5.4 Direct Payments for Families of Children with Disabilities and Disabled Young People |
SCOPE OF THIS CHAPTER
This chapter, which offers guidance for children's social care practitioners, managers and occupational therapists, was written for Peterborough by Helen Read, Consultant Aiming High for Disabled Children, and was first published in August 2009.
Contents
- Introduction
- Eligibility for Direct Payments
- What can Direct Payments be used for?
- General Restrictions on the use of Direct Payments
- Legal Framework - Direct Payments Legislation and Department of Health Guidance
- Decisions on whether or not to make Direct Payments
- Direct Payments through a Carers Assessment
- Advice and Support for Parents, Carers and Young People
- Care and Service Planning and Direct Payments
- Reviews
- Employment of Relatives as Direct Payment Carers
- Safeguarding Children and Young People
- Direct Payments and Childminding Regulations
- The Level of Payment
- Calculating the Direct Payments for Families who Employ Carers for their Children with Disabilities
- Direct Payments for Young Disabled People aged 16 and 17
- Direct Payments for Equipment
- Complaints
1. Introduction
The Direct Payments legislation requires local authority social services to give people cash payments as an alternative to arranging social care services to meet their assessed support needs. Direct Payments are just a different way of meeting assessed needs and the existing procedures and operational instructions on eligibility, assessment and charging for services apply.
NB Direct Payments cannot be offered to people who do not meet the Department's threshold for a service
2. Eligibility for Direct Payments
Eligibility Criteria
- Parents or people with parental responsibility for a disabled child and whose disabled* child has been assessed for services or equipment under the procedures used by the particular children's social care team using the Framework for the Assessment of Children in Need and their Families (2000)
- 16/17 year old disabled young people who have been assessed for services as above, and who have sufficient understanding to make informed decisions in relation to managing the payment. **
- Carers assessed for services under the Carers and Disabled Children Act (2000)
AND - The Council is satisfied that:
- The child's needs for the relevant services as revealed by the assessment can be met by securing the provision of such services through a Direct Payment.
- The welfare of the child will be safeguarded and promoted through a Direct Payment being made
AND
- The person consents to using a Direct Payment to meet the assessed care needs.
AND - The person does not come under the list of persons who may not receive Direct Payments ( Section 5, Legal Framework - Direct Payments Legislation and Department of Health Guidance)
** Young people under 18 have restricted capacity to enter into contracts in law. Legal advice on a case by case basis must be sought from the Council's Legal Services in all instances where an individual Direct Payment to a young person aged 16 and 17 is being proposed. (Section 16, Direct Payments for Young People aged 16 and 17)
* Definition of Disability
Peterborough City Council has adopted the relatively inclusive Disability Discrimination Act definition of a person with a disability: "someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities."
For these purposes:
- substantial means neither minor nor trivial
- long term means that the effect of the impairment has lasted or is likely to last for at least 12 months (there are special rules covering recurring or fluctuating conditions)
- normal day-to-day activities include everyday things like eating, washing, walking and going shopping
- a normal day-to-day activity must affect one of the 'capacities' listed in the Act which include mobility, manual dexterity, speech, hearing, seeing and memory
3. What can Direct Payments be used for?
- Care in the child's home i.e. domiciliary/personal care or sitting service
- Support to promote social inclusion and independence activities
- Short breaks
- Care in a carers home - both day and overnight care (except childcare whilst parents are at work)
- Transport costs, where provision for transport forms part of the service plan.
- Equipment where a disabled child has been assessed as requiring an item of equipment which would otherwise be provided by the local authority following an OT assessment
4. General Restrictions on the use of Direct Payments
In- house services
Direct Payments may not be used to purchase services provided by Peterborough City Council e.g. Link Carers, The Manor or Cherry Lodge. (Individual City Council employees may work independently as carers for families receiving Direct Payments as long as this does not conflict with their contractual responsibilities as PCC employees.)
Health Authority 'health' money cannot be used for Direct Payments. People funded under 'continuing care' arrangements may not purchase these services using Direct Payments nor can they use Direct Payments for the 'health' part of a joint package of care. See the Department of Health Question and Answers about Direct Payments and Continuing Health Care
Permanent residential care
Direct Payments cannot be used to purchase permanent residential or nursing care.
