2.9 Direct Payments

AMENDMENTS

This chapter was updated regarding the costing of the Care Plan and Appendix 1: Assessment Process Map and Appendix 2: Review Process Map

Introduction
Background
Eligibility
Ability to Manage
Consent
Employment of Close Relatives
Using Direct Payments
Restrictions on use of Direct Payments
Short Breaks
16 and 17 Year Olds and Transition
Assessment and Care Planning
Interim Arrangements
The Care Plan
Decision to Approve/Refuse Direct Payments Request
Approval of the Care Plan
The Direct Payments Agreement
Ongoing Case Involvement
Financial Arrangements and Direct Payments User's Responsibilities
E.S.C.R. Recording
Cessation of Direct Payments
Complaints
Additional Reading
Forms Used

Appendix 1: Assessment Process Map

Appendix 2: Review Process Map

1. Introduction

These procedures include the role and responsibility of the Actively Seeking Independence Support Team (ASIST) now referred to in this document as “The Direct Payments Support Service”.

Appendix 1: Assessment Process Map and Appendix 2: Review Process Map provide process maps of the Approval and Review process.

2. Background

Sections 57-58 Health and Social Care Act 2001, section 17A Children Act 1989, the Carers and Disabled Children Act 2000 and section 17A Children Act 1989, the Carers and Disabled Children Act 2000 and the Community Care, Services for Carers and Children’s Services (Direct Payments) (England).

Regulations 2003 gave local authorities the duty to make payments to eligible people, to enable the purchase of services required to meet assessed care needs, as detailed in the child’s care plan.

In April 2001 the Carers and Disabled Children Act was introduced making it possible for payments to be made to people with parental responsibility for a disabled child.

These procedures relate only to the provision of direct payments in Leeds for children and young people. They replace all previously issued procedures relating to direct payments for children and young people.

Throughout these procedures reference is made to parents; this includes those people with parental responsibility for a disabled child.

Where the term Care Plan is used it refers to:

Care plans following a Core Assessment

Or,
Child and Family Support Plan following a Core Assessment

It should be remembered that where payments are made to a person with parental responsibility for a disabled child, they are being made on behalf of the disabled child and for the benefit of that child. However, it should also be recognised that the person with parental responsibility will also benefit from the flexibility and independence direct payments can provide. The parent’s assessment (carried out as part of the Core Assessment) can therefore be an essential tool in ensuring that the needs of both the person with parental responsibility and the child are met.

This procedure should be used in conjunction with the Department of Health’s Direct Payments Guidance see additional reading.

3. Eligibility

Before a request for direct payment can be agreed there must be an up to date assessment of need undertaken. The assessment process is exactly the same whether the outcome will be a direct service or a direct payment.

Direct payments may only be offered to children and young people assessed as needing services and should not be offered to anyone who does not meet the authority’s assessment criteria. (See assessment procedures C.S.1.1 for further details).

In Leeds the following requirements will need to be satisfied:

The child/young person has eligible needs which, following an assessment, it is agreed that it is the responsibility of Children and Young People Social Care to meet
They are a young person who has a disability
A person with parental responsibility for a disabled child whose needs it is the responsibility of Children and Young People Social Care to meet. They must be willing and able to take on direct payments

4. Ability to Manage

Direct payments can only be made to people who will be able to manage them (with or without support).

A direct payment can only be offered to a young person aged 16 and 17 who Children and Young People Social Care considers will be able to manage either alone or with assistance. This judgement is made on a case-by-case basis, taking into account the view of the young person him or herself, as well as the views of those with parental responsibility.

The Direct Payments Support Service will be involved in the setting up of all new direct payments for children. The service is also available to provide support with all aspects of managing direct payments if the direct payments user wishes.

5. Consent

Direct payments allow for greater control and independence, but this increased freedom must inevitably be accompanied by increased responsibilities.

