Direct Payments Practice & Procedure

Transcription

1 Direct Payments Practice & Procedure Adult Social Care Revision History Version no. Date issued Author Change reference Issued to /02/14 Rebecca May Document creation based on Norfolk CC best practice P036 WS /02/14 Rebecca May Added comments from P036 Direct Payments Review project, WS4 P036 WS5 meeting 13/01/ /02/15 Nigel Chatfield Formatting anomalies corrected. P036 WS /04/04 Nigel Chatfield Incorporated suggestions from WS5 based on Milton Keynes Council policy. P036 WS /04/18 Nigel Chatfield Numbering and index added P036 WS /05/16 Rebecca May Safeguarding info from Emily White (point 40) and process for review by WS1 (point 19.4) P036 WS /06/ /07/ /09/13 Robert Mackenzie- Wilson Robert Mackenzie- Wilson Robert Mackenzie- Wilson Separated out policy and practice to create a draft DP Policy and draft DP Practice & Procedure Updated content following practitioner workshop Redrafted to contain key process and practice steps P036 WS5 P036 WS5 P036 WS /09/13 Robert Mackenzie- Wilson Integrate practitioner comments and redrafted sections accordingly. P036 WS5 Practitioners /10/ /01/14 Robert Mackenzie- Wilson Robert Mackenzie- Wilson Further revision of practice in relation to Review and Monitoring and DP Agreements Redrafted guidance on access to support from approved providers P036 WS5, TH Project Board 1

2 DIRECT PAYMENTS PRACTICE & PROCEDURE 1 SCOPE 4 2 KEY PRINCIPLES 4 3 ELIGIBILITY & RESTRICTIONS 5 4 CARE ASSESSMENT 6 5 CONSENT 7 6 CAPACITY TO CONSENT 9 7 SUITABLE PERSON 10 8 TRANSITIONS 11 9 SUPPORT PLANNING& BROKERAGE RATES AND CHARGES POOLED BUDGETS DIRECT PAYMENTS AGREEMENT MANAGING DIRECT PAYMENTS DIRECT PAYMENT BANK ACCOUNTS REVIEW & MONITORING MANAGED ACCOUNTS USING DIRECT PAYMENTS EMPLOYING A PERSONAL ASSISTANT DISCLOSURE AND BARRING SERVICE CHECKS SAFEGUARDING ADULTS VOLUNTEERS EMPLOYMENT OF RELATIVES RESPITE CARE AND SHORT BREAKS 24 2

3 24 EQUIPMENT RETAINER PAYMENTS GUIDANCE GLOSSARY OF TERMS 28 3

4 1 Scope 1.1 The Direct Payments Practice and Procedure outlines the detailed guidance for delivering Direct Payments and associated support functions within Adult Social Care services across Central Bedfordshire. 1.2 This practice and procedure applies to all Central Bedfordshire Council Officers involved in carrying out social care assessments, reassessments, reviews, support planning or who are otherwise involved in the arrangement and administration of social care services for people with eligible needs. 1.3 This practice and procedure should be read in conjunction with Central Bedfordshire Council s Direct Payments Policy and associated policies governing social care assessment and support services. 2 Key Principles 2.1 Direct Payments are monetary payments made to people with assessed care needs to purchase their choice of support services, activities and equipment as an alternative to accessing social care service provided by Central Bedfordshire Council. 2.2 Central Bedfordshire Council has a statutory duty to promote and offer Direct Payments to people that are eligible for social care services following an assessment, and provide sufficient support for people to manage the payments. 2.3 The aim of a Direct Payment is to give people choice and control over how their Personal Budget is spent to provide the support services they want and need to best meet their assessed care needs. This enables people to have greater flexibility and independence within their lives and in making decisions about how and when they receive support. 2.4 Direct Payments should be used: To enable people to exercise choice and control over their day to day lives, and to widen social and employment possibilities To enable people to exercise choice and control over their lives, to widen social, educational and employment possibilities and, as a key consideration, to reduce dependency on social care services To enable people to exercise choice and control over their day to day lives, and to widen social and community involvement possibilities Example: Older people with mobility difficulties or health conditions can use Direct Payments to employ a personal assistant to provide care and support in their home. Direct Payments can also help people of all ages with a disability or long-term condition to access alternative forms of support such as short breaks or holidays, support to prepare daily meals or maintain the garden, and assistance to maintain work commitments or attend social activities. 4

