Direct Payments

When providing information and advice to a person with care and support needs (or a carer with Support needs), it must be given in a way that it can be understood and used. This is a legal requirement of the Care Act.

See: How to Provide Information and Advice

If you feel that the person/carer will need support to understand the information and advice provided to them, you should consider:

1. Whether the information can be provided in a different way;
2. Whether you can take any additional steps to support them to understand it (for example talking through the information on the telephone or in person);
3. Whether it would be appropriate to appoint an independent advocate to support the person/carer to understand and use the information.

A person who lacks capacity to request or manage a Direct Payment can still receive one under the Care Act so long as the person making the request for the Direct Payment is either:

1. A person authorised under the Mental Capacity Act 2005 to make decisions relating to the person’s care and support (e.g. a Deputy or a Lasting Power of Attorney); or
2. A person approved by someone authorised under the Mental Capacity Act to make decisions relating to care and support; or
3. Where there is no authorised person under the Mental Capacity Act, the Local Authority considers the person making the request to be suitable.

If none of the above apply, a Direct Payment cannot be arranged.

If a person has fluctuating capacity, an authorised or suitable person must still be appointed to receive and manage the Direct Payments. However, during periods where the person has capacity to make decisions about the Direct Payment, the authorised or suitable person should allow the person to manage the Direct Payment themselves.

Before arranging the Direct Payment, you should be satisfied that the authorised or suitable person understands this and that it will be the case.

Monitoring a suitable person

You must make appropriate and proportionate arrangements to monitor the Direct Payment when you have concerns that a suitable person:

1. may not be able to manage the Direct Payment; and/or
2. may not arrange support and services that are in the Best Interests of the person; and/or
3. where the person has fluctuating capacity, may not permit them to make their own decisions about how the Direct Payment is used when they have capacity to do so.

The option of using a Direct Payment to manage some or all of the personal budget should be discussed and agreed as part of the Care and Support/Support planning process.

This section of the chapter should be used when:

1. a person or carer has requested a Direct Payment; or
2. you have deemed it to be in their Best Interests; and
3. you are satisfied that there is no reason why the person/carer, their nominated representative or a suitable person (if they lack capacity) should not receive a Direct Payment; and
4. the Care and Support Plan/Support Plan has been signed off.

See: Care and Support Planning

See: Support Planning

Before proceeding to arrange a Direct Payment, you should be satisfied that the individual that will be receiving and managing the payments will meet the following conditions. These are the conditions of all Direct Payments:

1. The Direct Payment will only be used to pay for arrangements which meet the needs that the Local Authority has agreed to meet;
2. The Direct Payment will not be used to pay a prohibited person to meet the needs;
3. Where a person lacks capacity to make decisions about Direct Payments themselves, the authorised person will notify the Local Authority if the person gains this capacity; and
4. Appropriate checks of carer’s criminal records will be carried out.

In addition to the above conditions, you should also be satisfied that:

1. A Direct Payment is the most appropriate way of managing the personal budget and meeting needs;
2. The person with care and support needs (or carer with support needs) is not excluded from receiving a Direct Payment under the Care Act;
3. The individual who will be receiving and managing the Direct Payment is capable (with or without support);
4. Where the individual who will be receiving or managing the Direct Payment is not the person with care and support needs (or carer with support needs), that they are willing and capable of managing it;
5. Where the person with care and support needs lacks capacity, the Direct Payment will be used to arrange services that are in their best interests;
6. If the Direct Payment will be used to employ a Personal Assistant, that employer related costs have been taken into account;
7. If used to pay for respite in a care home, no more than four weeks of this will be taken consecutively in any 12 month period.

Note: For guidance about the above, including the four consecutive weeks in a care home rule, see the 'Direct Payments' section of the Care Act 2014 resource.

If you have any doubts about the above conditions, you should seek the advice of your line manager or the team responsible for Direct Payments.

The Local Authority is permitted to attach other conditions to a Direct Payment if it considers it appropriate to do so, for example, if there are concerns that a Direct Payment will be mismanaged or misused, or that arrangements will not be made in the best interests of a person who lacks capacity.

Examples of conditions include:

1. Prohibiting a named individual from providing care;
2. That certain information must be provided to enable effective monitoring;
3. Using the most appropriate Direct Payment methods e.g. Pre-paid card, Virtual Wallet, Third Party Supported Account, dedicated own bank account or Suitable Person Account.

