Nottingham City Safeguarding Children’s Board Procedures Manual
Nottingham City Safeguarding Children’s Board Procedures Manual Nottingham City Safeguarding Children’s Board Procedures Manual

3.8.3 Direct Payment Procedure

SCOPE OF THIS CHAPTER

This chapter details arrangements for the making of direct payments for those with parental responsibility for disabled children, young disabled people aged 16 and 17, young carers aged 16 and 17 and appointed suitable persons.

Please see the DoH Care and Support Statutory Guidance (2016).

AMENDMENT

In May 2017, this chapter was revised to reflect the change from Carefirst to Liquid Logic.


Contents

  1. Aim
  2. Legislative Summary
  3. Current Policy and Legislation
  4. Explanation
  5. Direct Payments For Different Service Users
  6. Eligibility Criteria
  7. Assessments
  8. Monitoring and Reviews
  9. Transition
  10. Contingency Plans
  11. Safeguarding Children and Vulnerable Adults
  12. Specific Practice Issues
  13. Short Breaks
  14. Equipment
  15. Training
  16. Finance
  17. Direct Payment Procedure
  18. Direct Payment Support Service
  19. Sustainable Services
  20. Complaints Procedure

    Appendix 1 - Examples of an Impairment or Disturbance in the Function of the Mind or Brain

    Appendix 2 - Power (not duty) to make Direct Payments

    Appendix 3 - What is Support Planning and Brokerage

    Appendix 4 - Direct Payment Procedural Flow Chart

    Appendix 5 - Key Board Reports


1. Aim

Direct payments are local council 'cash' payments for people who have been assessed as needing help from social care, and who would like to arrange and pay for their own care and support services instead of receiving them directly from the local council.

The aim of direct payments are to give disabled children, young people and their parents/carers more choice and control over their own lives. These monetary payments give families the opportunity to design flexible service packages around their needs, increasing their independence and social inclusion by enabling people to engage in work, education and leisure.


2. Legislative Summary

The Children Act 1989 and 2004.

The Carers and Disabled Children’s Act 2000.

The Health and Social Care Act 2001 and 2008.

The Community Care, Services for Carers and Children’s Services (Direct Payments) Regulations 2009.

Carers (Equal Opportunities) Act 2004.

Mental Capacity Act 2005.

Chronically Sick and Disabled Persons Act 1970.


3. Current Policy and Legislation

This procedure reflects changes introduced by the Health and Social Care Act 2008 (2008 Act) and the Mental Capacity Act 2005 (2005 Act), that extended the system of direct payments to include people who lack the capacity to consent to the making of direct payments (DOH - Guidance on direct payments, 2009). Thus affecting children in transition into adult services. The policy and procedure documents also reflect The Community Care, Services for Carers and Children's Services Regulations 2009 that came into operation in September 2009.

In addition this update looks at implementing procedures to enable the local authority to be in a position to offer individual budgets by 2014. As set out in the SEN Green Paper: Support and Aspirations: A New Approach to Special Educational Needs and Disability.

Health and Social Care Act 2008

S57 of the Health and Social Care Act 2001 as amended by S146 of the 2008 Act allows for payments to be made to a "suitable person" on behalf of a person who does not have the "mental capacity" to consent, so long as that suitable person gives their consent. Health and Social Care Act 2008 (c. 14).

Mental Capacity Act 2005

A person lacks "capacity" if at the particular time when a decision is to be made, that person is unable to make a decision in relation to the matter, because of an impairment or disturbance in the functioning of the brain or mind. S3 of the 2005 Act sets the criteria for the inability to make a decision. Mental Capacity Act 2005 (c. 9).

Support and aspiration: A new approach to special educational needs and disability (SEN White Paper, 2011).

The 2011 SEN Green Paper recommended that by 2014 local authorities should be in a position to offer individual budgets to young people with special educational needs. An individual budget looks at providing support in a person centred way, increasing the transparency of resource allocation and enabling further choice, control and flexibility in more areas of a persons life. Direct Payments can form part of a person’s individual budget.


4. Explanation

Direct Payments are cash payments made in lieu of services provided from the local authority (directly or commissioned) to enable a person to obtain for themselves, services to meet their assessed needs and identified outcomes (see Section 7, Assessments).

Within Children's Services a direct payment may be made to:

  • Those with parental responsibility for disabled children;
  • 16 and 17 year old disabled young people;
  • Carers aged 16 and 17 in place of carer's services;
  • An appointed suitable person.

Local Councils have a duty or in some circumstances, a power (Appendix 2 - Power (not duty) to make Direct Payments) to provide direct payments for:

  • A community care service within the meaning of Section 46 of the National Health Service and Community Care Act 1990;
  • A service under Section 2 of the Carers and Disabled Children's Act 2000;
  • A service, which local councils may provide under Section 17 of the Children Act 1989 (provision of services for children in need, their families and others);
  • Practical assistance under Section 2 of the Chronically Sick and Disabled Persons Act (1970).