5 3 Eligibility & Restrictions 3.1 A Direct Payment is the Council s preferred method for people to arrange, manage and receive social care services. This will enable local people with care needs to have greater control and independence in their lives. 3.2 The Council must make Direct Payments to everyone that is eligible and willing to receive them. 3.3 The following groups of people are eligible to receive Direct Payments from Adult Social Care services: People aged 18 and over who are assessed as eligible for social care services under the Fair Access to Care Services (FACS) criteria. This includes older people, and people with physical and learning disabilities and mental health needs People over the age of 18 who are eligible for services under the Community Care Act People aged 18 and over who are eligible for equipment to meet their care needs following an assessment by Occupational Therapists (OT s) Carers aged 18 and over assessed as eligible for services under the Carers and Disabled Children Act (2000) An appointed Suitable Person. Refer to Section 7 Suitable Person for further guidance 3.4 Central Bedfordshire Council does not have a statutory duty to offer Direct Payments to people who have been placed under specific conditions in relation to mental health, community care or criminal justice. 3.5 The following groups of people are not automatically eligible for a Direct Payments: People subject to community care orders or serving suspended prison sentences under the Criminal Justice Act 2003, which includes a requirement to accept treatment for drug or alcohol dependency People subject to community rehabilitation orders under the Powers of Criminal Courts (Sentencing) Act 2000, which includes a requirement to accept treatment for drug and alcohol dependency People released from prison on licence under the Criminal Justice Act 1991, the Criminal Justice Act 2003 or the Crime (Sentences) Act 1997 subject to an additional requirement to undergo treatment for drug or alcohol dependency People subject to equivalent provisions under Scottish criminal justice legislation 3.6 Central Bedfordshire Council retains the power to provide, where circumstances allow, Direct Payments to people placed under specific conditions in relation to mental health, community care or criminal justice. Decisions to provide a Direct Payment in these circumstances should be 5

6 referred to and made by the Council s Social Care Panel or nominated senior officers. 4 Care Assessment 4.1 Practitioners are required to conduct all community care assessments in accordance with health and social care legislation and FACS criteria, which is set out within Central Bedfordshire Council s existing framework for assessment and care management. Please refer to the following documents: Assessment & Case Management Policy; and Assessment & Case Management Practice Guidance 4.2 Practitioners must explore all options for the customer, their family or carer(s) to access care services in the way that best suits their individual circumstances and develop a Care Plan to outline the services that must be provided to meet their assessed care needs. Definition: A Care Plan is the means by which a practitioner determines the care and support services that must be provided to meet a persons assessed care needs 4.3 The assessment process must include an explanation and offer to receive a Direct Payment as one of the options for the customer to meet their unmet and eligible needs. It is good practice to discuss the customer s preference for meeting their care needs and provide written information about Personal Budgets and Direct Payments for consideration in their own time. 4.4 Practitioners should use the [Practitioner Crib Sheet] to ensure that customers receive key information about Direct Payments, the process and their responsibilities should they decide to manage their Person Budget as a Direct Payment. 4.5 If a Direct Payment is requested by a person to meet their assessed needs it must be provided unless specific restrictions apply or it is not possible to put in place the necessary support arrangements to reduce identified risks, both for the individual or their potential employees, for the person to manage their own care arrangements. Refer to Section 3: Eligibility & Restrictions. 4.6 Risks associated with receiving a Direct Payment should be evaluated using the [DP Risk Assessment Form], which provides a tool for practitioners to understand and assess risks, record details and make a professional decision in relation to the likelihood and impact of each potential risk occurring. 4.7 If significant risks are identified then practitioners should assess how and when they are likely to occur, and explore the support options that can be put in place to minimise the risks. The identification of a risk on its own should not prevent the customer from receiving a Direct Payment. It is good practice to share and discuss the outcomes of a risk assessment with the customer, their family, carer(s) or advocate(s). 6

7 4.8 If identified risks cannot be mitigated to an acceptable level, practitioners should not make a recommendation for a customer to receive a Direct Payment. 4.9 People that lack the ability to consent or are not able to manage a Direct Payment because of a mental impairment can still receive them with support. Practitioners must ensure that the option of receiving a Direct Payment for people with a mental impairment or learning disability is fully considered when undertaking the assessment. Refer to Section 6Capacity to Consent for further guidance. 5 Consent 5.1 Practitioners must confirm that a Direct Payment is being made with the customers consent. While the Council has a duty to promote and offer Direct Payments, consent must be given by the customer without pressure or undue influence. 5.2 For practitioners, consent involves making sure that the customer understands both the benefits of receiving a Direct Payment and the additional responsibilities associated with managing the payment and buying services. For example this can include acting as an employer and being able to effectively manage and account for the payments. 5.3 Consent also requires practitioners to be satisfied that the customer has the ability to manage or control the payment alone or, for customers with learning a disability, ensure that appropriate advocacy or support arrangements are in place to enable the customer to receive a Direct Payment. Refer to section 7 Suitable Person, section 8 Brokerage & Support Planning and section 11 Holding & Managed Accounts for further guidance on support arrangements. Consent to receiving a direct payment means that a person must be aware of their responsibilities in using the payment and should make a fully informed choice with the support of accessible information, sufficient time to consider options, suitable ways of communicating with practitioners and help from family, carer(s) or advocate(s). To manage or control a Direct Payment people need to be able to understand their own care needs and be capable of directing their choice of day-to-day care services, with the appropriate level of financial and administrative support. 5.4 The key principles for gaining a customers consent to receive a Direct Payment include: Assuming that a person has the capacity to make and communicate their own decisions and choices unless it is determined that they are unable to do so Ensuring that information about all aspects of Direct Payments is accessible and provided in a format that enables the customer to make 7