Indicators that conditions may be required include concerns about:

1. a person's/carer's ability to receive or manage the Direct Payment (even with support);
2. the ability of a nominated representative or suitable person to manage the Direct Payment;
3. in the case of a person with care and support needs who lacks capacity, whether the suitable person will arrange services based on what is in their Best Interests;
4. if the person has fluctuating capacity, whether the suitable person will permit them to manage the Direct Payment when they have capacity to do so; and
5. the Direct Payment being used to purchase care from a family member living in the same household (without agreement to do so).

If you feel that it is necessary and appropriate for a condition to be placed on a Direct Payment, you should:

1. seek the advice of your manager; and
2. if they are in agreement, advise the person and / or the Direct Payments Support Service (if appropriate) responsible for monitoring and reviewing the Direct Payments of the condition that has been applied; and
3. make appropriate arrangements to monitor that the condition is met; or
4. if the condition relates to the provision of information about expenditure, recommend that the teams responsible for reviewing and auditing the Direct Payment apply and monitor the condition.

The Direct Payment should be arranged after the care and support plan is signed off and the final personal budget is agreed.

You should refer to available local processes and guidance to arrange the Direct Payment, including any requirements around the use of Direct Payment support services.

Direct Payments Procedure which is available in the Local Resource Library under Direct Payments (Section 10).

Prepaid cards

Direct Payments recipients can receive their Direct Payments via a Prepaid card unless this does not meet their needs. It is envisaged that this will speed up the process of putting Direct Payments in place as the person will no longer need to open a bank account.

There is Direct Payments Prepaid Card Guidance available in the Local Resource Library under Direct Payments (Section 10).

Virtual Wallet

The Virtual Wallet enables agreed funding (from social care, health, and the individual) to be loaded into an online account from which recipients pay providers for their services / care and support. Closely resembling an online bank account, the Virtual Wallet is easily used to make payments whilst also providing direct access to receipts, invoices, and spending reports.

Features of a Virtual Wallet:

• Can be set up instantly by the recipient, with support from the software provider;
• No need to open separate bank account;
• Impossible to overspend;
• Accessible 24/7;
• Easy monitoring of budget spend and services;
• Reduces the need to carry / handle cash;
• Simple record keeping and audit evidence all in one place;
• Access to a diverse marketplace;
• Online calendar to easily view, edit or cancel appointments;
• Simple care planning, with an easy to use drag and drop tool;
• Available to all.

Further Virtual Wallet information can be found on the ACCW – Direct Payments Microsoft Teams Channel.

Third Party Supported Accounts

If a person needs support to manage their Direct Payments, a Third Party Supported account can be considered to manage the funds on their behalf. The account should be in the name of the person, carer, nominee, or authorised person who has signed the Direct Payment agreement. Where a Third Party Supported Account is set up, usually with the Direct Payments Support Service (Penderels Trust), moving to a Prepaid card or Virtual Wallet should be considered at each review with the aim of maximising the person’s independence in managing their Direct Payment.

Own separate Bank Account

It may be agreed in some circumstances that a person opens their own dedicated bank account, where a prepaid card or Virtual Wallet is not appropriate. This must be an account dedicated to receiving and spending the Direct Payments, as bank statements and evidence of expenditure will be required at audit.

For all payment methods:

We need to ensure individuals are who they say they are; this means checking their identity when we think they are likely to have Direct Payments. Please follow the Know Your Customer Policy in the Local Resource Library under Direct Payments (Section 10).

Making a Referral to the Direct Payments Support Service provider (Penderels Trust)

• A referral must be made to Penderels Trust for any new Direct Payments set up, whether using an agency or Personal Assistant (PA), as it is crucial that people understand the support available, and their own responsibilities as outlined in the Direct Payment Terms and Conditions;
• The referral form must be completed for all new Direct Payments set up. It is important to also consider referring people who may have received Direct Payments for many years, as they too may benefit from advice and support from Penderels Trust;
• A Direct Payment should not be made to a person unless the referral to Penderels Trust is completed, or a clear rationale has been recorded in the person’s record as to why they have chosen not to receive this support. As a practitioner, you will need to discuss with your line manager to ensure the rationale gives confidence to us as an organisation that, in not making a referral, the person will not be disadvantaged, for example, in the provision of information and advice, or that the Direct Payments will still be managed properly.