Direct Payments within children's services are made under Section 17 the Children Act 1989 or can be made as an alternative to a service that would be supplied under Section 2 of The Chronically Sick & Disabled Persons Act 1970.


5. Direct Payments For Different Service Users

Direct Payments for People with Parental responsibility for a Disabled Child:

The responsibilities of parenting a disabled child are often made more difficult by the barriers that exist in accessing mainstream services. Families with Disabled Children may feel the direct services offered by Nottingham City Social Care Services are not the best way of meeting their child's needs and may well wish to make more suitable arrangements themselves. Direct Payments may allow parents to make these arrangements.

Parents should be encouraged to use direct payments in a way that enables their disabled children to access the same opportunities and activities as their, none disabled peers.

Direct payments can be made to parents or other carers with parental responsibility for a disabled child to meet:

  • Their own assessed needs as parent carers;
  • The disabled child's assessed need;
  • The families assessed need.

Direct Payments for 16 and 17 year old Disabled Young people:

Disabled young people are entitled to take advantage of direct payments where this will safeguard and promote their welfare. Direct payments for 16 and 17 year olds should be to encourage the start of independence as a transition to adult life. This will necessitate a shift in focus by the social worker from the child as part of the family to the independence needs of the young person.

Transition from childhood to adulthood is not a single event. It is a process for the young person of gradually taking on more responsibility. At age 16/17 the young person may wish and be able to, as part of their transition; start to manage parts or all of the direct payments received to meet their own needs. This can allow them on a gradual basis to gain experience of managing direct payments and so aid further their independence skills.

Where there is a difference in views between parents and young people aged 16 and 17 and the Social Worker is satisfied the welfare of the young person will be maintained and that the child has sufficient understanding to make an informed decision, Social Worker should give precedence to the views of the young person.

Futures Keyworkers should inform disabled young people about direct payments. The Lead Professional should ensure this forms part of the young person's transitions planning and is on the agenda of the transitions review, which occurs at aged 14.

Direct Payments for carers aged 16 and 17 in place of carer's services.

Direct payments allow carers to purchase the services they are assessed as needing as carers to support them in their caring role and to maintain their own health and well-being and may be used flexibly to support education, training, work or leisure activities.

Direct payments to young carers should only be made in exceptional circumstances, this is based on the principal that young carers should not be undertaking substantial care and where this is the case services should be provided to the cared for person to reduce this responsibility. A young carer aged 16/17 is eligible for a carers assessment under the Carers and Disabled Children's Act 2000 however: "Any assessment of a carer aged 16/17 needs should still be child centred and follow the guidance set out in The Framework for the Assessment of Children in Need and Their Families paying particular attention to Sections 3.61 to 3.63" (Carers and Disabled Children's Act 2000 and 2004 Act).

In the small number of cases were the young person is choosing to care and the team Manager is satisfied this is the best possible outcome for the young person a direct payment may be made to meet the young carers assessed need. In these exceptional circumstances particular attention should be paid to the extra responsibility direct payments would bring and the support mechanisms required (also see Adults Direct Payments Policy and Guidance).

An appointed suitable person

When a young person reached their majority at aged 18 and does not have the capacity to consent, then a ‘suitable person’ should be identified to take on, or continue, the management of the direct payments on behalf of the disabled person. In many cases it will be appropriate for the person with parental responsibility to continue to receive the direct payments as the suitable person. Thus attempting not to disrupt the current service provision (eligibility criteria for a suitable person are detailed below).


6. Eligibility Criteria

Eligibility criteria for receiving a direct payment.

In order to receive a direct payment the young person or person with parental responsibility must be/or be caring for a disabled child who is:

  • Defined as having an "impairment that is permanent and substantive" under Section 17 Children Act 1989 (see Appendix 1 - Examples of an Impairment or Disturbance in the Function of the Mind or Brain);
  • Assessed as needing a service to promote and safeguard their welfare under Section 17(6) or 20 (4) of the Children Act 1989 or Section 2 of The Chronically Sick and Disabled Persons Act, 1970;
  • A child who’s health and development would be significantly impaired without support.

The young person or person with parental responsibility must also:

  • Give consent to a direct payment;
  • Be able to manage a direct payment (with or without assistance);
  • Be able to ensure that any services purchased meets the child's/their own assessed need and are designed to safeguard and promote their/the child's welfare;
  • Not be exempt from receiving a direct payment (see Appendix 2 - Power (not duty) to make Direct Payments).

Consent

Direct payments may be made by councils with the consent of:

  • A person with eligible needs aged 16+;
  • An appointed "suitable person" where the person with eligible needs does not have the capacity to consent;
  • A person with parental responsibility for a disabled child under the age of 16;
  • A carer to support them in their caring role.

Consent should be informed consent; the Lead Professional should ensure that the person has an understanding of what is involved in managing a direct payment both practically and in respect of the legal responsibilities. And also what support is available. The Social Worker may find the involvement of the Direct Payments Support Service invaluable in this respect. Consent may therefore not be a single event but a process of ensuring the individual is fully informed in order to give consent.