8 an informed choice. Practitioners can provide and signpost to Direct Payments Factsheets Making every effort to ensure that the individual understands the information provided along with their role and responsibilities in managing the Direct Payment Appreciating that people may take time to consent to a Direct Payment, which could involve additional support and discussion at every step of the care assessment process. Scenario: Mrs J has a moderate physical disability as well as sight and hearing impairments. Her practitioner suggests the idea of receiving a Direct Payment, and takes time to explain what is involved along with leaving information for Mrs J to consider. When Mrs J agrees to a Direct Payment, the practitioner makes sure she understands what is involved and that she is able to manage the payment. Because Mrs J finds it difficult to decide how best to meet her needs she receives assistance from an independent advocate to help choose the right type of support. 5.5 While consent implies that people have understood their options and what those options might mean for them, it does not mean that they need to have a detailed understanding of social care finance or management. 5.6 Practitioners should be aware that people may express consent to take control of their care arrangements in different ways. Judgements on weather someone is capable of managing a Direct Payment will sometimes be difficult and should be made on an individual basis. Example: Consent might be someone saying that they would like to choose who provides support to them, or they would like to choose how they spend their time. It may be that people express dissatisfaction, perhaps through family or friends who know them well, about existing services and support options open to them. 5.7 Consent to receive a Direct Payment should take place during the customers community care assessment, review or Support Plan in order to assist their decision making and choice selection. The customer s views and wishes, reflecting their consent, should be captured in the assessment or support plan records. 5.8 Practitioners must ensure the customer is made aware of the fairer charging financial assessment that will be undertaken to determine whether customer needs to make a contribution towards their choice of care services when taking a Direct Payment. It is good practice to discuss customer contributions alongside consent and provide information for customer to consider in their own time. 5.9 Practitioners may need to arrange for the customer to access Council commissioned services where the option of receiving a Direct Payment is being considered It is important that practitioners recognise that confirming a person s consent for a Direct Payment is completely separate from identifying the type of support a person will need to manage a Direct Payment, which should be identified 8

9 within the Support Plan. Refer to section 9 Support Planning for further guidance Central Bedfordshire Council has commissioned a number of approved providers to deliver independent support services for Direct Payments customers in relation to Personal Assistant recruitment, payroll and managed accounts Because Direct Payments require people to take on additional responsibilities to meet their care needs, it will not be the right choice for everyone. If the customer does not want to receive a Direct Payment in lieu of direct services, this should be recorded as part of the assessment, review or Support Plan. 6 Capacity to consent 6.1 The Health and Social Care Act 2008 and sections of the Mental Capacity Act 2005 provides that a person who has assessed care needs and is eligible for a Direct Payment but who lacks capacity to consent can still receive a Direct Payment to meet their care needs. 6.2 Decisions on whether a person lacks the capacity to consent to receiving a Direct Payment should be based on their capacity to understand what is involved in buying and managing their care through a Direct Payment. For example, if the person wants to employ a personal assistant they must understand what this means in terms of choosing and accessing their care services. 6.3 Should practitioners have any doubt about a person s capacity to make a decision or informed choice about meeting their care needs, a Mental Capacity or Best Interest Assessment should be undertaken to determine the customer s ability to: Understand and retain the information relevant to the decision Make a decision based on the information, at the moment that a decision needs to be taken Communicate a decision or view of how they want to receive care. 6.4 Guidance on the Mental Capacity Act 2005 and a copy of the Mental Capacity Assessment Form can be found in the Council s Safeguarding Handbook or from the Mental Capacity Act 2005 Code of Practice 6.5 The decision about a person s capacity to choose how their care needs are met and what is involved in receiving a Direct Payment must be made on an individual basis. Practitioners should involve other professionals, advocates, family and carers as appropriate to assist with making a judgement about a person s capacity. 6.6 Examples of a mental impairment that may need to be assessed may include, but are not limited to: 9