Those with parental responsibility take on the responsibility for purchasing the services to which the payments relate. This involves ensuring that the services they receive are of an acceptable standard. It should be also be made clear to parents/carers/young people requesting direct payments that if they change their mind, at any stage, services to meet their needs will be arranged in the usual way.

6. Employment of Close Relatives

The 2003 Regulations dictate that direct payments cannot be used to pay parents, or a person discharging duties in a parenting role, for the care of their own child (birth - 17 years inclusive). This applies whether the parent lives in the same household as the child or elsewhere. This also applies to close relatives living in the same house hold as the recipient.

It is permissible however to use direct payments to employ a close relative who does not live in the same household, if it is the only effective way to meet a child or young person's needs. For example, if a child has complex communication needs and the direct payment is being made for a limited period, (for example over the summer holidays), in which time it would not be possible to train a new employee in the child's communication method, then it would be acceptable to employ a family member who could meet these needs.

This will need to be approved by the Chief Officer. A report will need to be compiled outlining the reasons for the request. The report should be submitted to the relevant Chief Officer Children and Young People Social Care (CYPSC) for a decision. These situations are likely to be an exception.

7. Using Direct Payments

The provision of a Direct Payment is a big undertaking for all concerned and therefore the disabled child/young person/ parent/carer should be fully involved in the assessment process.

Direct Payments may be made for all the support a child/young person may need or it may be that they receive a combination of direct payments and directly provided services.

Many parents are likely to want to use direct payments to directly employ a personal assistant or assistants. This option gives them the most control over the assistance they receive, but it also carries the most responsibility. The support, which is available from the Direct Payments Support Service, is likely to be of particular value in these circumstances.

Section 79D of the Children Act 1989 states that anyone caring for a child under eight for over two hours a day and for payment in their own home has to be registered as a child minder. Parents of disabled children should be aware of this requirement, designed to safeguard the welfare of young children, when purchasing support via a direct payment.

8. Restrictions on use of Direct Payments

Direct payments cannot be used to:

Purchase permanent residential care
Purchase local authority services
Purchase health care
Purchase equipment

The Department of Health Guidance states that it is not permissible for local authorities to restrict people to using particular approved voluntary or private providers. However, children under 16 are not subjected to financial assessments as part of an assessment.

If agency care better meets the family’s needs it is preferable for CYPSC to purchase the care, and then the VAT can be reclaimed, enabling nearly 20% more care to be bought for the same money. To provide flexibility, the family can be given a number of hours which they can negotiate flexibility with the agency.

9. Short Breaks

Payments can be made to enable people with parental responsibility for a disabled child to pay for short breaks. This can involve the child/young person going somewhere or a worker coming to the child/young person’s home whilst the person with parental responsibility goes out/away.

A direct payment cannot be made in relation to the provision of residential accommodation for a disabled child or disabled young person for any single period in excess of four weeks, and for more than 120 days in any period of twelve months (short breaks regulations apply). The time limit is imposed to avoid inappropriate use of residential accommodation.

The amount paid towards the cost (if applicable) of any short breaks will need to be agreed by the relevant manager(s). It is anticipated that the amounts will be equivalent to those paid where the service is commissioned by CYPSC on behalf of the service user. VAT can be reclaimed by CYPSC, enabling nearly 20% more care to be brought for the same money.

10. 16 and 17 Year Olds and Transition

Direct payments can play a useful part in preparing disabled young people 16 and 17 year old for adulthood. Where direct payments are being made to someone with responsibility for a disabled child (which can include 16 and 17 year olds) the possibility of preparing the young person for taking full or partial control over the payments should be considered. The Direct Payments Support Service can provide support with this task. The planning can start from the young person’s 14th birthday.

Prior to the young person 18th birthday, arrangements will need to be in place to ensure a smooth transitional arrangement from Children Services to Adult Services should they wish to receive direct payments as an adult.