The ability of individuals to consent to receiving direct payments will vary and the social worker should consider what support and information is needed to enable someone to consent within their own abilities, this may require formal or informal advocates and circles of support. The Lead Professional should also remember that consent and the ability to manage are two separate things. Someone who cannot manage without help but can consent should still be given the opportunity to receive direct payments with help to manage.

The Lead Professional should make it clear that a person is under no obligation to accept a direct payment or to continue to receive a direct payment once they have accepted it and that this will not effect the arrangement of direct services in the normal way. The lead professional should attempt to obtain the wishes and views of the young person when considering support required.

Capacity to consent - Over 16's

Section 2 of the Mental Capacity Act 2005 (Mental Capacity Act 2005 (c. 9) sets the criteria for mental capacity, however broadly speaking a person lacks mental capacity to make a decision if at the material time, they are unable to make a decision in relation to a matter because of an impairment of, or a disturbance in the functioning of, the mind or brain (Section 2(1) Mental Capacity Act 2005). Examples of which can be found in Appendix 1 - Examples of an Impairment or Disturbance in the Function of the Mind or Brain.

The inability to make a decision as set out in Section 3 of the 2005 Act Mental Capacity Act 2005 (c. 9), is when a person is unable to:

  • Understand information relevant to the decision;
  • Retain that information;
  • Use that information when weighing up the decision;
  • Communicate their decision.

Lead Professionals must assume that persons aged 16 and over have the capacity to make a decision. Only when a council has taken all practical steps to help a person reach a decision for themselves should they conclude that somebody lacks mental capacity.

The assessment of capacity must be based on the ability to make a decision at a given time. It must not be made on the basis of age, appearance, condition or behaviour, but rather on if a person has an impairment of mind or brain, and if so is that affecting them making a decision at that time.

When capacity fluctuates, regular assessments should be in place to ensure that needs are being met at times when conditions deteriorate. If capacity returns then councils have a duty to make payments to the recipient of the care and to discontinue payments to the suitable person, making sure that care is maintained throughout this process. If capacity only returns temporarily then councils may continue to make payments to a suitable person, whilst allowing the recipient of the care to manage it.

Ability to Manage

The department has a duty, or in some cases a power to make direct payments to anyone who appears to be able to manage them (either alone or with help), if it is satisfied that a persons need's can be met via direct payments. The same principle of being able to manage also applies to those with parental responsibility and suitable persons.

A judgement on a person's ability to manage a direct payment should be made on an individual basis, taking into account the views of the individual and what support is available to them. Blanket assumptions should not be made about whole groups of people. Information on what receiving direct payments will involve and support services in place should be communicated as early as possible. This will help the recipient make an informed decision as to if they can manage.

A whole range of support should be considered to enable the person to manage direct payments. For example The Direct Payments Support Service, Payroll Services and Managed Accounts. Further information on these support options can be given to the recipient by the direct payments support service. Persons worried about their ability to manage should be offered a mixture of direct payments and direct services, to enable them to build their confidence in managing direct payments whilst still receiving support.

If an assessment concludes that a person, even with support cannot manage a direct payment this should be discussed fully with the person concerned and if appropriate with any family, friends or advocate. The assessing worker should make it clear that they can use the complaints procedure to challenge the decision not to offer direct payments.

The Service Manager (Disabled Children's Services) will make the final decision that a person is not able to manage Direct Payments.

Appointing a suitable person

When appointing a suitable person councils must ensure that the best interests of the person lacking capacity are prioritised above all other considerations (DOH - DP guidance, 2009). A suitable person should be someone already involved in the provision of care however the suitable person must meet the regulations:

  • Firstly, it should be established if the proposed suitable person is a representative of a person lacking capacity, by either being a donee of lasting powers of attorney (LPA), or has been appointed as a deputy for a person by the court. Unless the representative was either unwilling or the council see them as incapable they would be first choice as a suitable person;
  • Secondly If it was believed to be in the best interest of a person lacking capacity then a close friend or family member that is involved in the provision of care would be reviewed after the representatives;
  • Finally if it was believed that an alternative person, who is not a representative but is involved in the provision of care, is more appropriate to appoint in the best interest of the person, then the council, if a surrogate consents, may accept the alternative person as a suitable person. A surrogate is a representative given responsibilities for caring decisions.

Where there is no representative or surrogate the council will have the overriding decision on who to appoint as a suitable person.


7. Assessments

Assessment for direct payments above 102 hours remains the same as for direct services as per The framework for the assessment of children in need and their families and will therefore be via a Single Assessment. This guidance emphasises the importance of a holistic assessment of the family needs and avoiding piecemeal, repetitive or parallel assessments. As per the Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004. This assessment should take account of the parent's ability to provide care for the child and consideration of whether they work or undertake education, training or leisure activity or wish to do so (a carer's assessment). Direct Payments can also be accessed by a CAF referral for 102 hours of support over a 12 month period (see Pathway One Eligibility Information).