Cost effectiveness
Direct Payments should be at least as cost effective as providing the direct service to meet the assessed need. This does not necessarily mean the cheapest service, but any increased cost must be justified by an increase in the family's ability to care for their child independently.
Child care
Many working parents will be eligible to claim childcare costs linked to a claim for Working Family Tax Credit in order to pay for child care whilst they are at work. This allows Direct Payments to be used for support other than child care, for example an extra pair of hands at particularly demanding times of the day or for Short Breaks.
Restrictions on periods of residential Short Breaks
A Direct Payment cannot be made to purchase residential accommodation for a disabled child for a period in excess of 28 days, and is restricted to a cumulative total of 120 days in any 12 months
5. Legal Framework - Direct Payments Legislation and Department of Health Guidance
Community Care (Direct Payments) Act 1996
The community Care Direct Payments Act 1996 gave local authorities the power to make direct cash payments to individuals aged 18 to 64, in lieu of community care services provided under the Community Care Act 1990. This was amended in 2000 to include older people, 65 years or over, so that they too could receive a Direct Payment.
Carers and Disabled Children Act 2000
This act extended the power to provide Direct Payments to include those services, provided within the framework of Part III of the Children Act 1989, to meet the needs of people with Parental Responsibility for a disabled child and disabled children aged 16/17.
It also extends the use of Direct Payments to meet the needs of adult carers of people aged 18 years and over ; and in certain circumstances 16/17 year old carers of people aged over 18 years.
Health and Social Care Act 2001
This Act, implemented in April 2003, requires local authorities to make Direct Payments to an individual who requests a cash payment in lieu of direct services that they have been assessed as needing. This means that the council has a 'duty' rather than just a 'power' to make Direct Payments.
'Community Care, Services for Carers and Children's Services (Direct Payments) Guidance England 2009'
Department of Health Question and Answers about Direct Payments and Continuing Health Care
Legal restrictions on who may receive Direct Payments
The 2003 Direct Payments Regulations specify that Direct Payments may not be offered to certain people whose liberty to arrange their care is restricted by certain mental health or criminal justice legislation is as follows:
- Those required to submit to treatment for his mental condition or for his drug or alcohol dependency by virtue of a requirement of a community rehabilitation order within the meaning of section 41 of the 2000 Mental Health Act or a community punishment and rehabilitation order within the meaning of section 51 of that Act;
- Those subject to a drug treatment or testing order within the meaning of section 52 of the 2000 Act;
- Those released on licence under section 37 of the Criminal Justice Act 1991 subject to the condition that he submit to treatment for his mental condition or for his drug or alcohol dependency;
- Those placed under guardianship in pursuance of:
- An application made in accordance with section 7 of the 1983 Act; or
- An order made under section 37 of that Act
- Those absent from hospital with leave given in accordance with section 17 of the 1983 Act;
- Those subject to after-care supervision within the meaning of section 25a of the 1983 Act;
- Where there is in force in respect to him a condition imposed in accordance with section 42(2) or 73(4)(including such a condition which has been varied in accordance with section 73(5) or 75(3) of the 1983 Act;
- Where there is in force in respect of him a supervision and treatment order within the meaning of Part 1 of Schedule 2 to the Criminal Procedure ( insanity and unfitness to Plead) act 1991;
- Those subject t o equivalent Scottish mental health or criminal justice legislation.
6. Decisions on whether or not to make Direct Payments
The offer of Direct Payments should follow an assessment using the Framework for the Assessment of Children in Need and their Families (2000). See the detailed procedures and operational instructions for the various frameworks under which all assessments are undertaken.
The Act authorises local authorities to make Direct Payments only with the consent of the person concerned i.e. a person with Parental Responsibility for a child under 16, or a young person aged 16 or 17.
Direct Payments give families greater control and independence, but this is accompanied by increased responsibilities. It is important for each family or young person to understand what is involved in taking on responsibility for purchasing their own services through Direct Payments. This may include a substantial commitment in terms of time and energy as well as, in some circumstances, legal responsibilities e.g. as an employer or by contracting with an agency.