10 6.6.1 Conditions associated with some forms of mental illness Dementia Significant learning difficulties Long term effects of brain damage Physical or medical conditions that cause confusion, drowsiness or loss of consciousness; Concussion following a head injury The symptoms of alcohol or drug abuse Should a customer be assessed as lacking capacity to consent, practitioners must be satisfied that the option of receiving a Direct Payment will be in the best interests of the customer before taking further action Judgements about a customer s best interest must be made as part of the assessment process as outlined in the Council s Assessment & Case Management Practice Guidance. 7 Suitable Person 7.1 Where a customer lacks the capacity to consent but it is in their best interest to receive a Direct Payment, a Suitable Person will be required to manage the payment on the customer s behalf. 7.2 Discussions about a Suitable Person should involve family members, carers and professionals at an early stage in the assessment process to determine who might perform the role and explore what the role involves. 7.3 It is good practice for customers to access independent advocacy support to assist with understanding the role and responsibilities of a Suitable Person and the range of support services available to manage a Direct Payment. Practitioners should signpost customers to Pohwer in order to access advocacy support. Example: A Suitable Person can be nominated from a range of individuals including family members, carers, friends, advocates or professionals. The nominated person must be assessed as being suitable to manage a Direct Payment and purchase services for someone who has been determined as lacking the capacity to consent to a Direct Payment, or who is not capable of managing a payment themselves. 7.4 Central Bedfordshire Council retains the power to approve whether or not someone can become a Suitable Person to manage the Direct Payment on behalf of the customer. 10

11 7.5 Someone can be considered a Suitable Person if any of the following applies: The nominated person is capable of managing the Direct Payment The nominated person understands and works in accordance with and Mental Capacity Act There is no reason to believe the nominated person poses a risk to the customer and there are no substantiated allegations of financial abuse or neglect There is a valid registered lasting (or enduring) power of attorney, a Court Appointed Deputy or an Appointee and there are no substantiated allegations of financial abuse or neglect There is a suitable Trust in place whereby the representative or suitable person acts as trustee holding property for the benefit of the Direct Payment recipient. 7.6 Someone can not be considered a Suitable Person if they also intend to be the care provider, which can include for example taking on the role as a Personal Assistant. 7.7 The role of a Suitable Person involves taking responsibility and accountability for arranging and managing the person s support and being responsible for all the processes associated with receiving a Direct Payment. Example: If a PA is being employed, the Suitable Person must be able to manage all responsibilities of being an employer and managing the payment, along with understanding the relevant legislation and legal requirements. In this situation, the Suitable Person is the employer and is responsible for all elements of the Direct Payment. 7.8 Safeguarding concerns in relation to a Suitable Person should be dealt with under Section 20 Safeguarding Adults. 8 Transitions 8.1 The transition to adulthood and increased independence is a gradual process that involves a young person taking on more responsibility. Ultimately, a young person will reach adulthood and move into adult social care services on the date of their eighteenth birthday. 8.2 Upon reaching adulthood a young person, with the capacity to consent, will take on a Direct Payment with additional support if necessary. Young people age 16 or 17 are eligible to take control of part or all of a Direct Payment, which can allow them to gain experience of managing the payment in a gradual way prior to reaching adulthood. 8.3 In all circumstances practitioners should advise customers, their families and carers of the support available to help them manage a Direct Payment. 8.4 The Health and Social Care Act 2008 and the Mental Capacity Act 2005 enables young people transitioning to adult services that lack the capacity to 11

12 consent to continue to receive a Direct Payment through a suitable person. Refer to Section 6 Capacity to Consent and Section 7 Suitable Person for further guidance. 8.5 It will often be appropriate for the person with parental responsibility who currently receives and manages the Direct Payment to continue to do so in the role of suitable person, as they are likely to be in the best position to understand the young person's needs and interests. 8.6 A young person s support plan should be updated with the transitional arrangements including the young persons support needs for managing the payment. 9 Support Planning 9.1 Support planning is the process that the customer will undertake to develop their individual Support Plan. 9.2 A Support Plan enables the customer to take control of their care by describing how they want to live their life and what support services they want to spend their Personal Budget on to achieve the care outcomes as identified in the care assessment. Definition: A Support Plan outlines the person s choice of care and support services along with how and where they will access care in order to take control over meeting their assessed care needs. 9.3 The Support Plan must record how the customer wants to use their Personal Budget; as a Direct Payment, to buy a package of locally commissioned services or to access services arranged by the Central Bedfordshire Council. It is possible to agree a combination of these options. 9.4 Practitioners should encourage customers to guide the preparation of the Support Plan as much as possible; enabling family, friends, carers and advocates to be involved and contribute to the process. 9.5 Practitioners should provide advice and guidance to customers on the range of support services available and what might be suitable to meet their needs. This may include signposting customers to the list of locally approved providers that provide support in relation to Personal Assistant recruitment, payroll and managed accounts. 9.6 The Support Plan can be designed in any way that enables the customer to understand or organise how they want their care needs to be met. 9.7 Practitioners should ensure the following content is included in the customers Support Plan: Confirmation of the assessed needs that the customer has opted to receive a Direct Payment for and how they will be met 12

