Direct Payments Information and Guidance 2015

Transcription

1 Direct Payments Information and Guidance 2015 Date: 8 April 2015 Version:1 Page 1 of 11

2 Partners in Care This is a controlled document. It should not be altered in any way without the express permission of the author or their representative. On receipt of a new version, please destroy all previous versions. Document Information Date of Issue: 1 April 2015 Next Review Date: 1 April 2016 Version: V1 Last Review Date: Author: Nicola Barker Owner: Directorate: Operations Approval Route Approved By:Finance and Operations Committee Date Approved:8 April 2015 Links or overlaps with other strategies/policies: Care and Support Planning Personal Budgets Review of Care and Support Plans Amendment History Issue Status Date Reason for Change Authorised Version:1 Page 2 of 11

3 1. Introduction What are Direct Payments? Individual Financial Contribution Who can provide care? Managing Direct Payments Exceptional Circumstances How will Direct Payments be paid? Evaluation Setting up a Payment: Temporary suspension and discontinuing of Direct Payments Recovery of Direct Payments Refusal and ending Complaints... 9 Appendix Version:1 Page 3 of 11

4 1. Introduction 1.1 The purpose of this document is to set out our policy for Direct Payments for adults and to provide standard operating procedures along with guidance about using Direct Payments to provide and manage agreed care and support arrangements. 2. What are Direct Payments? 2.1 A direct payment is a sum of money paid to a customer to meet all or some of their care and support costs. 2.2 A Direct Payment is one of the ways for people to receive their personal budget and gives them the greatest level of choice and control over the services they receive. The benefits of using Direct Payments should mean that: People have greater choice and flexibility over how and when their support needs are met. People have more control over their life and the way they choose to live it. People can choose support that helps them to remain more independent. People can choose who provides their care. 2.3 People who receive Direct Payments therefore take responsibility for arranging their services, managing the money and employing staff where required. There is help available to do this from a range of statutory support services available such as HMRC, ACAS, Skills for Care and they can have a nominated or authorised person. 2.4 A member of the Health and Social Care team will talk to the Individual about Direct Payments during their assessment and/or review and help them to consider the advantages and disadvantages of this option. A Direct Payment can only be used to purchase items and services that are legal, will meet assessed needs and have been agreed in a person s support plan. 2.5 The amount of personal budget that an Individual may receive will be determined by their eligible needs and an appropriate support plan. 2.6 Once the individual has been assessed as having eligible care and support needs, they will be asked if they want to receive their personal budget as a direct payment. 2.7 For self-funders, the Trust will not make a direct payment, but will provide support in managing their care and support planning. Version:1 Page 4 of 11

5 3. Individual Financial Contribution 3.1 The Individual will have a financial assessment to determine their contribution for their Social Care services in the same way as if they were having services directly arranged for them. This only applies to people aged 18 years and over. 4. Who can have Direct Payments: Legal Context and Regulations 4.1 Any disabled person or their carer aged 16 years or over or the parent of a disabled child under 16 who is eligible for Care and Support services and is both willing and able with appropriate assistance to manage the scheme. Direct Payments were introduced for adults through The Community Care (Direct Payments) Act They are now governed through Care Act 2014 section 26. The Care and Support (Personal Budget Exclusion of Costs) Regulations 2014 provides further updates 4.2 The Department of Health published Care and Support Statutory Guidance in October This requires the ability to meet needs by taking a direct payment must be clearly explained to the person in a way that works best for them, so that they can make an informed decision about the level of choice and control they wish to take over their care and support. This is supported by fact sheet 4 Personalising care and support planning An assessment of an Individual s care needs is required to determine eligibility before Direct Payments can be offered. Whilst people should not be forced to have Direct Payment, this option must be offered to all those who meet the criteria for eligibility. 4.4 However, a request for needs to be met via a direct payment does not mean that there is no limit on the amount attributed to the personal budget. There may be cases where it is more appropriate to meet needs via directly-provided care and support, rather than by making a direct payment. For example, this may be where there is no local market for a particular kind of care and support that the person wishes to use the direct payment for, except for services provided by the local authority. It may also be the case where the costs of an alternate provider arranged via a direct payment would be more than the local authority would be able to arrange the same support for, whilst achieving the same outcomes for the individual. 4.5 Consideration should also be given as to whether the personal budget is sufficient where needs will be met via direct payments, especially around any other costs that may be required to meet needs or ensure people are complying with legal requirements associated with becoming an employer for example DBS checks. Version:1 Page 5 of 11