If the parent, carer or young person requests a Direct Payment to meet their assessed needs it MUST be made unless it is not possible to put in place the necessary support to reduce any identified risks to the child or young person , or their potential employees, in managing their own care arrangements.
To help evaluate any potential risks please use the Direct Payments Support Matrix which balances level of understanding and ability to make responsible decisions against the support in place. If the DP Support Matrix shows a high score (12 or more) then a formal risk assessment should be undertaken.
PCVS can help identify any available support - see Direct Payments Support Service - Peterborough Community Volunteer Services. It is good practice to share any risk assessment with the people involved. If the risks cannot be minimised to an acceptable level a Direct Payment should not be made.
If a family decides not to accept Direct Payments, services should be arranged in the normal way. Concern over becoming an employer should not be allowed to discourage a family who would otherwise be willing and able to manage Direct Payments. It is important that the complexities and risks are not over-emphasised in the early stages and kept in perspective.
Councils can arrange for services to be provided while the family is considering the pros and cons of Direct Payments for their particular circumstances.
Families have the option of withdrawing their consent to receive Direct Payments at any time. Likewise, families who are receiving services arranged through Children's Services can ask to be considered for Direct Payments.
If a family managing Direct Payments runs into difficulties of any kind, every effort should be made to enable them to continue to manage their own independent arrangements. If their needs are not being appropriately met this may mean helping families to make other arrangements or arranging services to be provided directly.
7. Direct Payments through a Carers Assessment
The Purpose of Direct Payments for Carers
Direct Payments enable carers to purchase services they are assessed as needing to support them in their caring role. Direct Payments can give carers, the flexibility they need to find solutions to their particular situation
Eligibility for Carer assessment Direct Payments
Only carers who are providing regular and substantial care, and who are therefore eligible for a Carers Assessment, can be considered for a Direct Payment. Direct payments can not be set up without a Carers assessment taking place.
Assessments for Carers
'Regular and substantial care' is not defined in government guidance but local authorities are asked to help carers to think about the impact that being a carer is having on their lives; whether or not the situation is sustainable; what support might be useful in the circumstances. The Carers (Equal Opportunities) Act 2004 requires that local authorities consider the impact on the carer with regards to their ability to do paid work, to their chance to study or to have any leisure time.
Young carers should be assessed as children in need under the Children Act 1989. However there are a small number of circumstances where it might be appropriate for a 16 or 17 year old young carer to have a direct payment. A young person who is looking after a terminally sibling for example, may benefit from a direct payment in order to have a break.
The Use of Carer Direct Payments
A carer can receive a direct payment to purchase a 'carers service'. The 'Carers and Disabled Children Act 2000' does not define 'carers services' but suggests they can be anything that could 'Help the carer care for the person cared for'.
Local authorities are asked to be flexible and innovative when considering a Direct Payment. The focus should be a service that: "the carer would value in terms of supporting them in their caring role and maintaining their health and well-being" Examples given in the Practice guidance of the Carers Act include: help with housework; laundry; training; gardening; driving lessons; travel assistance (including for instance help with taxi fares).
8. Advice and Support for Parents, Carers and Young People
Ability to manage a Direct Payment is not an all or nothing concept, and is related to motivation and the support an individual will require. It can also vary over time depending on the family circumstances and the demands made upon them. In the same way as anyone might use a solicitor or accountant to assist with their affairs recipients of Direct Payments may choose and agent, e.g. a family member, to assist them to manage the payments.
The City Council funds Peterborough Community Voluntary Services (PCVS) to provide a Direct Payments Support Service. This is available to all Direct Payment recipients who choose to use them. PCVS have a role in helping people to understand what is involved and to consider how they might be able to manage these responsibilities themselves or with appropriate assistance. Contact details for PCVS and a full description of the support and services they offer to parents, carers and young people can be found in Direct Payments Support Service - Peterborough Community Volunteer Services. Booking an appointment for the family to meet with PCVS is an integral part of the process of setting up a Direct Payment arrangement.
Other guidance for families is also available in the Contact a Family Guide for Parents "Getting Direct Payments for your Child"
and
Scope's guide to Direct Payments for Young People "my money, my way"
If it is not possible to put in place enough support to enable the family to manage Direct Payments successfully then a Direct Payment should be refused.
