payments Care Act 2014 Outline of content Introduction Making direct payments available Adults with and without capacity Administering and monitoring direct payments Payment and additional costs ID: 156107
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Slide1
Direct payments
Care Act 2014Slide2
Outline of content
Introduction
Making direct payments available
Adults with and without capacityAdministering and monitoring direct paymentsPayment and additional costsUse of a direct paymentMonitoring usage of direct paymentsReviewing direct paymentsSafeguarding through direct paymentsDirect paymentss and hospital staysDiscontinuing direct paymentsSummary
2Slide3
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 authorityThe local authority must ensure that people are given relevant and timely information about direct payments and supported to use and manage the payment appropriately 3Slide4
Direct
payments
4Slide5
Number of people receiving direct
p
ayments
5Client Group/Year2008 / 2009
2012 / 2013
2013 / 2014
Physical
Disability
24,895
35,885
37,015
Mental Health
4,450
8,2459,090Learning Disability11,95527,75531,210Older People25,85043,26543,785
Source:
www.hscic.gov.ukSlide6
Care and support planning
6Slide7
Making direct payments available
7
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 providersSignposting to local organisations that can helpsomeone who agrees to manage a direct payment on behalf of the person with care needssomeone who agrees to manage a direct payment for a person who lacks capacitySlide8
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 paymentsThe local authority is not prohibited from meeting the adult’s needs by making direct payments to the adult or nominated personThe adult or nominated person is capable of managing direct payments It is an appropriate way to meet the needs in question8Slide9
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 requestThe 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 interestsThe 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 9Slide10
Considering the request for a direct payment
10Slide11
Refusing the request
11Slide12
Payment and additional costs
The direct payment
must
be sufficient to meet needs which the local authority has a duty to meetThe amount will reflect:the financial contributions the person is required to makewhether it is for part or all of the care and support requirementsany other direct payments from partner organisations, such as personal health budgetsAny ‘on-costs’ as result of a direct payment should be incorporated into the personal budget amountLocal authorities still have a duty to ensure needs are being met, so contingencies may be needed 12Slide13
Use of a direct payment
13Slide14
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 providerMonitoring should check PAYE income tax and National Insurance contributions and that payments conform to the national minimum wage using the Working Time DirectiveAlternative arrangements should be put in place if the direct payment recipient is failing to meet their obligations as an employer14Slide15
Monitoring usage of direct payments
Key features of systems to monitor direct payment usage
:
They must not place a disproportionate reporting burden upon the individualThey must enable greater autonomy, flexibility and innovationThey should be proportionate to the needs to be met and the care packageLowering monitoring requirements should be considered for people that have been managing direct payments without issues for a long period15Slide16
Reviewing direct payments
16Slide17
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 inOverprotective approaches can in themselves put people at riskDirect payment holders employing personal assistants may be reluctant to disclose problems of harm or neglect17Slide18
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 18Slide19
Discontinuing direct
payments
A recipient of direct payments may decide at any time that they no longer wish to continue receiving
themDirect 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 plan19Slide20
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 concernedWhen 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 themselves20Slide21
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 appropriatelyThe DP must be sufficient to meet needs which the local authority has a duty to meetDPs must be reviewed annuallyIf 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 plan21