. In addition to monitoring direct payments generally to ensure they are being used
to meet care and support needs, the Regulations set out that local authorities
must also review the making of the direct payment within the first six months of
making the first payment. NB: six month review applies to direct payments issued
under the Act, not existing ones.
Page 35
2. This review is intended as a light touch one. It should be incorporated within the
initial review of the care and support plan 6-8 weeks after sign-off and include
elements such as:
 managing and using the direct payment
 a discussion to consider any long-term support arrangements that may be
appropriate such as payroll, insurance cover and third party support
 If the direct payment recipient is employing people, the local authority should
check to ensure the individual is fulfilling their responsibilities as the employer
– within the first six months period or earlier if possible.
3. In practice, after the initial six-month review period, local authorities may wish to
consider combining the annual review of the direct payment with the general
review of the care plan. This will reduce bureaucracy and allow the local authority
to review both at the same time. Link to review workbook.
4. The review should incorporate the person in need of care and support, a
nominated/authorised person and, where relevant, any family carer being paid for
administrative support. The outcome of the review should be written down, and a
copy given to all parties. Incorporating these people will ensure that the local
authority receives views from everyone involved in the direct payment, so that it
can satisfy itself that there are no initial issues that require resolving. Naturally, if
elements of the care and support plan change when the plan is reviewed, then so
might the direct payment arrangements.
5. Where there are issues that require resolving, the resolution method should be
agreed with all parties involved, as far as is reasonably practicable. Where
appropriate, local authorities should advise people of their rights to access the
local authority complaints.
6. The review process may result in the independent advocacy duty arising again or
indeed for the first time. See independent advocacy workbook.
Page 36
Case study
Florence Brown is 75 years old and lives alone in a house that she used to share
with her husband (who died six months ago) and her two daughters. She suffers
from COPD4, is frail and has restricted mobility. She has been admitted to hospital
several times for short-periods because of respiratory infections. She used to smoke
heavily but gave up when she was first diagnosed five years ago.
She receives practical and emotional support from one of her daughters (Mary) who
lives nearby, who is divorced with no children. She also has supportive neighbours.
The other daughter (Jane) is willing to do what she can, but lives 100 miles away
with her husband and three young children and works full-time.
Assessment summary
Florence has two eligible needs:
 Maintaining a habitable home environment – Florence is unable, without
assistance, to keep her home sufficiently clean to make it safe for her, given
her respiratory condition.
 Maintaining and managing nutrition – Florence is able to consume food and
drink, and do some food preparation with assistance, but she would be unable
to access it without assistance.
The first need is an unmet need. Even after pulmonary rehabilitation Florence is
unable to meet this outcome. The second need is currently being met by Mary who
prepares her Mum’s evening meal every night and takes her shopping.
Florence has one ineligible need:
 Accessing necessary facilities or services in the local community – Florence is
unable to meet this outcome without assistance, but accessing the community
is not something Florence is bothered about and hence it does not have a
significant impact on her wellbeing.
Mary also has eligible needs:
 Engaging in work, training, education or volunteering – it appears that Mary’s
caring responsibilities are preventing her from training to be a teacher
 Engaging in recreational activities – it appears that Mary’s caring
responsibilities are preventing her from engaging in recreational activities
4
Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases
including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD
have difficulties breathing.
Page 37
Florence and Mary agreed a combined care and support plan and personal budget.
They would like a direct payment to pay the neighbour to support Florence with
keeping her house clean and preparing some of her evening meals. However,
neither of them know what to pay her and they are not confident about taking on the
role of employer.
Mary suggests that Jane be the nominated person for the direct payment, but Jane
says she would rather Mary undertook this role, and Florence agrees.
Questions
1. What steps have to be taken before the direct payment can be agreed?
2. How should the local authority monitor the use of this direct payment?
Suggested answers
1. The local authority has to decide whether the meeting of the care and support
needs is appropriate for a direct payment. In this case, as in most cases, it is
appropriate. Check that none of the conditions set out in the Regulations
preventing the local authority from making a direct payment, apply to Florence
and Mary’s circumstances. If Mary is to act on Florence’s behalf for the element
in the personal budget that is exclusively for meeting Florence’s needs, then
Mary will need to undertake the role of the nominated person as set out in the
Guidance, and Florence would need to agree to this. The local authority must be
satisfied that Mary is capable of managing the direct payment and provide her
with support if she needs it.