A Single Assessment should establish if a child/young person has a "permanent and substantive impairment". (Section 17 Children Act 1989) and that they are likely to require a service to promote and safeguard their welfare. A Single Assessment may recommend up to 360 hours of direct payments per year.

A core/carers assessment will be carried out to identify the young person’s and family’s needs for higher levels of direct payments (over 360 hours per year).

If it is established that a child or young person is eligible to receive support then the lead professional must notify the family of the option to receive direct payments in lieu of a direct service.

As part of the assessment the lead professional should utilise the short breaks Threshold policy to identify the appropriate pathway for the young people. A Direct Payment may also be made in lieu of services assessed as being needed under Section 2 of the Chronically Sick & Disabled Persons Act 1970. As part of the assessment a monitoring risk assessment should be completed, which will highlight the risk of fraud posed to the local authority (see Appendix 5 - Key Board Reports). The completed assessment and recommendations should be presented to the Team Manager to add their views and approved by the decision maker.

Once eligibility criteria has been established through a Single Assessment and services agreed through appropriate channels, the family and young person must create a support plan identifying the outcomes to be achieved from accessing a short break through direct payments. Full details on support planning, brokerage and its contents can be found in Appendix 3 - What is Support Planning and Brokerage. The support plan can be done independently, with support from the lead professional or with an independent support planner. This support plan should then be used as the base for monitoring and reviewing direct payments, and must be approved by the lead professional and the decision maker.


8. Monitoring and Reviews

Statutory reviews for children in need will apply to those receiving more than 180 hours of Direct Payments per year (see children with disabilities reviewing policy). The reviewing officer should check that not only are the child/young person's needs being met and outcomes being achieved as set out in the support plan, but also that the direct payments are promoting choice and independence. Those receiving less than 180 hours of Direct Payments per year will be reviewed by the CAF framework (see CAF Guidelines).

Personal assistants are the employees of the direct payment recipient and therefore should only be at the review by either direct invitation by the parent or young person or by the social worker/OT with the agreement of the parent/young person.

Cases where over 180 hours of direct payments are agreed will be allocated and Social Work/SSW visits undertaken as per policy minimum recommended levels or as identified in the service plan/social workers supervision if more frequent visiting is deemed to be required. Recipients receiving less than 180 hours of Direct Payment will be reviewed by their Lead Professional. A copy of this review must be sent to the Short Breaks Co-ordinator.

Parents and Young people aged 16/17 will be required to sign an agreement that they accept their responsibilities and the conditions under which a direct payment is made. Should the child or young person be at risk from the arrangements or if monies are being used fraudulently then an immediate termination may be sought.

A separate bank account will be required for the purpose of direct payments. Families may opt to have a managed account should they not wish to be involved with managing the money themselves. Monitoring will comprise a monitoring form template to be completed by service user, accompanied by bank statements for corresponding periods, payslips and receipts. When cash is taken from the account all receipts must be provided. The direct payment officer will create a running balance and where receipts do not account for cash taken then the service user will be requested to reimburse the balance back into the direct payment account. Where the necessary monitoring is not received, follow up letters will be sent to families. If money has still not been received then a final letter will be sent to arrange a review between allocated worker, direct payments officer and family.

Monitoring should be proportionate to the risk involved. Initial monitoring will take place on a quarterly basis. All monitoring is scanned to the child’s record on Liquid Logic and appropriate observations added to The case notes.

Should there be any funds remaining in the account at the annual review then these can be carried over to the following year should the support plan identify a need for this. If there is no need to carry these funds over then they will be reclaimed or used as part of the following year’s budget. Any money remaining in the account should be investigated, as this could mean support needs and outcomes are not being met.

Fraud Reporting

It is recommended that all social care staff and lead professionals with financial responsibility should complete the online Meritec Fraud Awareness Training. Any suspected cases of Fraud by direct payment recipients should be reported to the direct payments officer and as a result appropriate actions taken by the lead professional to address safeguarding concerns that have arisen as a result of fraud. The Direct Payments Officer is responsible for investigating fraudulent actions further with the family and attempting to recover any misused funds. A monthly report is sent from the direct Payments Officer to the internal audit team detailing any cases of fraud.


9. Transition

The transition to adulthood and increased independence is a gradual process that involves a young person taking on more responsibility. A young person who decides to go to college will move into adult services on the date of their eighteenth birthday. A young person who stays at school sixth form will move to adult services on the final day of the summer term once they have turned nineteen.

Upon reaching their majority a young person with the capacity to consent will take on the direct payment for themselves, however they may still receive support to help them manage the payment. At the age of 16 and 17 a young person is eligible to be in receipt of direct payments. It may be that this is too much of a daunting prospect at this age and therefore it should be encouraged by the social worker that they take control of parts of the direct payment to gradually gain experience before reaching adulthood. Lead professionals should advise families of support available to help them manage a direct payment.