If the assessor decides that someone would not be able to manage Direct Payments successfully it is good practice to discuss the reasons with the person and to advise him/her of the complaints procedure
9. Care and Service Planning and Direct Payments
Direct Payments may be used at the same time as other community or carers services including in house and agency care. It is not an 'either-or' option. The Service Plan must set out those needs to be met through Direct Payments, and those which the assessor will arrange to be met through service providers.
The needs to be met through Direct Payments should be listed as follows:
- The total weekly number of hours of assistance to be purchased using Direct Payments, and/or
- The annual number of short breaks (respite weeks/days) and/or
- The description of the activity
- Any one off payments to carers
- Assessed need for transport
- Assessed need for equipment for daily living
10. Reviews
All reviews for people purchasing their assessed social care services using Direct Payments will follow the departmental review procedures. Any concerns arising from the financial returns submitted by recipients or failure to submit these returns should be taken into account at this review.
The following questions should be considered by the social worker to help determine whether Direct Payments remain a viable service option:
- Has the person's needs changed?
- Is the amount of the money sufficient to enable the person to secure the relevant services?
- Is the person still able to manage the Direct Payments?
- Does the person wish to continue receiving Direct Payments?
- Has the money been spent on the services for which it was intended?
- Have the services for which the service user has paid been received?
Has there been a break in service for example where the worker has left or he/she has been unable to provide a service for a significant period of time.
11. Employment of Relatives as Direct Payment Carers
Relatives who live in the same household
As a general rule of thumb Direct Payments cannot be used to employ a close relative or partner who lives in the same household as the recipient of the Direct Payment.
The DoH Direct Payments Guidance 2003 states:
'Unless a council is satisfied that it is necessary to meet satisfactorily a persons needs a council may not allow people to use Direct Payments to secure services from a spouse( husband or wife) , from a partner( the other member of an unmarried couple with whom they live) or from a close relative (or their spouse or partner ) who live in the same household as the Direct Payment recipient'
In this context a close relative is a parent, parent -in - law, aunt, uncle, grandparent, son, daughter, son-in-law, daughter- in- law, stepson or daughter, brother or sister.
This restriction is not intended to prevent people using their Direct Payments to employ a live in personal assistant, provided that that person is not someone from the above list. The restriction applies where the relationship between the two people is primarily personal rather than contractual.
A Direct Payment will only be considered for employing a relative or partner living in the same household where circumstances are exceptional and this is the only satisfactory way of meeting the need.
This will probably be the case because of e.g.:
- Communication difficulties - including foreign language only spoken
- Cultural needs
- Complex care needs
- Emotional and behavioural needs
- Terminal care
- Inability to recruit other personal assistants ( may be a temporary arrangement whilst efforts are made to recruit an alternative carer)
The local process for approving Direct Payments to employ a relative living in the same household in exceptional circumstances is as follows.
The social worker through his/her team manager should put forward a written submission to their Service Manager which should confirm and describe the following:
- The specific exceptional circumstances
- That this is the only satisfactory way to meet the need and all other options have been explored
- Both the recipient and carer would enter the arrangement freely and without coercion
- A carers assessment has been completed
- The carer has received information about any changes this would mean for any benefits they receive
- It is lawful
- It is cost effective
A decision to allow a close relative in the same house to be employed with Direct Payments should only be made by the Services Manager on the basis that the circumstances are exceptional and that there is no other reasonable alternative to satisfactorily meet the child's care needs.
Relatives who do not live in the same household
Direct Payments exist to enable people to have more choice and independence. They can choose to employ whom they like. However, sometimes the service user's freedom of choice may be compromised by pressure to employ a relative when a non-relative would enable them to be more independent. This may be particularly pertinent for a young person aged 16/17.
It is good practice to discuss the pros and cons of employing a relative with the user at the outset. For some people, employing someone they know is the right option. But of others, thinking through the alternatives may take a bit of time and support. Encouraging people to try non family assistance first before opting for family or stressing the benefit of keeping relatives available for back up service would be ideas to consider.
PCVS can give independent advice to service users of the potential difficulties surrounding employment of people they know well.