Delays in arranging the Direct Payment must not lead to delays in meeting eligible needs.

If a delay in arranging the Direct Payment occurs, you must arrange interim services as required to ensure eligible needs are met.

The duty to meet eligible needs is not discharged when the Direct Payment is arranged, but when the services to meet eligible needs are in place.

If delays in arranging services occur, including delays in the person employing a Personal Assistant, you must arrange interim services as required to ensure eligible needs are met. These interim services should be commissioned by the Local Authority, and an adjustment should be made to any future Direct Payment paid.

You should consider what support the person or carer may need to arrange services:

• Is a family member or friend able to assist?
• If they have an advocate, can they support?
• Is there anything you can do to help arrange the service e.g., speaking to a provider?
• Making a referral to the Direct Payments Support Service, Penderels Trust.

If the person is finding it difficult to recruit a personal assistant, you should make sure they have access to specialist support and advice through the Direct Payments Support Service (Penderels Trust).

Initial reviews of a Direct Payment must take place no later than 6 months after the first payment is made.

Further reviews must take place no less than every 12 months after that.

It is prudent to carry out more frequent reviews when specific conditions have been placed on the Direct Payment, or where there are concerns about mismanagement or misuse.

The purpose of the review is to:

1. Reflect on what is working and not working about the Direct Payment;
2. Consider what may need to change about the Direct Payment;
3. Make sure the Direct Payment remains the most appropriate way to manage the personal budget and arrange the required services; and
4. Make sure the Direct Payment is supporting the person/carer to meet the outcomes in the Care and Support/Support Plan.

In order to achieve its purpose, the following must all be reviewed, making use of information from the most recent Direct Payment audit:

1. How well the process of receiving payments is working;
2. How well the Direct Payment is being managed;
3. Whether records required by the Local Authority are being maintained by the person receiving/managing the Direct Payment;
4. Whether information is being provided to the Local Authority as required;
5. Whether the Direct Payment is being used as anticipated;
6. Whether the Direct Payment is supporting the person/carer to meet the outcomes in their Care and Support Plan/Support Plan.

The Direct Payment review must involve:

1. The person receiving care and support (or carer receiving support); or
2. Any carer a person with care and support needs has;
3. The individual to whom the payments are being made (if this is not the person/carer);
4. Anyone who is providing administrative or management support;
5. Anybody the person/carer asks the Local Authority to involve;
6. In the case of a person who lacks capacity, anybody authorised by the Mental Capacity Act to make decisions about care and support provided to the person (a Deputy of Power of Attorney); or
7. Where no authorised person exists, anybody the Local Authority deems to be interested in their welfare.

It is also important to involve the team responsible for Direct Payments in the review. They will be able to provide information about whether the necessary record keeping and administrative requirements for receiving and managing a Direct Payment are being met.

If a Direct Payments audit / review is being carried out, this should be considered alongside any other statutory review that is taking place at that time, unless there is a valid reason not to do so.

This includes the review of:

1. a Care and Support Plan;
2. a Support Plan; or
3. an Education, Health and Care Plan (EHC Plan).

Direct Payments Support Service and Audit Team

It is not possible to carry out a Direct Payment review without the involvement of the Direct Payments Support Service or the Direct Payments Audit Team because they are the people who will be able to provide information about:

1. whether records required by the Local Authority are being maintained by the person receiving/managing the Direct Payment; and
2. whether information is being provided to the Local Authority as required.

They may also have been involved in monitoring existing concerns or have gathered other information that may be prudent to any decision about the ongoing appropriateness of the Direct Payment.

There are a number of options for involving the Direct Payments Support Service or the Direct Payments Audit team in the review, ranging from:

1. consultation only; to
2. a joint review.

The nature of the team's involvement in the review will depend on:

1. the complexity of the Direct Payment;
2. the existence of any concerns or conditions; and
3. should be agreed in advance with them.