6 4.6 The Trust has a legal responsibility to review the care and support plan to make sure that the adult s needs and outcomes continue to be met over time. If anything has changed, the Trust must carry out a new assessment. The person themselves also has the right to request a review of their care and support plan, if they wish. 5. Who can provide care? 5.1 The following options can be considered; Personal Assistants. The responsibility for employing personal assistants (enablers or carers) becomes that of the Individual or their nominee/s when direct payments have been agreed. Personal Care Agencies, where the responsibility for employing the care staff remains with the agency. 5.2 A direct payment should not be used to secure services from a close relative, spouse or partner unless the Trust is satisfied that: This is the only way to satisfactorily meet the person s care and support needs Securing a service from such a person is necessary to promote the welfare of a child in need. In such cases there should be approval from the General Manager. A written explanation as to why the care is not able to be provided in another way should be fully recorded and given to the Individual in writing including the expectation that this arrangement will be reviewed. 6. Managing Direct Payments 6.1 The individual can nominate someone to manage the direct payment on their behalf. If the individual lacks capacity, then anyone authorised under the Mental Capacity Act 2005 can provide support. In both cases, the Trust must be satisfied that the nominated or authorised person will act in the individuals best interests. 7. Exceptional Circumstances 7.1 The Regulations state that a family member or partner living in the same household cannot be used to provide services including Personal Assistance unless the Trust is satisfied that it is necessary to do so to meet the assessed needs of the Individual. These are considered exceptional circumstances and must be agreed by the Trust in writing stating what the exceptional circumstances are, how the needs and outcomes of the Individual will be met Version:1 Page 6 of 11

7 and when these circumstances will be reviewed. It is the responsibility of the Health and Social Care Worker to have the discussion about who the Individual will be employing when completing the Support Plan and to make the necessary referrals. See appendix 1 8. How will Direct Payments be paid? 8.1 The Individual or the authorised person nominated to receive the Direct Payment will need to sign a Direct Payment Agreement. The Agreement will specify how much Direct Payment they will receive, provide an overview of the support plan showing how the money is split if it is used to buy different services, the date it will start and how much their contribution will be which will be deducted from their gross weekly Direct Payment. Payments are made two weeks in advance into a specific Direct Payment Account or onto their Torbay Card should this be developed in Torbay. 8.2 Single or one off payments can be given, this is usually required where equipment is provided and/or for some carers services. Where a single or one off payment is given a single payment agreement should be used, it will not be necessary to open a separate bank account in this instance. 8.3 Financial monitoring will be conducted by the Finance Team who will request a summary of expenditure and copies of bank statements relating to the Direct Payment account, the Finance Team will inform the Individual how often they will require this information. The Finance Team will evaluate the information and if there are any issues that cannot be resolved they will refer back to the zone team to assess the suitability of the Direct Payment. Where significant balances of more than 8 weeks money have accrued the Finance Team will reclaim the excess from the account and make a referral to a Health and Social Care Worker who will arrange to visit to review the arrangements for the scheme. 9. Evaluation 9.1 Outcomes within the support plan will be overseen by the Health and Social Care Worker. Please refer to the Trusts Assessment and Eligibility Policy. 10. Setting up a Payment: 10.1 The Individual or their nominated/ authorised person managing the Direct Payment must consent to being the recipient and must be made aware that if they choose to employ Personal Assistants they will be subject to the requirements of being an employer. Version:1 Page 7 of 11