When undertaking the planning for direct payments for someone of this age workers will need to ensure, as in all cases, that:

The young person is able to manage the direct payment alone or with assistance
Other support is available if needed (e.g. from the Direct Payments Support Service)
The services the young person intends to purchase will be able to achieve the outcomes identified
Anyone the young person wishes to employ is subject to a criminal records check (see section 14 Criminal Records Checks)
Checks are made to ensure that any contracts the young person enters into are legally binding. Workers should refer to the Direct Payments Support Service for assistance with this matter
16 and 17 year olds cannot use direct payments to employ their parents

11. Assessment and Care Planning

Roles & Responsibilities of Care Managers and the Direct Payments Support Service Advisors

The Direct Payments Support Service must be involved in the setting up of all direct payment packages (see Appendix 1).

The care manager must arrange a three-way meeting to be attended by the parent/young person, their carer/advocate etc. (if required), the care manager and the Direct Payments Support Service Adviser
This meeting ensures that both the parent/young person the care manager has all the information they need about direct payment and the process in order to make an informed decision
The adviser will ensure that the care manager has information about all costs that need to be included in the care plan, including additional costs that can vary depending on the needs to be met. If required the Direct Payments Support service will advise the care manager on how to proceed with the direct payments application
The care manager must make a note of the Direct Payments Support Service involvement on the ESCR Case Episode screen

12. Interim Arrangements

Direct payments may take some time to set up. Care managers must be prepared to arrange for alternative provision to be put in place in the meantime if necessary.

13. The Care Plan

The care manager draws up a Care Plan, which must include:

Details of all proposed provision and contingency arrangements if the usual provision breaks down
The resources that are to be provided through direct payments (e.g. numbers of hours of personal assistance each week)
The resources that are to be provided through direct provision if requested
Specific provision for any additional funding required to cover the cost of providing alternative support in the event of a planned or unplanned absence of the service user’s regular personal assistant/s e.g. services
Any other additional costs (on costs) including: advertising, stationary, Employer’s and Public Liability Insurance and a repayable two-week ‘float’ totalling twice the cost of one week’s support
All required training needs including any moving and handling issues; health and safety issues, child protection issues identified during the assessment and alternative funding to support package, e.g. Inclusion funding

Costing the Care Plan

If the intention is for the service user to employ a personal assistant, the care manager costs the Care Plan using the Worksheet SS27 for the direct payments elements
The amount of the weekly direct payment is calculated using the current hourly payment rates. The hourly rates include an amount to enable people to pay their Employer's National Insurance Contribution (ENIC). If they are not required to pay ENIC, the rate excluding the ENIC allowance should be paid.
If required the Direct Payments Support Service will provide information about ENIC thresholds and advisors can provide support to cost the care plan.
If the plan includes short breaks then the charges, which currently apply for that service, should be made in the usual way. The Local Authority will not pay more than it would usually cost them to provide the same service

Funding for Insurance and Advertising

There will be occasions when the direct payments user will need the money allocated to them in the initial Care Plan to cover insurance and advertising prior to the commencement of their care package. If the money is required for advertising it may not be possible to fix a date for the care package to start until the person has received the money, advertised and recruited a personal assistant.

The task agreed to be undertaken for the disabled child/young person must be insurable. If the tasks are not insurable, that is usually because they are on the edge or are fully health needs. Direct Payments cannot be used to meet health needs. Therefore, another way to meet these needs must be sought, through the Care Planning process.

Checking the Care Plan

If the care manager requests the Direct Payments Support Service will check that the Care Plan includes all the required details regarding direct payments before the care manager submits the Care Plan for approval.

