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1 10. You keep records of DP spend, and allow us to check the records regularly. If there are any problems with your DP spend, we will work together to try to resolve them. 9. You buy the support and services agreed in your support plan. RB Greenwich will help you do this, and will help you to recruit your own staff, if this is what you want. 8. RB Greenwich will set up the DP for you, and make regular payments into your DP bank account. 7. If you decide to proceed with a DP, the broker will help you fill in all the paperwork. 1. You are eligible for a personal health budget (PHB) and are interested in having a direct payment for healthcare. 6. The broker will explain the DP process, and how it works. This will include information about the different types of DP account, and your responsibilities for managing a DP. 2. We have to agree that you are willing and able to manage a DP, with support if necessary. 3. You can ask someone to manage a DP for you, if you like (a nominee). We would have to agree that the person is suitable. 4. With your consent, we refer you to the care brokerage service for children and young people at the Royal Borough of Greenwich. 5. You will be contacted by one of the care brokers from RB Greenwich. The broker will explain more about DPs for healthcare. Introduction This is the direct payments (DP) for healthcare process for children and young people eligible for NHS Continuing Care in Greenwich. Notes on each step of the process can be found on the following pages. This process needs to be read alongside the personal health budgets (PHB) process for children and young people, as taking a DP is simply one way of managing a PHB. This process is under 18 years old. Where we say you, this means the child or young person and/or his/her parent/s. The process is new to all of us. Please bear with us as we test it out and make it better. 1

2 1. You are eligible for a personal health budget (PHB) and are interested in having a direct payment for healthcare. 2. We have to agree that you are willing and able to manage a DP, with support if necessary. 3. You can ask someone to manage a DP for you, if you like (a nominee). We would have to agree that the person is suitable. You are eligible for a personal health budget and direct payment (DP) for healthcare only if you are eligible for NHS Continuing Care. A DP for healthcare is one way of managing a PHB (see PHB process for other options). Choosing a DP means you are deciding to take direct control over the NHS money available for your care and support, and will find and buy your own support services from independent service providers. If you wish to employ your own care workers or personal assistants, taking a DP is the only way of doing this. There is lots of support available to help you manage a DP for healthcare. If you decide you want a DP, we have to agree you are willing and able to manage it. By willing, we mean that you want a DP. By able, we mean that you understand what s involved in managing a DP, and you have the skills to manage your DP effectively, possibly with help from someone else. If we don t think you re able, we will tell you, and explain the reasons why. Where someone does not have capacity or is under the age of 16 and cannot receive a DP directly, a representative may be appointed to receive and manage the DP on the person s behalf. This person would take on all the responsibilities of the DP recipient. Oxleas (in consultation with the CCG) will need to agree whether a proposed representative is suitable. We will require a DBS check for any proposed representative who is not a close family member living in the same household, or friend involved in the DP recipient s care. If you have capacity, you can ask someone else to manage your DP. This person would be your nominee. Your nominee would need to be willing and able to manage the DP, and would need to understand the responsibilities involved. If you wanted to employ someone with your DP, your nominee would become the employer. In other words, a nominee takes on all the responsibilities that you would carry, if you managed the DP yourself. Oxleas (in consultation with the CCG) will need to agree whether a proposed nominee is suitable. We will require a DBS check for any proposed nominee who is not a close family member living in the same household, or friend involved in the DP recipient s care. 2