2. The main focus to begin with is likely to be ensuring that Mary is compliant with
the requirements of HM Revenue & Customs (HMRC) in her role as employer,
although the local authority will also want to ensure that it is being used for the
purpose which has been agreed. After the required first review (after six months)
the local authority may lessen the monitoring requirements, if things are running
smoothly.
Page 38
14. Safeguarding through direct payments
Slide 17
Notes
1. Personalisation and safeguarding are two sides of the same coin: empowering
people to speak out, enabling them to make informed choices and encouraging
communities to look out for one another. Personalisation needs to work for
everyone including those who are least able to access services or those
considered at greatest risk. Well designed self-directed support processes should
be unique to the individual and have checks and balances built in –
overprotective approaches can in themselves put people at risk.
2. The introduction of personalisation has brought a change to how safeguarding
risks present themselves and how they are recognised and managed. Along with
increased freedom to choose and arrange your own care has come the concern
about risk of exploitation. Local authorities are losing their leverage as large scale
commissioners with some ability to ensure quality in provider standards, while
individual service users are a lone voice.
3. When people use a direct payment to employ a personal assistant they are put in
a very difficult legal and emotional situation if the assistant abuses them. They
are expected to act within employment law and may also be reluctant to disclose
problems of harm or neglect as they are afraid of having their payment
suspended and the ultimate fear of losing their independence.
4. Contract management and quality assurance will go a long way to addressing
safeguarding and personalisation, but without social work skills people will remain
with merely increased services or monitoring rather than improved circumstances
Page 39
and outcomes. The LGA "Making safeguarding personal: A toolkit for responses" 5
is a good practical guide to methods of working with individuals and families.
5. Some local authorities have developed market places which control quality
assurance of care providers and easy-access to the full range of services for
people with direct payments. The Department of Health's guide "Practical
approaches to safeguarding and personalisation"6 provides a briefing on how
self-directed support can help to prevent or reduce the risk of harm and shows
how councils are integrating safeguarding and personalisation.
Question
 What would you do if someone using a personal budget told you that their
personal assistant was taking money out of their bank account?
Example
Andy, a young man who lives with his family in Cumbria, has Autism and a learning
disability. He received a statement of special educational needs (SEN) while
attending mainstream school. After leaving college Andy was offered a place at a
day centre for adults with learning disabilities, but he knew he could do much more.
He wanted a job – working with cars if possible.
Andy found a course at Preston University where he could learn about the different
aspects of motor sport, his real passion. But people around Andy were worried about
the risks. They worried Andy might not cope with the course, managing money,
meals and day-to-day- life. Mostly, they worried Andy would be vulnerable to abuse
or exploitation. Andy had, so far, led a very sheltered life, but had also been bullied
at college and by local young people who did not understand him. He had a personal
budget and wrote a support plan. The plan made clear that the course was so
important that the risks were worth it. So the money from social services enabled him
to go to Preston and to have some support there. Andy used the natural support of
5
Local Government Association (December 2010) Making safeguarding personal: A toolkit for
responses.
6 Department of Health (November 2010) Practical approaches to safeguarding and personalisation.
Page 40
the college’s pastoral care team, and gradually made friends as any other young
person would do.
However, Andy was vulnerable and some people took advantage of him. During his
first months at college, Andy lost several hundred pounds, his PSP games console
and his TV. He thought these were ‘loans’ to people he could trust. He got support to
speak to the police. His supporters helped him to learn from this experience so he
wouldn’t be exploited again. Andy successfully finished his course. He now has a
part-time job at Halfords. He also works as a volunteer for a community recycling
organisation.
He says if he had been completely protected from risk, he would never have learned
about trust. He wouldn’t have gained the confidence to deal with people trying to
take advantage. (Source: In Control factsheet 16 managing risks and safeguarding)
‘People learn by making mistakes. I needed to make mistakes too so I could learn.’
13.
Direct payments and hospital stays
Slide 18
Notes
1. There may often be occasions when direct payment holders require a stay in
hospital. Suspending or even terminating the payment could result in the person
having to break the employment contract with a trusted personal assistant,
causing distress and a lack of continuity of care when discharged from hospital.
2. Where the direct payment recipient is also the person requiring care and support,
the local authority should explore options to ensure that both the health and care
and support needs of the person are being fully met in the best way possible.