8 Once the Individual or nominated/ authorised person has been agreed Health and Social Care staff should follow the Direct Payment Process set out in appendix Temporary suspension and discontinuing of Direct Payments 11.1 If the Individual or the Trust decides to suspend or discontinue Direct Payments the Individual or their nominated/ authorised person would be informed in writing in advance of the payments being stopped. The letter would include an explanation of why the payments are being stopped, how long they will be stopped for and the date payments will stop When Direct Payments are stopped temporarily or permanently careful consideration should be given to any continuing contractual responsibilities for staff. 12. Recovery of Direct Payments 12.1 Where it is necessary to recover the unspent Direct Payment careful consideration should be given to what contractual responsibilities the recipient has when determining any balance to be paid back to the Trust. If there are difficulties recovering the money the Trust may instigate the Trust s debt recovery procedure. 13. Refusal and ending 13.1 If following an assessment the Health and Social Care Worker concludes that someone is not willing or able to manage a Direct Payment with or without the assistance of another person or that such an arrangement is not justifiable in terms of cost effectiveness or quality the Trust can refuse to provide a Direct Payment. The Health and Social Care Worker should inform the Individual in writing to explain the reason. If at any time a Health and Social Care Worker becomes aware that Direct Payments are not being managed effectively and /or the assessed needs identified in the support plan are not achieving the agreed outcomes the following steps should be taken: Discuss the concerns with the recipient and outline the Trust s responsibility to ensure that care needs are met and that the Direct Payment is used appropriately. Ensure the recipient has access to any support or assistance that would be required to rectify the situation. Give notice in writing to the recipient that consideration must be given to replacing Direct Payments with services purchased directly by the Trust. Version:1 Page 8 of 11

9 Inform the service Lead and /or General Manager as well as the Trust s Finance Team. 14. Complaints 14.1 Current complaints provision for care and support is set out in regulations. The provisions of the regulations mean that anyone who is dissatisfied with a decision made by the Trust can make a complaint about that decision and have that complaint handled by the Trust. Local Authority Social Services and NHS Complaints Regulations 2009, made under powers in Sections 113 to 115 of the Health and Social Care (Community Health and Standards Act) 2003 Version:1 Page 9 of 11

10 Appendix 1 Apply eligibilty and obtain indicative budget (RAS) Complete SSAQ Flow chart for Direct Payments (page 1) Agree budget with line manager Refer to FAB Agree eligible outcomes in line with RAS. Apply cost, choice, risk policy Discuss with client and agree how budget meets need Establish whether authorised person/nominated agent is required Complete MCA following 5 principles Client has capacity/ authorised person or nominated agent identified No client will not meet conditions to have a DP. Client needs to be informed in writing yes Give Leaflet Your responsibilities Explain the implications and responsibilities of managing the account Explain the service that DFCT can offer and provide DFCT contact details, Advise re 5 charge payable to DFCT by TSDHCT AGENCY Give list of approved agencies Agency or PA Complete and agree support plan detailing how eligible needs will be met On support plan clearly identify how DP s are to used, ensuring client is involved and in agreement Advise client that DP will be paid to them direct less their assessed charge Input all details onto RAS and the support plan on PARIS DP rate is the amount the client has agreed to pay providers ( this may be a privately negotiated rate).the total amount paid should not exceed the RAS On support plan under my spending record DP rate and put in separate lone itemising 5 admin charge State that the 5 will be funded by TSDHCT Agree service provision with line manager who adjusts the RAS and closes the support plan Run new DP agreement Version:1 Page 10 of 11

11 Flow chart for Direct Payments (page 2) Line manager must sign DP Worker must sign DP Ask client consent to forward support plan to DFCT if they are to be used Take copy of the DP agreement to client with2 copies of the support plan. Ask client to sign both copies and leave one with client Bring clients attention to section support I need to remain safe which identifies how the DP links to this document Scan signed copies of support plan and DP agreement onto PARIS and store in MDT documents or external documents Make a note in PARIS case notes to say where documents have been saved Send hard copy to DP team at regents house If DFCT being used copy of DP agreement to Mike Benton at DFCT Advise the client that the finance team will post them the final DP agreement for their records Place client on stable list. Advise client that their needs wiil be reassessed by adult social care annually and that finance will review expenditure Version:1 Page 11 of 11