Submitting the Care Plan for Approval

The care manager submits the costed and checked Care Plan to the Team Manager and Service Delivery Manager for Care Plan approval before it is sent to the direct payments panel
The costing worksheet SS27 must be used by the care manager for all direct payments applications where the intention is that the service user employs personal assistants
Care managers must attach the completed paperwork (including costing worksheet SS27 where necessary) and send to the direct payment panel administrator to present at panel for budget approval

14. Decision to Approve/Refuse Direct Payments Request

The Direct Payments Panel may defer a request for further information from the care manager/SDM before approving a new care plan. This action will lead to decisions being deferred. Care managers should therefore ensure the Care Plan and documentation is clear, complete and accurate.

A request may be refused if the panel believes that the provision should /could be met through an alternative funding source. The panel may make some suggestions of alternative resources.

Budget holders and members of gate keeping panels are reminded that direct payments must be offered to all eligible service users and that direct payments cannot be refused because direct provision is available.

15. Approval of the Care Plan

Roles and Responsibilities of Care Managers and the Direct Payments Support Service Advisor

Once the Care Plan is approved for direct payment it is returned to the care manager with the panel’s decision. The care manager should then inform the parent/young person of the panel’s decision. The panel decision is recorded on ESCR by the care manager.

The panel administrator will send the relevant sections of the approved care plan and the completed worksheet SS27, if appropriate, to the Direct Payments Support Service.

The Direct Payments Support Service will send paperwork to Children’s Carers Payments Team, as appropriate (care managers should not send approved care plans directly to the Finance section).

Once established the Direct Payments Support Service will send copies of the paperwork with agreed start date for the care plan to the care manager and Children’s Carers Payments Team Finance.

16. The Direct Payments Agreement

The care manager ensures that the Direct Payments Agreement (SS480) is completed, signed and copies retained by the care manager and the parent. In the case where 16 and 17 year olds are managing their own direct payments the care manager must ensure that the Direct Payments Agreement that the young person enters into is legally binding. A copy of the agreement must be sent to the Direct Payments Support Service for their records. It will not be necessary to send Children’s Carers Payments Team Finance a copy of the Direct Payments Agreement.

Checks

The Direct Payments Support Service ensures that all the following checks are carried out as required regarding the prospective personal assistant, verifies each personal assistant's identity and follows up the checks.

The following checks must be undertaken:

Enhanced Disclosure Criminal Records Bureau checks
Checks of ESCR
Checks with the Department’s Child Protection Unit
Checks with the Department’s Human Resources Section

Personal assistants must not take up their duties until all satisfactory record checks have been completed. It is important to let service users know from the outset that the final decision about suitability will remain with Children and Young People Social Care.

The Direct Payments Support Service notifies the service user that the person can work for them only if the checks are clear
If a problem is highlighted by the checks, the Direct Payments Support Service refers this to the care manager who will take any necessary action
The Direct Payments Support Service ensures that a repeat CRB check is done after three years

Payments of Direct Payments

The Direct Payments Support Service ensures that the person with parental responsibility who will be managing the payments, opens a separate bank account in their name on behalf of the child and obtains the account details
In the case of a young person aged 16 or 17 (if they have agreed to manage their own direct payment) a bank account should be opened in their name if they are the recipient of the direct payment
The Direct Payments Support Service provides the bank account details to nominated persons in the Children’s Carers Payments Team and instructs them to pay one-off start up costs to the parent/young person (for advertisement and administration)
Payments will be made fortnightly. The usual procedure is for payments to be made by BACS direct credit to the client’s bank account. The bank account will be credited on the fortnightly on a Thursday following the payment run
The Direct Payments Support Service provides the start date and costing sheets to Children’s Carers Payments Team and instructs them to begin making the payments into the bank account
The Direct Payments Service will inform the care manager that the start date for full payments has been established
Where the start date of the care package has been delayed to allow time for the recruitment of a personal assistant(s), the direct payments support service informs the care manager and Children’s Carers Payments Team when the start date is agreed and full payment begins
The Direct Payments Support Service will fill out and submit to the Children’s Carers Payments Team additional expenses forms as required e.g. change in the hourly rate, extra money agreed in the care plan, such as annual leave payments
Additional expenses for bank holidays may be sent directly to the Children’s Carers Payments Team by the parent/young person with a time sheet showing that the hours have been worked. Children’s Carers Payments Team will then pay these additional expenses