3 4. With your consent, we refer you to the care brokerage service for children and young people at the Royal Borough of Greenwich. 5. You will be contacted by one of the care brokers from RB Greenwich. The broker will explain more about DPs for healthcare. 6. The broker will explain the DP process, and how it works. This will include information about the different types of DP account, and your responsibilities for managing a DP. The Royal Borough of Greenwich care brokerage service sets up and makes direct payments (DPs) for healthcare for children and young people on behalf of NHS Greenwich CCG and Oxleas. We will refer you to RB Greenwich only with your consent, and we will ask for your consent to share your support plan at the point of referral. The care broker will need to see your plan to help with setting up your DP. The duty telephone number for the RB Greenwich care brokerage service is , and the address is There is no charge to your DP for services provided by RB Greenwich. On receiving the referral, RBG care brokerage will send you a letter confirming the referral, and will also send you information about DPs. The care broker will then contact you to arrange an appointment to go through all the information in detail. The care broker can advise you first by phone, if you like. You can then arrange for the broker to visit you in your own home or at RBG Woolwich Centre, and you can have someone else present if you wish. If you think you might want to ask someone else (a nominee) to manage your DP, it would be helpful if this person was present at the meeting with the care broker. Taking a DP may mean opening a current bank account into which your regular (4-weekly) DP payments will be made in advance. Unless your DP is a one off or single payment in a 12-month period, you cannot have your DP paid into your own personal bank account. There are two types of DP account offered an own account and a holding account. If you choose the own account, you will have to open the DP current bank account and manage all the financial transactions yourself. If you choose the holding account, RB Greenwich will open a DP current account for you, and will manage the financial transactions for you, following your instructions. This is much less work for you, at no cost to your PHB. There are other responsibilities that come with managing a DP, and you will have to sign a DP agreement with Oxleas to confirm that you agree to meet your responsibilities. We will explain everything to you, so you understand what is involved. 3

4 7. If you decide to proceed with a DP, the broker will help you fill in all the paperwork. 8. RB Greenwich will set up the DP for you, and make regular payments into your DP bank account. 9. You buy the support and services agreed in your support plan. RB Greenwich will help you do this, and will help you to recruit your own staff, if this is what you want. Once you have all the information you need, you can then decide whether to proceed with a DP. If you decide to proceed, the care broker will help you to complete all the relevant forms and paperwork, so that setting up the DP is as easy as possible. This will include asking you to sign the DP agreement. Deciding whether to take a DP can be a bit stressful for some people. So it s important to say that if you decide to try the DP option, but find it doesn t work for you, or the responsibilities are too much for you to manage, you can always change your mind later. But many people feel that taking a DP is the only way they can have the level of control over their support that they want. Once all the DP paperwork has been completed, the care broker will set up your DP. This means you will have an electronic record on the RBG system, as well as on the Oxleas system. If you ve chosen an own account, we will not be able to make payments to you until you have set up your DP current bank account. Payments will not begin until we know how your day-to-day support will be provided, and Oxleas has agreed these arrangements. When Oxleas is happy with the support arrangements you propose to put in place, Oxleas will enter the DP agreement start date (on the copy bearing your signature), sign and date the agreement, and send you a copy. Once your DP has been set up, you will buy and manage the support and services agreed in your support plan. RB Greenwich care brokers will help you find and purchase the services you want. This will include helping you to recruit your own staff, if you wish. There will be no charge to your PHB for support from RBG care brokers. If you choose a holding account and employ your own staff, RB Greenwich will also do your staff payroll, and will make relevant tax and national insurance contributions to HM Revenue and Customs. There will be no charge to your PHB for this service. However, if you choose an own account and employ your own staff, you will need to use a payroll service from an independent service provider, the cost of which will be met from your PHB. 4

5 10. You keep records of DP spend, and allow us to check the records regularly. If there are any problems with your DP spend, we will work together to try to resolve them. You must keep records relating to payments made into your DP account, and of how you spend your DP. These records must be kept for 6 years, by law. You must allow us to inspect and check these records, as your DP comes from public funds, and must be audited, like all public funds. If your DP account is an own account, you must keep all bank statements, cheques and paying in books, invoices and receipts, and all other records relating to your DP income and spend. If you employ staff, this will include keeping PAYE, NI and other payroll records. If you have a holding account, RB Greenwich will be able to monitor spend continuously. But you will need to keep any records (such as payroll) for any DP financial transactions not carried out by RBG on your behalf, as well as keeping copies of any invoices not seen by RBG, where you have instructed them to make payments. If we have any concerns about how you are spending your DP, we will raise them and discuss them with you, and try to resolve them. However, we may stop a DP if we have concerns about your ability to manage it effectively. And we will definitely stop your DP and may seek to recover monies from you, if you intentionally misuse the funds. If more than 8 weeks worth of DP funding builds up (accumulates) in your DP bank account without being spent, this will automatically trigger a conversation with you, so we can discuss the reasons. 5