Previously when reaching their majority a child who did not have the capacity to consent to the making of direct payments would no longer be eligible to receive them and would receive services directly from the council. As detailed above the Health & Social Care Act 2008 enabled young people lacking capacity who received direct payments to be able to continue to receive them after their transition to adulthood through a suitable person. It will often be appropriate for the person with parental responsibility who currently receives and manages the direct payment to continue to do so in the role of suitable person, as they are likely to be in the best position to understand the young person's needs.

A young person’s support plan should be updated with transitions in mind. The family have the choice who updates the plan, however advice should be sought from Futures and transition social workers to advise on services available. The support plan should also detail what support is required to manage the direct payment and who will fund this. Any funding for services provided through a direct payment from the children and Families Team should be reclaimed. For example insurance and support service costs will often span into adults. This will be reclaimed by internal transfer to reduce disruption for families. When moving to adults but opting not to receive a direct payment, the direct payments team will notify appropriate agencies and stop the support on the necessary date, reclaiming money where appropriate.


10. Contingency Plans

The Lead Professional should advise recipients of direct payments of their responsibility to make contingency plans for any breakdown in their care arrangements and these should be identified in the support plan.

If the direct payments recipient cannot make contingency arrangements and an interim lack of service would be detrimental to either the child's welfare or to the parents ability to continue care the lead professional should arrange direct services with the appropriate Short Breaks Manager until the service users regular arrangements are resumed. In these circumstances direct payments should be stopped until the regular service is resumed.

Where the direct payment recipient has not been able to make contingency plans, the lead professional should review with them their current arrangements with the aim of avoiding a similar situation in the future. If there are repeated failures to provide contingency arrangements, the provision of the direct payment should be reviewed and direct services considered. This should occur within the child's formal review to ensure all parties are consulted. The family should also be made aware of support they can receive from the Direct Payment Support Service.


11. Safeguarding Children and Vulnerable Adults

Research suggests that disabled children and young people are especially vulnerable to abuse. The lead professional should advise parents and young people of their right to request Nottingham City Children's Services to carry out a check under the Protection of Children Act 1999 via the Disclosure and Barring Service (DBS). If such a check is requested the prospective employee will complete the application and the lead professional should arrange for a check to be made. Nottingham City Council will cover the costs of such a check. At the time of the request the Social Worker should advise the parent/young person that should a check find someone unsuitable a direct payment will not be made to enable them to employ this person.

Such checks are strongly recommended but are not compulsory in a domestic setting and if a parent does not wish for a check to be carried out a test of "reasonableness" shall apply. The lead professional should ask the question "is this a reasonable decision?" i.e. does the parent/young person have other reasonable evidence to negate the need for a check?

If the local authority has any concerns about the employee or feels the parent/young person is not being reasonable in their refusal for a check to be undertaken direct payments will not be made without a satisfactory check being undertaken.

Any disagreements as to the need for a check should be referred to the Disabled Children's Service Manager, who will make the final decision in relation to the need for a check to be undertaken. In all circumstances where a check is not undergone a Disclosure and Barring Service (DBS) waiver form must be signed by the DP recipient.

The lead professional should also advise the parents/young person of the limitations of checks and that they do not guarantee that an individual is safe to work with children. The lead professional should give advice to the direct payment recipients about safe practice when employing someone via direct payments i.e. the need to obtain two references.


12. Specific Practice Issues

Backdating Pay

Families are eligible to receive monies from the service agreement date however payments will only be back dated to a specific date when a family was ready to start using the direct payment for support but they were delayed due to council/third party processes. When using agencies e.g. nurseries, families can claim for any services purchased themselves back to the service agreement date or for any lack of services not purchased due to a delay from the council/third party (so long as the agency could provide the service in the interim period).

The Lead Professional should communicate to the families however that they should not become overly reliant on the back dated pay. Once they have used it they will have to manage on their standard weekly service amount.

Employers Responsibilities

The direct payment recipient must be made aware of their legal responsibilities as an employer (terms & conditions of employment). These responsibilities should be explained by the lead professional. A Direct Payments support service can be provided to assist families to adhere to their employment responsibilities. See Appendix 4 - Direct Payment Procedural Flow Chart.

Close Relatives

Direct payments may not be used to secure services from a spouse, partner (living at or away from the home) or from a close relative who lives in the same household as the person receiving direct payments. Unless the assessment concludes that it is necessary and only way to satisfactorily meet a persons needs. Should an assessment conclude that providing support in this was the only way to satisfactorily meet a persons needs then the service manager must approve this, with necessary signed minutes being added to Castle and observations updated on Care First. The City Council will not make a Direct Payment to pay for care provided by a parent of a minor (under age 18). Direct payments may be made to secure services from a relative living outside the family home, however direct payments are not designed to replace informal networks of support. Direct Payments can be used to employ a live-in assistant, so long as they are not excluded by the regulations and would not be living in the home in any event.