The review conversation must confirm:

1. How well the process of receiving payments is working;
2. How well the Direct Payment is being managed (including whether any conditions attached to it are being met);
3. Whether the records required by the Local Authority are being maintained by the individual receiving and managing the Direct Payment;
4. Whether information is being provided to the Local Authority as required;
5. Whether the Direct Payment is being used as anticipated;
6. Whether the Direct Payment is supporting the person/carer to meet the outcomes in their Care and Support Plan/Support Plan.

The Local Authority is responsible for deciding the outcome of the review. However, all reasonable steps should be taken to reach an agreement with all those involved in the review.

The decision must have regard for:

1. The views of the person/carer about the outcome;
2. The impact of the outcome on the person/carer's wellbeing; and
3. The views of anyone else consulted in the process.

Any decision must be evidence based and robust.

Throughout the process of audit / review, the practitioner carrying it out should talk to the person (or their representative) / carer and others involved about the likely outcome, endeavouring to reach an agreement about this as the process progresses.

The Local Authority is, however, responsible for making the final decision about the outcome of the audit / review. This is a decision that must be made with full regard for:

1. information provided by the Review or Direct Payments Audit team; and always with regard for
2. the views of the person/carer about the outcome;
3. the impact of the outcome on the person/carer's wellbeing; and
4. the views of anyone else consulted in the process.

Possible outcomes

There are four possible outcomes that may be recommended following a Direct Payment audit or review, which will be decided by the team involved:

1. No changes required to the Direct Payment;
2. Changes to one or more element of the Direct Payment;
3. Suspension of the Direct Payment; or
4. Termination of the Direct Payment.

There may be times when the person/carer, their representative or another person disagrees with the decision made about the review outcome. In this situation, you should be open to reviewing the available evidence to ensure that the decision is robust. You should be open and transparent about the evidence sources you have used and take steps to try and support the person/carer to understand the decision you have made. Where ongoing disagreement persists, you should make the person (or their representative)/carer aware of their right to complain.

The team reviewing the Direct Payments and the Direct Payments Audit team are responsible for:

1. using the current review / audit tools used by the Local Authority for recording purposes; and
2. establishing the timeframe for making a formal record; and
3. understanding any particular local requirements for recording a Direct Payment review / audit.

If the audit / review is being completed as a combined review with another plan, the information should also be recorded as part of that review record.

If you are unclear, you should speak to your line manager before proceeding to make a formal record of the audit / review.

The following information should be recorded in a review record:

1. Any issues or concerns about the processes of receiving and managing Direct Payments;
2. Whether records required by the Local Authority are being maintained;
3. Whether information is being provided to the Local Authority as required;
4. Whether the Direct Payment is being used as anticipated;
5. Whether the Direct Payment is supporting the person/carer to meet the outcomes in their Care and Support Plan/Support Plan;
6. Whether the Direct Payment is still the most appropriate way to manage the personal budget and meet eligible needs;
7. Whether any changes are required to the Direct Payment;
8. Whether the Direct Payment will continue;
9. The views of the person/carer receiving and managing the Direct Payment (or a nominated, authorised or suitable person) about all of the above.

The person/carer and any nominated, authorised or suitable person receiving or managing the Direct Payment must be provided with a copy of the formal record.

Actions following the review / audit

Deciding the timeframe for the next review / audit

If the Direct Payment is to continue, the next review / audit must be carried out within 12 months. However, the date can be earlier and decisions about the timeframe must consider:

1. the need to monitor any aspect of the Direct Payment;
2. when other statutory reviews are scheduled to take place (as a combined review should be arranged wherever possible);
3. whether the Care and Support Plan/Support Plan is stable.

The agreed timeframe for the next review / audit should be clearly recorded on the review / audit record and any Care and Support Plan/Support Plan.

If it is unclear about an appropriate timeframe for review / audit, the teams should:

1. seek the advice of their line manager; and
2. obtain the views of the team responsible for managing / reviewing the Direct Payments.

See also Deciding the Outcome of a Care and Support Plan Review and Making a Formal Record.

Changing to a Prepaid card or Virtual Wallet

People who receive their personal budget via Direct Payments should be given the opportunity to have a Prepaid card or Virtual Wallet account at a review.

There is information in the Local Resource Library under Direct Payments – Section 10 about:

• the internal process of changing to a prepaid card or Virtual Wallet;
• information about changing to a prepaid card or Virtual Wallet for people.