6 These are the things which NHS England (NHSE) says PHBs (and DPs for health care) can t be spent on NHSE PHB exclusions Emergency or acute health (hospital) services Primary care (including GP) services Optical, dental or other charges which everyone has to pay (unless exempt) Prescription charges which everyone has to pay (unless exempt) Gambling Debt repayment Tobacco, alcohol or any other drugs Day to day living expenses. And if you need any of these health services, they will be arranged for you, not paid for from your PHB or DP Local health services outside PHB scope School nursing Special school nursing Health visiting Speech and language therapy, occupational therapy, physiotherapy and music therapy Audiology Community paediatric services Short breaks Child and adolescent mental health services Clinical training for carers and care workers 6

7 Other important points to note about PHBs and DPs for healthcare DPs for healthcare can be used to pay for permanent residential or nursing home care. But NHS England has advised that there may not be significant benefits in doing so, and using PHBs in this way may increase costs, as private individuals often pay more for residential or nursing home care than the NHS. If you would like to use your DP to pay for permanent residential or nursing home care, we will need to explore issues of costs and benefits with you, and decide whether it is likely to be cost-effective. Unlike social care, where nominees can carry out only some of the functions DP recipients would carry, where DPs for healthcare are concerned, nominees take on all the responsibilities which DP recipients themselves would otherwise carry. This includes being the principal for any contracts with service providers, and the employer of any staff paid for with the DP. It is important that all nominees are aware of this, as it may affect their willingness to take on the role. If someone has to be registered with a professional body to carry out their professional duties lawfully (eg nursing), you cannot employ someone or buy their services with a DP if they are not registered (with the relevant professional body). If you wanted to buy a service which the National Institute for Health and Care Excellence (NICE) says is not cost-effective, you would have to get permission from NHS Greenwich CCG under its usual exceptions procedure. You may not use a PHB or direct payment to pay a close family carer living in the same household. You would have to ask NHS Greenwich for permission, if there were special circumstances (for example relating to your culture or religion) which meant your needs could only be met appropriately in this way. If you decide to employ your own care workers, you must meet all the legal requirements of being an employer. Local services will be able to help you with this. We strongly advise you to have DBS (Disclosure and Barring Service) checks carried out on anyone you propose to employ with a direct payment, as this will tell you whether the person has a criminal record, and whether s/he is barred from working with children and vulnerable adults. If you decide not to have DBS checks carried out, this may give rise to significant safeguarding concerns on our part, and may impact on our willingness to sign off your support plan. To make it as easy as possible for you, RB Greenwich will arrange for the DBS checks to be carried out, at no cost to your PHB. We aim to ensure your support plan is put into action within 28 days of you being referred to us for assessment. If you choose to work with an independent support planner, and/or to take a DP for healthcare and employ your own staff, it may take longer to put your preferred support arrangements in place. If you need a short-term (interim) package of support in the meantime, this will be arranged for you by the NHS. DPs are paid into your DP current bank account 4-weekly, in advance. If a surplus of 8 weeks funding accumulates in your account, we will discuss with you why the surplus has accumulated, and whether your DP value needs to be adjusted. If you do not need all your DP funds, we may ask you to give some of the surplus monies back to us. You cannot top up or add to your PHB with your own or someone else s money. There are further, detailed national rules about PHBs and DPs for healthcare. These can be found at:- Regulations_March_2014.pdf You won t be on your own if you take a DP for healthcare. We re here to help you, and will support you through the process. Document ref Greenwich PHB direct payments process information for parents and young people short v1 Feb

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