13 9.7.2 How the customer will purchase the appropriate services either alone or with support from local agencies e.g. help with the recruitment and employment of a Personal Assistant The arrangements to be put in place to manage emergencies Details of the Indicative Personal Budget including amount and how often it will be paid Any conditions or variations attached to the Direct Payment that will need to be monitored and reviewed The initial review date, along with what the customer should do if they are not coping with the Direct Payment or do not wish to continue receiving the payment 9.8 Practitioners should refer to the Council s Assessment & Case Management Practice Guidance for further guidance on support planning quality and standards. 10 Rates and charges 10.1 Legislation requires that a Direct Payment must be equivalent to the Council s costs estimate of meeting the customers assessed needs, subject to any personal contribution. This means the calculated Direct Payment must be sufficient to enable a person to lawfully secure a service to a standard that the Council considers is reasonable to fulfil their assessed needs As part of the Support Planning process practitioners must complete an Indicative Personal Budget as a guide to the amount of Personal Budget a customer is likely to receive in order to meet their care needs. Customers must be informed of the indicative budget ready to develop their Support Plan and decide on the support services and care arrangements to meet their assessed need The Direct Payment amount will vary depending on whether the customer intends to access care services through a local agency package or directly employ a Personal Assistant. Example: A Personal Assistant can provide a range of tasks or activities that the person will need to meet their care needs. These arrangements are made directly between the care recipient and the Personal Assistant through an employment contract. Alternatively, people can by an Agency Package that will provide a variety services that they can choose from to meet their care needs. These arrangements are made with the agency provider without the need for an employment contract Practitioners should refer to the DP rates and charges document for the latest PA rates and on-cost charges Once a support plan has been completed practitioners must complete an Actual Personal Budget to calculate the final Direct Payment amount and obtain the necessary financial approval. Once approved, the customers Direct 13

14 Payment will be set-up using the established financial process, which will confirm the actual payment amount Practitioners should refer to guidance on calculating indicative and actual budgets Agencies will be paid per customer, per service and this will be approved through the Central Bedfordshire Council care management process. Any subsequent renewal can only be approved through the care management process Transport costs will be paid only where provision of transport is recorded as an eligible need in the customers Care Plan. If the customer is using a private vehicle the payment is at the rate of 45 pence per mile. For other forms of transport the Direct Payment is the actual cost of the journey(s). 11 Pooled budgets 11.1 Groups of customers receiving a Direct Payment can choose to pool a part of their payment in order to purchase services or support as a group. A pooled budget can offer customers that want similar services or equipment greater purchasing power to achieve cost efficiencies and value for money Pooled budgets should be operated in a way that suits everyone in the group and meets agreed shared outcomes. This means the group of people working together, with support if required, to identify the arrangements for setting up and managing the pooled amount of their individual Direct Payments Customers should be referred to Ruils, Pooledbudgets.org and Skills for Care, for independent information and guidance on considering the use of pooled budgets. 12 Direct Payments Agreement 12.1 A Direct Payments Agreement must be completed and signed by the customer or the Suitable Person, on behalf of the customer, when confirming that the Personal Budget will be delivered as a Direct Payment to purchase a choice of care and support services The Direct Payments Agreement is a binding agreement between the customer, Suitable Person and Central Bedfordshire Council, which sets out the rights and responsibilities for all parties along with formal terms and conditions for managing the payment The agreement confirms that the customer or Suitable Person has read the terms and conditions and accepts their responsibility for to using the Direct Payment to buy the appropriate care services, maintain financial records and receipts, and submit financial information for monitoring purposes when required The agreement also sets out any requirements for the customer to make a financial contribution towards the costs of meeting their care needs, the 14

15 payment of contributions into the Direct Payments bank account and how contributions are used to pay for the care services The Direct Payments Agreement will be sent to customer following confirmation of the Direct Payment amount. This will be managed by the Direct Payments Team Practitioners and the Direct Payment Team should support the customer or Suitable Person to understand the agreement terms and conditions. The [Practitioner Crib Sheet] will help to provide key information about Direct Payments, the process and customer responsibilities Customers are required to sign two copies of the counterpart DP Agreement One copy of the counterpart agreement should be returned to the Direct Payments Team for customer records management with the other copy retained by the customer or Suitable Person While the customer or Suitable Person is required to sign the agreement, all terms and conditions contained within the agreement automatically apply once the Direct Payment begins regardless of a formal signature Issues in relation to a customer s refusal to sign a Direct Payments Agreement should be explored and resolved with the support from the Direct Payments Team A separate agreement is required for Direct Payments made to carers and for one-off payments to customers. 13 Managing Direct Payments 13.1 Ability to manage a Direct Payment closely relates to the support a person will require. The kind of support will vary from person to person and is linked to any changes in a persons ability to manage a payment such as if someone has a condition that is likely to deteriorate over time. Customers may use an agent to assist them in managing the payment to buy services in the same way someone might use a solicitor or accountant to assist them with their personal affairs Practitioners and staff involved in setting up a Direct Payment must not recommend or introduce prospective personal assistants to a customer. This practice could expose the practitioner, staff member and Central Bedfordshire Council to litigation in the event of problems arising out of any future employment. Refer to Section 14 Employing a Personal Assistant for further guidance The appropriate level of support to manage a Direct Payment must be identified and set out in the Support Plan, with arrangements in place ready for when the Direct Payment begins. 15