12. Safeguarding Children and Young People
Criminal Records Bureau Checks
It is not lawful for a local authority to insist that a CRB check is acquired for a carer, personal assistant or befriender employed by parents or young people using their Direct Payments.
However the local authority has to be satisfied that:
- The child's needs for the relevant services as revealed by the assessment can be met by securing the provision of such services through a Direct Payment.
- The welfare of the child will be safeguarded and promoted through a Direct Payment being made.
Peterborough City Council strongly recommends that families request a Fully Enhanced CRB check for all their employees. The reasons for this should be explained to the family. If the parents or young person are unwilling to request a CRB check the local authority must consider whether this is likely to put the child at risk bearing in mind, for example:
- Whether the potential employee has a current CRB disclosure document through another employer
- How well the family knows the carer
- Whether the carer has experience of looking after the child or other children with disabilities
- Whether there are any risk factors and child protection issues concerning the child that are already known to the authority
- Any information or intelligence that the authority is aware of, that indicates the person may not be an appropriate person to care for the child or provide them with a positive experience in terms of the short break.
If the social worker and his/her manager have reason to believe that the child may be put at risk, or their welfare not promoted, then they must refuse to make Direct Payments.
Parents should be made aware that a CRB check alone does not guarantee that a person is suitable and that taking up references is also strongly advised.
NB When involved in setting up a Direct Payment all staff must ensure they do not recommend or introduce particular prospective carers, personal assistants or befrienders to Direct Payment users. This practice could expose the social worker/care assessor and the City Council to litigation in the event of problems arising out of this employment.
13. Direct Payments and Childminding Regulations
The statutory requirements for carers of children under 8 apply in the case of Direct Payments as they do for all other children. If a Direct Payment is made to enable a parent to pay a carer to look after a child under 8 years old in the carer's home for more than two hours a day, the carers must be registered as a child minder. The exceptions to this are if the carer is a relative of the child, a registered or private foster carer, or only looks after the child between the hours of 6pm and 2am, or during the day for less than 5 days a year.
Workers should explain the requirements to parents if arrangements are being made for a Direct Payment for a child under 8 to be cared for in the carer's home - and also should direct them to the council's list of registered childminders.
Childminders may be registered by Ofsted to look after a child for overnights, provided they meet additional registration criteria.
Carers who look after children under 8, in the child's own home for payment, have to be registered with Ofsted as a home child carer if the parent is claiming the working child tax credit towards the cost of their child's care.
14. The Level of Payment
The amount offered must be sufficient to enable the recipient to lawfully secure a service of a standard and at a level which Peterborough Children's Services considers reasonable to meet the recipient's assessed needs. In legislation there is no maximum or minimum amount of a Direct Payment either in relation to the amount of care to be purchased or the value of the payment itself.
Peterborough Children's Services will not fund the cost of a family's preferred package, if the costs of that package exceed the Directorate's estimate of the reasonable cost and the service can be secured more cheaply, whilst still meeting the required standards. Thus if, for example, the family wishes to use the services of a specific agency and another agency can provide an equal level of service of equal quality, at a lower cost, the Directorate will only fund to the level of the lower cost. If the family wish to use the higher cost agency they may pay the difference out of other monies.
In essence the amount of Direct Payment must be sufficient to allow the recipient to secure services appropriate to his or her assessed needs. The amount of the Direct Payment should reflect the true cost of providing the services outlined in the care plan to an adequate standard, including any overheads and taking account of any health and safety needs identified by the risk assessment.
The Directorate is entitled to set an upper limit on the hourly rate payable. There are occasions when this ceiling will have to be exceeded, as it will not always be sufficient to meet the actual costs of securing an adequate service. It may not be possible to recruit staff at the standard rate if the family requires staff with specialist skills or experience, for which payment at a higher rate is required. Each case must be treated on its merits.
Best Value
Best Value principles also apply and this often means using the least expensive service which meets quality standards. However there will be occasions when paying a higher price may be justified if there are additional factors which make it cost effective. Examples might be that the higher cost is justified by the extra benefit of enabling the young person with a disability or family to manage their own services and live independently, or helping a family through a crisis. Higher costs, or increased levels of service, during a crisis might be acceptable if the payments prevent someone having to become Looked After, as this would be cost effective in the longer term.