3. The person may prefer the personal assistant to visit hospital to help with
personal care matters. This may be especially so where there has been a long
relationship between the direct payment holder and the personal assistant. This
Page 41
should not interfere with the medical duties of hospital personnel, but be tailored
to work alongside health provision.
Key learning point
Where the nominated or authorised person managing the direct payment requires
a hospital stay, the local authority must conduct an urgent review to ensure that
the person continues to receive care and support to meet their needs.
Example
Peter is deaf and blind and is required to stay in hospital for an operation. Whilst the
hospital pays for an interpreter for the medical interventions, Peter needs additional
support to be able to move around the ward, and to communicate informally with
staff and his family. The local authority and the NHS Trust agree that Peter’s
communicator guide continues to support him in hospital, and is paid for via the
direct payment, just as it was when Peter was at home. Personal and medical care
is provided by NHS staff but Peter’s communicator guide is on hand to provide
specialist communication and guiding support to make sure his hospital stay is as
comfortable as possible.
Question
 What can be done to ensure needs are met in hospital?
Page 42
14.
Discontinuing direct payments
Slide 19
Notes
1. If a person decides that they no longer wish to continue receiving direct
payments, the local authority should ensure there are no outstanding contractual
liabilities and conduct a review of needs to consider alternate arrangements to
meet needs.
2. A local authority may also stop direct payments, but this should only be done as a
last resort if there is a breach of the regulations or the direct payment conditions
are no longer met – see slides 7 and 8 for the conditions. This might happen for
example if:
 the person no longer appears to be capable of managing the direct payments,
or managing them with whatever support is necessary
 the person, or authorised person, fails to comply with a condition imposed
under regulations to which the direct payments are subject
 for some reason the council no longer believes it is appropriate to make the
direct payments – an example of this is if it is apparent that direct payments
have not been used to achieve the outcomes of the plan
 the local authority is no longer satisfied for whatever reason that the
authorised person is acting in the best interests of the beneficiary – direct
payments must be discontinued. The local authority may wish to consider if
someone else can act as an authorised person
 the person’s circumstances change and the local authority becomes
prohibited from meeting the adult’s needs by making direct payments, e.g. as
a result of mental health or criminal justice provisions ( See Schedule 1 of the
Care and Support (Direct Payments) Regulations 2014).
3. Local authorities should explain to people, before they begin to receive direct
payments, the exceptional circumstances in which this might occur and discuss
with them the implications this has for the arrangements that individuals might
make, and any obligations they may have.
Page 43
4. It is hoped that effective, but proportionate monitoring processes will help local
authorities to spot any potential issues before a termination is necessary. The
local authority should discuss with individuals, their carers and any person
managing the direct payments if it is considering discontinuing direct payments to
them – in order to explore all available options before making the final decision to
terminate the direct payments. For example, if ability to manage is an issue, the
individual should be given an opportunity to demonstrate that they can continue
to manage direct payments, albeit with greater support if appropriate. The local
authority should not automatically assume when problems arise that the only
solution is to discontinue or end direct payments.
5. A minimum period of notice should be established that will normally be given
before direct payments are discontinued, but in serious cases the local authority
may discontinue without giving notice.
6. There may be circumstances in which the local authority discontinues direct
payments temporarily. An example of a temporary discontinuation might be when
an individual does not require assistance for a short period because their
condition improves and they do not require the care and support that the direct
payments are intended to secure. The local authority will need to discuss with the
person, their carer, and any other person how best to manage this. The person
should be allowed to resume responsibility for their own care after the
interruption, if that remains their wish, unless there has been a change of
circumstances which means that there is no duty on the council to make direct
payments or, in certain exceptional circumstances, the council decides not to
exercise the power to make direct payments.
7. In all cases, the local authority will need to arrange the relevant care and support
provision instead, to ensure continuity of support.
Page 44
Slide 20
Notes
1. Where someone with capacity was receiving direct payments but then loses
capacity to consent, the local authority should discontinue direct payments to that
person and consider making payments to an authorised person instead, making
alternative arrangements in the interim to ensure continuity of care.
2. If the local authority believes the loss of capacity to consent to be temporary, it
may continue to make payments if there is someone else who is willing to
manage payments on the person’s behalf. The situation should be:
 treated as strictly temporary and
 closely monitored to ensure that, once the person has regained capacity, they
are able to exercise overall control over the direct payments as before.
3. If the person’s loss of capacity to consent becomes prolonged, more formal
arrangements for an authorised person to take over receipt of the direct payment
need to be put in place.