Employing Minors (under 18)

Direct payment recipients may employ staff between the age of 16 to 18 in some circumstances. The allocated professional must undertake a risk assessment to identify specific risks of employing a minor. The assessment must ensure that the employee is suitably mature and that the service provided does not involve any personal/domiciliary care. The risk assessment must also stipulate that the contract of employment/job description clearly states the roles and responsibilities of the employee. Direct payment recipients cannot employ members of staff under the age of 16. The risk assessment must be completed by a qualified social worker and authorised by the team manager/service manager to ensure appropriate risks have been considered before recipients begin any employment of staff under the age of 18.

Health and safety

The assessment process should consider any health and safety implications of direct payments. This should be shared with parents/carers and young people so that they can take reasonable steps to minimise the risks to the Health and Safety of any staff they employ and formulate their strategy of how to overcome any health and safety issues (the direct payment recipient has a common law duty of care toward the person they employ). Further support around risk assessment can be provided by a direct payment support service.

Intimate Care

Parents may purchase care services of an intimate nature for their children however as the child matures his/her wishes should be taken into account regarding intimate care.

Childminders

Lead professionals should advise parents that under Section 79 of the Children Act 1989 that anyone providing care for a child under 8 for over 2 hours a day in their own home has to be an Ofsted registered childminder. Details of registered childminders can be obtained from early year's department and details of how to register as a childminder can be found at OFSTED.

Health Needs

Updated legislation enables young people with continuing health care needs access to a direct payment so long as their health authority is part of the NHS personal health budgets pilot. NHS Nottingham city are part of this pilot enabling young people to access a direct payment to meet their continuing health care needs. Social care support will be provided under the current assessment process with health funding being delivered by a continuing care assessment. Once eligibility criteria has been established a support plan needs to be completed. This support plan should look at both health and social care funding, establishing outcomes and detailing potential risks.

Parent/Carers

Direct Payments may be used flexibly by parent/carers to assist them to undertake employment, education, training or leisure activity. As long as this is also meeting the child/young person's identified outcomes. Direct payments cannot be provided to pay for childcare to allow a parent/carer to work. Parents may be eligible for child tax credits and the lead professional should advise them of this provision if the assessment identifies a need for child care.

Flexibility

Service users with initial fears are allowed and should be encouraged to partake in mixed care packages where they receive part direct services and part direct payments. The amount of direct payments can be as small as service users wish, to enable them to see how they manage whilst still having a stable service in place. This idea should be communicated to service users who are unsure of how they would cope managing a direct payment.


13. Short Breaks

A direct payment cannot be made to provide residential accommodation over 17 day block or 75 days in total in any 12 month period (Children's and Young Persons Act 2011)

A direct payment may be made to purchase overnight short breaks. If a parent/young person purchases short breaks from a registered provider under Section 20 (4) of the Act the child will be regarded as "looked after" and for the period they are away from home and the Short Breaks - Threshold and Access Criteria Procedure regulations will be applied and an Independent Reviewing Officer appointed. However, if direct payments are used to purchase overnight care from a friend or personal assistant under Section 17 (6) of the act, the child will not be regarded as looked after and an IRO will not be appointed.


14. Equipment

A direct payment may be made to enable people to purchase equipment that would otherwise have been provided by Nottingham City Children's Services. This maybe particularly beneficial where a parent or young person may wish to purchase a more desirable or more expensive model than would be statutorily provided as the parents may then top up the direct payment. A direct payment may also be made to pay for adaptations, which would have been provided or arranged by Nottingham City Children’s Services however a direct payment cannot be made for adaptations covered by the Disabled Facilities Grant.

The allocated Occupational Therapist should be satisfied that the individual is receiving adequate advice on the suitability of any equipment and that the user's needs will be met by the proposed piece of equipment. (See ICES Direct Payments policy).

Occupational Therapist's responsibilities for reviewing equipment and ensuring an individual can safely use equipment remain unchanged by the provision of direct payments. Citizens receiving a direct payment to purchase their own equipment/ minor adaptation must understand and agree that they will be the joint owner of that equipment/minor adaptation. This includes taking all legal and contractual responsibilities that may arise from this and this should be made explicit on the agreement form. Although the citizen purchases the equipment/minor adaptation, ICES will be responsible for repair and maintenance in the same way as they are for a directly provided piece of equipment/minor adaptation (on behalf of the Department).

This is to ensure that maintenance is managed to the required standard and a full maintenance history is known for any equipment/minor adaptation that may be returned to the service.

It also provides the citizen/carer/staff with security that arrangements are in place for responding to emergency breakdowns for more complex items of equipment.

It is the responsibility of the lead professional to notify their local ICES Partnership Manager of all equipment/minor adaptation bought with a direct payment so that it is recorded on the service database for tracking, maintenance and review purposes. The lead professional also needs to provide information on warranties and maintenance where necessary so that the ICES service provider can complete annual repairs and maintenance.

The OT should make it clear to the direct payment recipient in receipt of equipment, where ownership and responsibility belongs. Hired equipment could also be purchased using direct payments however ownership would not fall to the DP recipient.