16 13.4 If it is not possible to put in place sufficient support arrangements to enable the customer to manage a Direct Payment successfully the option to receive a Direct Payment should be removed Practitioners should discuss the reasons to remove a Direct Payment at any stage with the customer, their family, carer(s) and advocate(s) along with advising on the way any objections or concerns can be raised through the Adult Social Care complaints procedure Customers that use Direct Payments to support a fluctuating condition will need to consider all their support needs, ranging from the most complex to the most simple, and make arrangements accordingly If practitioners consider that family members, carer(s) or advocate(s) are not acting in the best interests of the customer they can refuse a Direct Payment. Similarly, if sufficient support is not in place to ensure a customer s safety and well being, a Direct Payment should not be made. 14 Direct Payment Bank Accounts 14.1 In order to receive a Direct Payment the customer must open a bank account designated for the on-going receipt and management of the funds The type of account required varies on who the recipient is. A list of the potential recipients and the type of accounts required are listed below. Direct Payments Recipient A service user who has consented to receive Direct Payments. A service user who has consented to receive Direct Payments and has nominated a Third Party to assist with the on going management of the funds. A Suitable Person who has consented to receive Direct Payments to purchase care for a service user who lacks the capacity to consent. Type of Bank Account Required A dedicated Direct Payments account in the name of the service user only. A dedicated Direct Payments account in the name of the service user with a Third Party mandate, or with a Team Manager s approval a joint account. A dedicated Direct Payments account in the name of the suitable person only One-off Direct Payments do not require a separate account and should be paid directly into the customers existing account. 15 Review & Financial Monitoring 15.1 Practitioners must undertake a review of the Direct Payment in line with the [Care Management Review] process to ensure funds are being used to achieve the customer s care needs and outcomes as set out in their support plan. 16

17 15.2 The outcome of all Direct Payment reviews should be recorded within the customer s social care records contained in the review section of the SWIFT system. Financial Monitoring 15.3 In addition to ensuring that the customer s care and support needs are being met by the Direct Payment, financial monitoring will be undertaken to: Assess the customer s ability to manage the Direct Payment account, associated financial payments and receipts Confirm the customer s ability to manage their financial responsibility for purchasing care services. For example, if a customer is employing a Personal Assistant it is important to review whether they have sufficient support to understand and meet their employment responsibilities Monitor the amount of Direct Payment funds in the customers account and check that the correct contributions have been paid into the account Safeguard customers against financial abuse or lack of care through insufficient funds There are two levels of financial monitoring: Standard - The customer or Suitable Person will be required to submit regular monthly spending returns of their spending receipts and bank statements to account for the Direct Payment Light-Touch - The customer or Suitable Person will need to maintain spending receipts and bank statements and only submit an annual spending return to account for the Direct Payment Customers will be placed on the Standard financial monitoring as default once the Direct Payment has been put in place. A risk-based approach will be used to access a customer s suitability for moving onto Light-Touch monitoring When undertaking the Care Management Review, Practitioners should use the [Direct Payments Support Analysis Tool] to assess the customer s management of the Direct Payment and determine level of monitoring required going forward, along with any additional support requirements needed for the customer to manage the Direct Payment The outcome of review will determine whether the customer is suitable for Light-Touch monitoring or if they should remain on Standard monitoring until the next review is undertaken Customers should not be forced onto Light-Touch monitoring where they express a preference to submit regular monthly spending returns. Practitioners should be aware that some customers may feel more comfortable with the Standard monitoring arrangements. 17