4. Direct payments to an authorised person must be discontinued where the local
authority has reason to believe that someone who had lacked capacity to consent
to direct payments has now regained that capacity on a long-term or permanent
basis. The local authority should not terminate direct payments to the authorised
person before beginning to make direct payments to the service recipient
themselves or to arrange services for them, according to their wishes.
5. If the local authority is satisfied that the regaining of capacity will only be
temporary, then it can continue to make direct payments to the authorised
person, on the basis that the beneficiary should control how the direct payments
are used.
Page 45
15. Summary
Slide 21
Questions
 What has struck you most about this session?
 Thinking about what you have learnt about direct payments (and on any other
modules you have completed so far):
 What links can you make between topic areas?
 How might the necessary changes impact on your current arrangements?
 What might the key challenges be?
Exercise
 What are your top three priorities in relation to direct payments?
 Complete the action plan to identify the next steps for each priority.
Page 46
Appendices
Links to key resources
HMRC Tell HMRC about a new employee. This guide explains how to work out
whether a worker is an employee or self-employed. It lists the key factors that affect
employment status, and it explains how HM Revenue & Customs (HMRC) can help
you get it right if a worker's status isn't clear.
HMRC Register as an employer. This guide explains who needs to register as an
employer, what information you'll need with you when you register, when you need to
register and how to do it.
HMRC PAYE and payroll for employers. This guide explains what you need to know
as a new employer. It includes important information on setting up your payroll,
paying employees, payments to HM Revenue & Customs (HMRC) and employment
rights.
HMRC Tell HMRC about a new employee. This guide tells you what checks you
need to make on potential new employees, what you need to do to register as a new
employer and how to get the information you must report to HMRC.
TLAP (2012) Best Practice In Direct Payments Support – A guide for commissioners.
This report was initially developed by Groundswell Partnership for the London Joint
Improvement Partnership (JIP) and published in November 2011. This revised
edition is launched through the Think Local Act Personal partnership and the London
JIP to support commissioners in all parts of the country who are grappling with the
same challenges of developing support services for much larger numbers of direct
payments recipients. It was written with the support of the National Centre for
Independent Living (NCIL) and was informed by representatives from London
councils, direct payment support providers, people using direct payments in the
London area, Directors of Adult Social Services and members of the Think Local Act
Personal Partnership.
HFMA (2012) Direct Payments for Healthcare is a practical guide produced by
members of the HFMA’s Commissioning Finance Group working closely with the
Department of Health’s personal health budget pilot sites. The guide provides an
overview of the approach and focuses on the practical issues involved in the
financial management of direct payments for healthcare.
TLAP (2013) Self-Directed Support: Reducing process, increasing choice and
control. This is a report of three workshops commissioned by the Think Local Act
Partnership (TLAP) organised and delivered by Sitra. The workshops were held in
April 2013 and aimed at council staff responsible for implementing Self-Directed
Page 47
Support (SDS). The purpose of the workshops was to share experience and ideas
on improving and reducing unnecessary process that has grown up around SDS.
This brief report explains the background and context to the workshops and
summarises the key themes that emerged from the discussion that took place. Some
areas for further consideration are suggested. A number of case studies have been
put together from councils that took part in the workshops giving examples of
developing practice which show what councils are doing to improve their SDS
processes.
Skills for Care Employing personal assistants toolkit. This toolkit guides you through
the process of employing a personal assistant and what to do when they are working
for you, as well as helping you to understand your responsibilities as an employer
and your legal obligations. There are some really useful templates that you can use
such as job descriptions, application forms and contracts of employment.
DH (2010) Practical approaches to safeguarding and personalisation. This briefing
paper sets out how personalisation of support and more effective safeguarding can
be mutually supportive. It shows how self-directed support can help to prevent or
reduce the risk of harm and abuse.
Local Government Association and Association of Directors of Adult Social Services
(2014) Making Safeguarding Personal 2013/14: Selection of tools used by
participating councils. A very useful collection of practical ways to actively involve
adults in their own assessment, planning and control.
Local Government Association Knowledge Hub: Adult Safeguarding Community of
Practice Group. Interactive site where those working in adult safeguarding can post
helpful documents and exchange information to improve practice. You need to
register to access this site.
Page 48
Handouts
Handouts, exercises and case studies relevant to this topic area:

Handout: Nominated and authorised persons

Case Study: Florence and Mary Brown (person-centred care and support
planning)