Direct Payments can also be used to purchase equipment not normally provided by Nottingham City Council. This equipment would need to be identified in a young persons support plan and be linked to specific social care outcomes. The lead professional would have to be satisfied that the outcomes identified were relevant and that the equipment could achieve these outcomes. For example, an outcome may be that a young person wishes to loose weight therefore request an amount of direct payment to purchase some exercise equipment in the home. Direct payments cannot be used to purchase equipment such as this unless a support plan has been completed and identified this as a requirement. Where equipment is purchased in this way the direct payment recipient will be responsible to service and maintain its upkeep.


15. Training

Employers in receipt of Direct Payments can access training opportunities through Nottingham City Council for themselves and their staff. Safeguarding, direct payment training, health and safety, first aid and an autism awareness training is provided by Nottingham City Council at no charge. Training from the e-learning website is also provided free of charge and covers a vast amount of relevant topics for parents, employers and personal assistants. Training for health care needs can also be provided free of charge. The allocated professional should advise and arrange this with the family. All other training that parents, employees and personal assistants wish to access must be self funded or funded through contingency money built up in the direct payment account or identified and costed in the young persons support plan. The lead professional must approve training funded by direct payment contingency money to ensure that it meets an assessed need. Manual handling training can be accessed through Nottingham City Council where there is an OT assessment identifying a need for this.


16. Finance

Payment rates are currently set at £10.57 per hour. Sleep in overnight at £31.90, with a 24 hour period of support paid at £110.61. In future budgets will be established through a resource allocation system (RAS), which will establish an indicative budget. Support planning and brokerage will then look at ways in which to use that budget to achieve the identified outcomes. At present while the RAS is being established budgets will be created from the level of assessed need that has been identified multiplied by payment rates above. The Support planning and brokerage will establish how this budget is going to be used. It is recommended that during the support planning and brokerage process that it is taken into consideration that payment rates for support are often lower in adults. Failure to pay consideration to this now, can lead to employment disputes in future and disruption to the support that is provided.

Further enhanced hourly rates can be paid at the discretion of the Disabled Children’s Service Manager to enable the direct payments recipient to employ a person with essential skills to meet a child's/young person's needs i.e. a deaf/blind communicator.

An application should be made to the Independent Living Fund for all packages for 16+ year olds, which will cost £340 or more. The young person must be working over 16 hours per week for the application to be accepted. If successful the ILF's contribution policy and procedures will apply.

The principal in funding will be that the amount agreed will not be more than the reasonable cost to the local authority of providing or securing an equivalent service of reasonable quality. Families are free to top up direct payments as they see fit to either purchase additional services or those they consider to be of better quality.

Additional costs of securing services through direct payments should be highlighted in the support plan. These services will be agreed on a best value approach.

Trusts

Trusts can be set up where a group of people wish to help manage the support that someone receives. An example would be where 2 people are receiving funding through social care and they wish to pool their funding to be able to purchase the required level of support to be able to live together. A trust could be set up by the young people and the people that support them. This trust would make the decisions around how to manage budgets to meet the established needs.


17. Direct Payment Procedure

Please refer to the document Direct Payment flow chart and procedure (Castle) for full information on the direct payment process. See Appendix 4 - Direct Payment Procedural Flow Chart.

The direct payment implementation process should provide recipients with up to date information that enables them to make clear decisions whilst adhering to legal responsibilities.

Not until lead professionals have attended the Direct Payment Training Session should they attempt to implement a direct payment. Alternatively when referring through a CAF lead professions must read and adhere to Direct payment CAF guidance.

It is policy that any young person wishing to receive a direct payment creates a support plan identifying the outcomes that are to be achieved.


18. Direct Payment Support Service

Direct Payments recipients can choose where their support comes from if they need help managing a direct payment. Recipients will need to inform Nottingham City Council of their choice of service provider. Payments will subsequently be paid to recipients who will pay their service provider directly. Payments will be made at a rate which is assessed as reasonable for the level of support received.

Lead professional should provide families with the information that enables them to make an informed choice with regard to a direct payment support service (see guidance to professionals supporting families to choose a DPSS).


19. Sustainable Services

Families should be encouraged to buy in sustainable services from the community. They should not purchase services that aren't sustainable e.g. when employing a personal assistant used by other families, service users should be aware of the time restrictions that multi working can cause. A solution to this would be to recruit a second PA that could assist to spread the workload.


20. Complaints Procedure

The lead professional should advise parents, children and young people of their right to use the representations and complaints procedure should they wish to complain about any aspect of the department's action or decisions in relation to direct payments.


Appendix 1 - Examples of an Impairment or Disturbance in the Function of the Mind or Brain

Examples of an impairment or disturbance in the function of the mind or brain, may include, but are not limited to:

  • Conditions associated with some forms of mental illness;
  • Dementia;
  • Significant learning difficulties;
  • Long term effects of brain damage;
  • Physical or medical conditions that cause confusion, drowsiness or loss of consciousness;
  • Delirium;
  • Concussion following a head injury;
  • The symptoms of alcohol or drug abuse.