15. Calculating the Direct Payments Package for Families who Employ Carers for their Children with Disabilities
Care in the child's home- domiciliary/sitting/independence activities /personal care
Multiply the standard hourly Direct Payment rate by the number of assessed hours
Care outside the child's home- day care/child centred respite) /inclusion & independence activities
Multiply the standard hourly Direct Payment rate by the number of assessed hours
FISH insurance costs
At the level of the annual premium charged.
Transport costs
Transport costs can only be paid where provision for transport forms part of the care plan. If a child is being transported by a private vehicle the payment is at the current mileage rate. For other forms of transport the Direct Payment is the actual cost of the journey(s).
16. Direct Payments for Young Disabled People aged 16 and 17
Important issues for consideration when offering a Direct Payment to a young disabled person
Transition to adulthood
For any young person (with or without an impairment) the process of growing up involves the gradual taking on of more and more responsibility for himself or herself. As part of the transition to adulthood, some young people may wish to have a Direct Payment to manage parts or all of the elements of their care package. This option should be explored at an appropriate time during the Transition Planning Process which will start from age 14.
Planning and the Direct Payment option
Once needs have been assessed and services/funding agreed, consideration must be given to making interim arrangements where necessary. Always bear in mind that recruiting a carer can take months and families should not be left without services in the meantime. Sometimes parents will prefer to avoid too many changes and will not wish to have temporary arrangements but this must be discussed with them.
Issues to consider when planning services in partnership with parents and young people remain the same when Direct Payments are being discussed:
- the family is usually the natural and most appropriate place for the young person
- local councils work in partnership with parents, while
- recognising that young people are individuals with their own wishes and feelings.
In making decisions about Direct Payments to 16 and 17 year old disabled young people the social worker should balance, as they do now (in relation to providing services) the young person's wishes and feelings and the views of those with parental responsibility. The overriding requirement is that the intervention of the Local Authority, whether by providing a service or a Direct Payment, should promote and safeguard the welfare of the young person.
Young people who receive Direct Payments may also find it helpful to have access to advocacy support. This should be separate from any support/advocacy provided to their parents. Advocacy is available from the following organisations:
- National Youth Advocacy Service - 0800 616 101
- Speaking Up - telephone 01223 566258 or Speaking Up website
Where there is a difference of views between parents and disabled young people aged 16 and 17 and provided that the young people have sufficient understanding to make informed decisions, the Local Authority should give precedence to their views. It follows that there may be situations where it would be right for a young person to receive a Direct Payment whether the parents agree or not.
There will also be situations where a disabled young person will express a wish to manage a Direct Payment but it is apparent to their parents and to the Local Authority that they do not, at the moment, have the capacity to exercise this level of control in a way that will promote their welfare.
Legal issues concerning a minor entering into a contract as an employer need to be taken into account when seeking to make a Direct Payment to a young person under 18 years old. Young people under 18 have restricted capacity to enter into contracts in law and legal advice on a case by case basis must be sought from the Council's Legal Services in all instances where an individual Direct Payment to a young person aged 16 and 17 is being proposed.
In most cases young disabled people will have a parent or carer who is able to act on their behalf and take legal responsibility from an employer's perspective.
Mixed package of support
The Direct Payment does not have to be made for all the services the young person receives. There may be some situations where providing a mixed package of support that allows the 16 or 17 year old to manage some elements of the care package will be in the young person's best interest at this time. The young person can use the experience of managing the delivery of one or two services to develop life skills so that as time goes on they can make more choices about the way support for them is delivered. The Carers and Disabled Children Act allows for the parent carer to continue getting some services direct or indeed also to have Direct Payments to purchase support that meets the needs of the disabled child and family. This right will remain for parents until the young person's 18th Birthday.
Within Peterborough, Children's Services continue to manage services for young disabled people until their 18th birthday when they are to be assessed for services through Adult Social Care. Social workers from the Adult Service will become involved with the young person's case when they reach 17 to increase the chances of a smooth transition.