Recruitment and Selection of Personal Assistants

The Direct Payments Support Service provides support to:

Produce all necessary documents to recruit suitable personal assistants e.g. job description, application form, adverts, person specifications etc. An Adviser attends the interview if required (but cannot take part in any decision making)
Check that a contingency plan is in place in the event of a break in the regular arrangement and records what the plan is. The care manager needs to check this and record it on the care plan
Produce employment contracts for personal assistant/s. If the direct payment is for a young person who is aged 16/17, the Direct Payments Support Service checks with Legal Services to ensure that all contracts are legal and binding. The care manager/the Direct Payments Support Service checks with Legal Services depending on which contract we are checking for example the care manager would check that the direct payment agreement is binding
Ensure that the service user has purchased employers and public liability insurance and reminds the service user to renew this as required
Ensure that personal assistants agree to any training identified by the care managers as being necessary and arranges this training, e.g. CYPSC moving and handling training
If the personal assistant is employed to work with a child or if there are children in the household then the personal assistant must attend Safeguarding Training. The personal assistant does not have to have undertaken the training as a prerequisite of starting work but they must attend the training at the earliest opportunity
Help to set up suitable recording systems and the Direct Payments Support Service as appropriate with any amendments to forms such as times sheets and other record sheets
Support personal assistant employers to administer their own payroll or access a payroll service as required
Support the personal assistant employers need to develop and maintain good employer/employee relationships. The Direct Payments Support Service is available to help with any problems that arise, including liaising with bodies such as ACAS if required
The Direct Payments Support Service will inform the care manager if the service user experiences any serious problems managing their payments or personal assistant/s
The Direct Payments Support Service informs the care manager if it becomes aware that the service user wishes a change to be made to their care package

17. Ongoing Case Involvement

Roles and Responsibilities of Care Managers and the Direct Payments Support Service Advisors

When direct payments are set up the care manager and team manager will need to determine whether the case can be made passive or whether it needs allocation for long-term care management. Cases will always be allocated to a worker in the care management team and will require monitoring.

Reviews of Direct Payment Packages

Reviews of Packages will take place as follows:

All new approved requests must be reviewed after three months of the panel approval and then every six months there after
All existing packages are subjected to a six month review and are returned to the panel for approval (they can then be monitored and equity ensured)
Outside of the review time scale all additional requests for increases of over 10% in the cost of the package must be presented to panel for approval
If there is a change to the cost of the package being requested then, care managers should where necessary include costing worksheet SS27 and send to the Direct Payment Panel Administrator to present at panel

18. Financial Arrangements and Direct Payments User's Responsibilities

A separate bank or building society account specifically for direct payments must be opened. If the payments are to meet the needs of a disabled child the account should be opened in the name of the person with parental responsibility who will be managing the payments. In the case of a young people aged 16-17 that are to manage their own payments then the bank account should be opened in their own name.

It is the direct payments users’ responsibility to maintain adequate financial records. The following should be retained for audit purposes:

Bank or building society statements; chequebooks and paying in books
Invoices and receipts (e.g. from care agencies and homes)
Payroll records and any other documents relating to employment of staff including evidence of appropriate insurance cover
Personal Assistants time sheets
Income and expenditure sheets where appropriate

These documents will need to be made available to representatives of the Children and Young People Social Care Finance Section, or other section of the Council, if requested to do so. The Direct Payments Support Service can be consulted for advice and assistance.

Monitoring the Care Plan

The care manager should monitor the care plan to ensure that the direct payments are spent on the agreed services and are meeting the assessed needs.