18 15.9 Where a customer is subject to Light-Touch monitoring arrangements, Practitioners should use the [Direct Payments Light-Touch Review Checklist] to undertaken a brief assessment of the customers ability to manage the funds and review bank account records associated with the Direct Payment. It is expected that this will take place on an annual basis as part of the Care Management Review. Managing Concerns The Direct Payments Light-Touch Review Checklist also allows Practitioners to refer any care or financial concern to the Direct Payments Team for further investigation. Example: A customers Direct Payments bank account could contain a shortfall or excess of funds that could highlight a more serious problem including the customer not being capable of purchasing the necessary care services or buying items or activities that do not meet their care needs Practitioners should make a referral to the Direct Payments Team where: A customer has accumulated a significant amount of money, (more than 12 weeks worth of Direct Payments) in excess of any funds held for contingency, and which have not been designated for a planned expenditure such as respite The account contains less than 2 weeks worth of Direct Payments or is overdrawn The customer is experiencing problems or has expressed concerns about money management and record keeping It is good practice for Practitioners to consult the Direct Payments Team about concerns associated with a customer that has been placed under Light-Touch monitoring, particularly in relation to financial management and access to suitable care services Where there are minor concerns about financial management or record keeping, Practitioners should offer customers support and signpost them to local organisations that can provide detailed advice and guidance. Depending on the issue identified, Practitioners may find it appropriate to provide advice and support jointly with the Direct Payments Team Where there are high-level concerns about use of funds or the customer s capability to manage the Direct Payment and buy suitable care services, Practitioners should make a referral for the Direct Payments Team to consider the option of undertaking a full financial audit, review and reassessment of the Direct Payment. In some circumstances this may result in terminating the payment and moving the customer into care services provided by the Council. Recovery of unused or misused funds Practitioners should make customers and Suitable People aware that the Council will seek to recover any unspent Direct Payment funds or sums where 18

19 the Direct Payment has not been used to pay for services to meet the customers eligible care needs The recovery of Direct Payment funds will be pursued through the Council s standard debt recovery processes. 16 Managed Accounts 16.1 Managed bank accounts are used to hold and control customers Personal Budget taken as a Direct Payment, in circumstances where they are unable to manage it themselves A managed bank account should only be used in situations where a customer wants a Direct Payment as all or part of their personal budget but they do not have the capacity to manage the necessary financial arrangements in order to employ a Personal Assistant or buy an agency service Independent brokerage services can control the account in order to make the necessary payments for the purchasing of care services to meet the customer s eligible needs. This can include for example processing payments to an agency or to a Personal Assistant. Example: A managed account would support customers with dementia, a learning disability, or a person who is unable to hold a bank account and manage their financial arrangements alone. In these circumstances a managed account offers the customer a solution to take control of their care arrangements and benefit from the independence and flexibility Direct Payments offer Before making recommendations for a managed account, Practitioners should satisfy themselves that the following criteria have been met: The customer has been assessed as lacking the ability to manage the financial arrangements associated with using a Direct Payment The customer does not have family, friends or advocate(s) who is willing or able to support them to manage the financial arrangements connected with their Direct Payment Confirmation that the customer, or a suitable person acting on their behalf, accepts responsibility as the employer where a Personal Assistant is used to provide care 16.5 Practitioners should consider and explore the option of a managed account in the following circumstances: Support Planning when the customer is deciding how to use the funds assigned for their care and support, and is considering taking all or part of their personal budget as a Direct Payment. At this stage it may be apparent that a Direct Payment is desirable but that the management arrangements would be beyond the capacity of the customer concerned, and that they have no-one close to them who is willing or able to take on this responsibility. 19

20 Review & Monitoring when a customer s Direct Payment is being reviewed it may become apparent that they are no longer be able to manage the financial arrangements related to their Direct Payment but wish to continue managing their own care and support arrangements. Alternatively, when reviewing a Support Plan it may become apparent that the customer would prefer to receive a Direct Payment but that they lack the capacity to manage the financial arrangements The decision to provide a managed bank account should be taken by the practitioner and their manager in consultation with the customer and their family, friends and carer(s) The decision to provide a managed bank account should be taken when the Practitioner and their Manager is satisfied that all other support options have been explored and utilised The cost of a managed bank account provided by an independent brokerage service will be added to the customer s Direct Payment once the criteria for access has been determined and agreed. 17 Using Direct Payments 17.1 Direct Payments can be used for the following: (this is not an exhaustive list but whatever is purchased must meet the individual s eligible needs) Payment to employ a personal assistant/carer of the person s choice, in lieu of an agreed Home Support package Transport to be paid, if it is part of the Care Plan, at the actual cost A Direct Payment to undertake a respite (short) break, which can be used to pay for a break either within the UK or abroad. For example in a hotel or B&B, self-catering or staying with relatives See section 23 for restrictions on respite or short breaks A range of equipment to support independent living See section 24 for details on using a Direct Payment for equipment Support to help individuals stay independent in the home and reduce risks Support to reduce social isolation Support to access or maintain employment Support to participate in physical activities Support to access cultural, religious activities, social event or outings 17.2 Direct Payments cannot be used for any of the following: Any activities that may bring the Council into disrepute including all illegal activities 20