Ability to manage a Direct Payment
An authority should only offer Direct Payments to a disabled 16 or 17 year old whom it considers will be able to manage them (alone or with assistance). Such judgements should be made on a case-by-case basis, taking into account the views of the individual disabled young person, as well as the views of the parents and health or Education professionals as appropriate. The ability to indicate preference and choice is key to decision making.
To help evaluate any potential risks please use the Direct Payment Support Matrix which balances level of understanding and ability to make responsible decisions against the support in place. If the DP Support Matrix shows a high score (12 or more) then a formal risk assessment should be undertaken.
PCVS can help identify any available support. It is good practice to share any risk assessment with the young person/people involved. If the risks cannot be minimised to an acceptable level a Direct Payment should not be made.
Disagreement
Where there is a disagreement about the young person's ability to manage all or part of a Direct Payment this should be recorded on the young person's file together with the views of other involved professionals, parents and the young person themselves. It may be sensible to set up a 3-month trial period to see if any problems arise and if they can be dealt with. A review of the trial period should take account of the young person's vulnerability generally but particularly in relation to getting into debt through managing a Direct Payment.
Support to manage the Direct Payment
A decision about whether someone is able to manage a Direct Payment should be made with regard to the degree of management required. For instance the ability to manage the whole of the support package requires a different level of management skill than the ability to manage just part. If the conclusion is that someone could only manage Direct Payments with help, we should ensure that adequate help is available. PCVS are able to support both parents and young people (Please see Direct Payments Support Service (Tri-x add link). The young disabled person may choose to ask family or friends, advocacy or other support groups to help them. Other adult experienced Direct Payment users are likely to provide good role models for first time Direct Payment users. Direct Payment users often choose to seek practical support from a payroll service such as is offered by PCVS.
Other guidance is available in:
Scope's guide to Direct Payments for Young People "my money, my way"
Contact a Family Guide for Parents "Getting Direct Payments for your Child"
17. Direct Payments for Equipment
A Direct Payment for equipment, as for other Direct Payments, can only be made following
- an occupational therapy assessment and agreement that the family has eligible needs for equipment, and
- a recommendation made by a suitably qualified member of staff about the type of equipment required.
The amount of the Direct Payment should be the actual cost to the service user of the basic piece of equipment which is recommended to meet their assessed need. If the user wishes to purchase equipment of a higher specification then they must fund the higher cost themselves and the equipment chosen must still be capable of safely meeting their assessed need.
A Direct Payment cannot be made to purchase equipment that the Health Authority should pay for and/or provide.
Some possible target areas for Direct Payments for equipment are :-
- specialist chairs and high chairs
- postural seating
- bathing aids
- ceiling track hoists
- commodes
- shower chairs
- movement sensors
- sensor alarms
- cost sides
- telecare
- personal equipment that promotes independence and enable short break opportunities
- maintenance, servicing and insurance of equipment (so that equipment can be used safely)
The legislation allows for local authorities to seek repayment of the money if the Direct Payment has not been used to obtain the type of service or equipment for which it was intended. This is not intended to penalise genuine mistakes, as opposed to wilful misuse of the money.
As part of the process of informed choice in Direct Payments, the local authority via the care manager/ OT must satisfy themselves that recipients and potential recipients are aware of health and safety issues that affect them as individuals, anyone they employ and anyone else affected by the manner in which their support is delivered e.g. informal carers/ members of the same household).
Therefore any risk assessments that were undertaken as part of the care management assessment should be shared and recommendations should be given about the maintenance of the equipment and accessing basic training in how it should be used. Any costs associated with the maintenance of, and training to use the equipment should be reflected in the amount of the Direct Payment.
Once equipment has been purchased using a Direct Payments it then becomes the property of the service user. The service user or their representative is therefore responsible for arranging maintenance, staff training etc.
If the assessed needs change and the equipment is no longer required, the service user or their representative can either dispose of it themselves or ask us if we wish to re-cycle it.
A Direct Payment for equipment, like all other Direct Payments, gives much greater flexibility and choice to the user but also remains a care managed service and so remains subject to the same requirements to review as a directly provided or purchased service.
18. Complaints
If the family is not happy with a local authority decision regarding Direct Payments, and the issue cannot be resolved by the social work team manager, they should be directed to use the Council's complaints procedure.
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