(Taken from Guidance on Direct Payments 2009)


Appendix 2 - Power (not duty) to make Direct Payments

Councils have a power (but not a duty) to make direct payments where somebody has been conditionally discharged from hospital under the Mental Health Act 1983.

Where someone is compelled to receive a service as a result of any of the following legislative provisions relating to mental health disorder, councils have a power (but not a duty) to make direct payments to them in respect of that service. The provisions in question are:

  • Supervised community treatment, guardianship, or on leave of absence from a hospital in which they are detained under the 1983 Act;
  • The supervision of a social worker or the Probation Provider as a result of a supervision order made under the Criminal Procedure (Insanity) Act 1964;
  • An offender released on licence under the Criminal Justice Act 1991, which includes a requirement to accept treatment for a mental health condition;
  • An offender on a community rehabilitation order under the powers of Criminal Courts (Sentencing) Act 2000, which includes a requirement to accept treatment for a mental health condition;
  • An offender on a community order or serving a suspended prison sentence under the Criminal Justice Act 2003, which includes a requirement to accept treatment for a mental health condition.

Where a relevant service is one that has not been imposed by a condition under any of the above provisions, councils have a duty to make direct payments to the person concerned to meet their needs for that service (DOH, Guidance on direct payments, 2009).

Exclusions to Direct Payments

Direct payments may not be made to people who have been placed under certain conditions or requirements by the court in relation to drug and/ or alcohol offences, listed below:

  • Anyone who under the Criminal Justice Act 2003, is an offender on a community order, or is serving a suspended prison sentence which includes the requirement to be treated for drug or alcohol dependency;
  • Anyone who is an offender on a community rehabilitation order or a community punishment and rehabilitation order that includes the requirement to be treated for drug and alcohol dependency;
  • Anyone who is an offender released from prison and is subject to treatment for drug or alcohol dependency.


Appendix 3 - What is Support Planning and Brokerage

A support plan is a description of how the person wants to live their life and how they are going to use their personal budget to achieve their outcomes across the Every Child Matters framework, whilst at the same time giving them more choice and control over the support they receive. It describes what the person would like to achieve or keep the same, what support they need and how they will spend the budget. Support planning and brokerage is the process of developing a support plan. Individuals can create their own support plan, with the help of family and friends (there is self help guidance available as well) or can get support from a Support Broker. Even if it is not possible for the young person to prepare their own support plan, their views should guide the preparation of the support plan as much as possible. The support plan can be in whatever format the person chooses such as a letter, photos, audio or DVD. Nottingham City Council has also developed support plan guidance for practitioners and families that can be used to get started. Below is a summary of the guidance. Please refer to separate guidance pack for further information.

Criteria What should this look like?

What is important to the person?

 

Information about things that are important to the person from their point of view (people or relationships, activities, places, belongings, rituals, routines and dreams). This section should reflect who the person is and should be specific rather than general.

What does the person want to achieve or change?

 

Short and/or long term changes, which should be broken down into realistic actions that are positive and possible. The actions should link to outcomes that the person wants to achieve.
What does the person bring that can help make the changes that they want? Things the person is good at and positive things that others say about the person.
How will the person be supported? Details of support the person will need to make changes happen with evidence that it will help to achieve the 5 Every Child Matters outcomes.

How much is the personal budget and will the person use it? How will the budget be managed?

 

The plan should say how the person is going to spend the personal budget. It should say how much each part costs. It should also include how the budget will be managed - direct payment, trust and individual service fund or ‘virtual budget’.
How will support be managed? Description of how any support that the person gets will be organised; it should also cover training, management and support of staff and any legal aspects and include plans in case problems arise or things change.

How will the person stay in control of their life?

 

Information about how the person will be involved in decision making. The plan should describe what decisions the person will be taking and who else will be involved in decision making.

What are we going to do to make this plan happen?

 

The support plan must have a clear, specific, measurable, achievable action plan. This action plan should have a clear link with the changes the person wants to make.

The support plan must answer the following questions:

  • What is important to you?
  • What do you want to achieve or change?
  • What do you bring that can help make the changes you want?
  • How will you be supported?
  • How will you spend your budget?
  • How will your support be managed?
  • How will you stay in control?
  • What are you going to do to make this plan happen?


Appendix 4 - Direct Payment Procedural Flow Chart

Click here for Appendix 4 - Direct Payment Procedural Flow Chart


Appendix 5 - Key Board Reports

Key Legislation:

  • The Children Act 1989 and 2004;
  • The Carers and Disabled Children's Act 2000;
  • The Health and Social Care Act 2001 and 2008;
  • Carers (Equal Opportunities) Act 2004;
  • Mental Capacity Act 2005;
  • Chronically Sick and Disabled Persons Act 1970.

Key documentation:

  • The Community Care, Services for Carers and Children's Services (Direct payments) Regulations 2009;
  • Direct Payments Policy and Procedure 2007.

Policy Links:

Direct Payments - Arranging Your Own Care and Services (Directgov, now archived).

The Community Care, Services for Carers and Children's Services (Direct Payments) (England) Regulations 2009 No. 1887.

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