As described in Section 13, the additional expenses payments are made to enable direct payments users to pay for additional costs associated with using direct payments. However, if their personal assistant is on sick leave Employers National Insurance Contributions will not be sufficient to cover Statutory Sick Pay payments. Therefore, they will need to consult with the Direct Payments Support Service who will assist them to liaise with the Department’s Finance Section to ensure that they are able to pay any outstanding sick leave payments.

If any of the checks described in Section16 give cause for concern the Direct Payments Support Service should refer the situation to the care manager who will discuss with the relevant Team Manager/Children’s Service Delivery Manager. A decision should be made as to whether children and young people’s social care agrees to the making of a direct payment for the employment of the individual in question. Advice can also be sought from the Duty Child Protection Co-ordinator.

19. E.S.C.R. Recording

Where a service user is in receipt of a direct payment this should be recorded on the ESCR system as a product by the care manager.

20. Cessation of Direct Payments

The expectations of direct payments users will be high. People will see the payments as a means of achieving greater independence in their lives. It is likely therefore, if the payments have to cease, that the user involved will be profoundly disappointed. This will need to be acknowledged in all aspects of the Children and Young People’s Social Care dealings with the individual at such times.

If, for whatever reason, an applicant is no longer able, or willing, to continue using direct payments the Children and Young People’s Social Care has a responsibility to return to meeting their needs by the provision of services. This would, of course, also be the case if it were Children and Young People’s Social Care, which terminated the payments.

Cessation of payments may be considered in the following circumstances:

Where there are serious concerns that a parent/young person ability to manage the payment
The direct payment is not being spent on the services identified in the Care Plan
Any of the terms or condition in the direct payment agreement is not being met by the parent/young person
The parent/young person is no longer willing or, no longer able to manage the direct payment
The child/young person no longer meets the Eligibility Criteria for services

In the event of the death of the direct payments user any payments owed to personal assistants is the responsibility of the person with parental responsibility who manages the payment on the child/young person behalf and not that of the Children and Young People Social Care. In the case of a young person aged 16-17 in receipt of their own payments, any payments owed to personal assistants should be met by the young person’s estate and not Children and Young People Social Care.

The personal assistant needs to claim unpaid wages from the person with parental responsibility who manages the payment on the child/young person’s behalf or whoever is administering the estate of the young person aged 16-17.

Children and Young People Social Care will only pay the personal assistant wages (when the bank account has been frozen) when the cheque issued by the Council to the direct payments user has been cancelled.

In the event that the Children and Young People Social Care requires a repayment of unused funds then an account should be sent to the person with parental responsibility who manages the payment on the child/young person behalf or whoever is administering the estate of the young person aged 16-17.

21. Complaints

Direct payments users should be made aware of the Department’s Complaints Procedure and given a copy of the “Complaints and Compliments” leaflet. If workers have any queries regarding the Complaints Procedure they should contact the Designated Complaints Officer at Merrion House on 2478627.

22. Additional Reading

The Department of Health’s Direct Payments Guidance - Community Care, Services for Carers and Children’s Services (Direct Payments) Guidance England 2003.

See Parents guide to direct payments for disabled children final 29th July 2009

See Guidance on direct payments for community care, services for carers and children's services: England 2009

23. Forms Used

Direct Payment Panel Request Children (SS/483)

Direct Payment Panel Review Children (SS/484)

Direct Payments Costing Without National Insurance SS/27

Additional Expenses Claim Form (SS/501)

Appendix 1: Assessment Process Map

Click here to view Appendix 1: Assessment Process Map

Appendix 2: Review Process Map

Click here to view Appendix 2: Review Process Map

Document Control
Document Status:	Final Version 1.0
Document Replaced:	New Procedure
Date status agreed:	April 2008
Date of status review:
Subject:	Direct Payments Children Young People Social Care
Title:	Direct Payments in Leeds Procedure Children and Young People's Social Care
Departmental contact:	Julie Bringloe
Date Revised	August 2010

End