21 Any activities or services that another Authority or Trust would provide Day to day living i.e. rent, mortgage, food To purchase services provided by staff directly employed by Central Bedfordshire Council, e.g. in-house home care To purchase permanent residential or nursing care To purchase a service that that could expose an individual to serious risk, harm or abuse Any service, activity or item that cannot be shown to improve or maintain support for the customer s quality of life 17.3 Central Bedfordshire Council must be satisfied that the support arrangements put in place by the customer will achieve the care outcomes identified in the original assessment. 18 Employing a Personal Assistant 18.1 Many customers will use their direct payment to employ a Personal Assistant. In this case the Direct Payment recipient becomes an employer and must make adequate arrangements to fulfil their responsibilities as an employer in compliance with the relevant legislation As an employer, it is the responsibility of the Direct Payment recipient (social care customer or their Suitable Person) to ensure compliance with employment legislation, insurance requirements, and, if necessary, the provision of employment training Practitioners should ensure customers are made aware that they can access information, advice and support on employing a Personal Assistant through approved providers listed on the Central Bedfordshire Council s website and the organisation Skills for Care The Direct Payment recipient must ensure that they retain sufficient funding from the Direct Payment to cover their potential employer responsibilities such as care training or possible redundancy Practitioners should refer Direct Payment recipients to the DP rates and charges document for the latest PA rates and on-cost charges. 19 Disclosure and Barring Service checks 19.1 Vulnerable adults should be advised to request disclosure from the Disclosure and Barring Service (DBS) of criminal records for all their employees Practitioners or customers can request a DBS form and guidance booklet from the Direct Payments Team On receipt of the information you will be advised that either: 21

22 The prospective employee is suitable for the post, or Matters have been disclosed that warrant further discussion with practitioners or support services At the same time the DBS will inform the prospective employee of all disclosed convictions Central Bedfordshire Council reserves the right to refuse or stop a Direct Payment if it decides that any employee or care provider is unsuitable. 20 Safeguarding Adults 20.1 Central Bedfordshire Council has a suit of multi agency safeguarding policies and procedures to support practitioners in assessing safeguarding risks and putting in place appropriate protection plans. Refer to the Council s Safeguarding Handbook for detailed guidance The Council is the lead agency for safeguarding adults at risk, but all agencies working with adults at risk within Central Bedfordshire are required to work within the safeguarding policy and practice framework The definition of an adult at risk is: A person aged 18 years and over (whether or not eligible for community care services) who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation The definition of safeguarding adults at risk is: All work which enables an adult who is or may be eligible for community care services to retain independence, well being and choice and to access their human right to live a life that is free from abuse and neglect If practitioners believe they are working with a person who is at risk from abuse, neglect, discrimination, harm or exploitation, you must report the concern to the safeguarding team on or report the concern using the Safeguarding Alert Form If concerned about a crime or the immediate safety of a person, practitioners should call the police. 21 Volunteers 21.1 There are occasions where the person receiving a personal budget cash option (Direct Payment) may choose to use someone to support them to meet their eligible social care needs on a volunteer basis for example: occasional support at home, domestic, gardening, shopping tasks, occasional support with personal care / bathing, occasional supervision when main carer is unavailable. 22

23 21.2 Central Bedfordshire Council expects that any person providing support on a regular or ongoing basis would be formally employed as a Personal Assistant Central Bedfordshire Council considers it reasonable that volunteers should not be financially inconvenienced by offering to provide support. There is scope to agree for reasonable expenses, associated with the volunteer s activity, to be paid from the Direct Payment for example: travel and meals when out with the customer. As a guide travel costs, petrol or mileage for up to 20 miles per session could be agreed at the approved HMRC mileage rate Any such arrangements must be determined and captured as part of the initial Support Planning process with the customer, which is agreed in advance with Central Bedfordshire Council. 22 Employment of relatives 22.1 The Council does not allow customers to use a Direct Payment to employ a spouse (husband or wife), a common law or civil partner (the other member of an unmarried couple or civil partnership) or a close relative who lives in the same household as the Direct Payment recipient A close relative is defined as a parent, parent-in-law, aunt, uncle, grandparent, son, daughter, son-in-law, daughter-in-law, stepson, stepdaughter, brother or sister This restriction is not intended to prevent a person from using their Direct Payments to employ a live-in personal assistant, provided that person is not a close relative living in the same household. The restriction applies where the relationship between the two people is primarily personal rather than contractual Customers should have the freedom to choose the person they believe will provide the best care and support, which includes relatives who do not live with them Practitioners should be aware that in some circumstances a customer s freedom to choose who provides their care and support may be compromised by pressure to employ a relative when a non-relative would enable them to be more independent A Direct Payment will only be considered for employing a relative / partner living in the same household where the circumstances are exceptional and this is the only satisfactory way of meeting the eligible care need Where the employment of a close relative or partner living in the same household is necessary, the arrangements should be treated as temporary and regularly reviewed to identify alternative solutions for meeting the customers care needs. 23