AMENDMENTThis chapter was updated in October 2016 including the addition of a new Section 7, Hospital Stays.
1. What are Direct Payments?
A direct payment is money given to children aged 16 years or over who have a disability and to parents or carers aged 16 or over of young people, giving them the freedom and independence to choose and manage a service to meet the assessed need(s). This can be instead of, or in addition to support provided by Bedford Borough Council.
Direct Payments do not affect any benefits the recipient is in receipt of.
Direct Payments can be made for special educational provision, health care and social care provision.
Local authorities must offer the option of Direct Payments in place of services currently being received. For both education and social care the local authority must be satisfied that the person who receives the Direct Payments is able to manage the direct payments either by themselves or with whatever help the authority thinks the applicant or nominated person will be able to access; will use them in an appropriate way to meet the needs in question and that they will act in the best interests of the child or young person.Regulations governing the use of Direct Payments for special educational provision place a number of additional requirements on both local authorities and parents before a Direct Payment can be agreed. These include requirements to consider the impact on other service users and value for money and to seek agreement from educational establishments where a service funded by a Direct Payment is delivered on their premises. Direct Payments for health require the agreement of a Care Plan between the Clinical Commissioning Group and the recipient.
2. Who can get Direct Payments?
Those who have been assessed as meeting the criteria for Children with Disabilities Team aged 16 or over. Children and young people who have Education, Health and Care Plans and their parents have the right to request a Personal Budget, which may contain elements of education, social care and health funding, and may be delivered by way of Direct Payments. Under the Children and Families Act 2014, this covers those aged 0-25 having special educational needs and disabilities. Direct payments are available if a child or young person is disabled and aged 16 or over or is a carer or parent aged 16 or over for a child with disabilities. No-one can be forced to have a direct payment.
Direct payments can also be made to a willing and appropriate person on a disabled person's behalf if they lack the mental capacity to agree to and manage direct payments themselves.Direct payments cannot be used to pay for services from a spouse, partner or a close relative living in the household unless the local authority consider it is necessary to do so. However, a direct payment can be used to employ a relative if they are not living in the household.
3. How Often are Direct Payments Made?
Direct payments can be paid monthly or as a one-off payment. They are paid in advance into a bank or building society account specifically set up for this purpose.
If the direct payment is assessed as needing to differ at key times e.g. school holidays/term time, then payment will be made accordingly.
4. What is the Process?
The arrangements for Direct Payments will be included in the child's/young person's Education, Health and Care Plan, following an Education, Health and Care Needs Assessment. See Children and Young People Aged 0-25 with Special Educational Needs and Disabilities Procedure.
5. Direct Payments Can be Spent on Employing a Personal Assistant (PA)
- To take the young person/child into the community to access an activity, support inclusion, going to a club etc;
- To work with the child directly within the home, to give parents and siblings a break or providing personal care;
- To stay overnight to give respite to parents;
- Or a registered childminder or child home carer (for children aged under 8).
6. Direct Payments Can also be Spent On
- Using an approved agency to provide direct care to meet your child/family's needs;
- After school clubs and holiday play schemes for your disabled child;
- On agreement, equipment that would have otherwise been provided by Bedford Borough Council;
- On agreement, any service which meets the assessed need for a short break. This is subject to regular CIN Meetings to review needs and unmet needs, and any changes required;
- Special educational provision specified in an Education, Health and Care Plan.
7. Hospital Stays
When a child or young person under 16 years needs to go into hospital, the parent, carer or the person managing the Direct Payment, should advise the local authority straight away to discuss the continuation of the payment.
It is possible that the payment will continue for a time-limited period, if only to allow for the person managing the Direct Payment to ensure that any contractual obligations around termination of the support can be met. However, there might also an issue of continuity of care post-discharge to consider in some instances.
Where a Young Person is 16 years or older and in receipt of Direct Payments, hospitalisation may not necessarily mean that the Direct Payments should cease. Guidance advises that consideration should be given by the local authority, the carer, the holder and NHS Trust to as to how the payments might be used to meet non-health needs or to ensure that the employment arrangements can be maintained. For example, the holder may prefer some personal care tasks to be undertaken by the carer rather than hospital staff. However, the personal care and medical input need to be tailored so as not to interfere with the medical treatment. (Terminating or suspending the carer's employment may lead to a delay of continuity of care and a delay in discharge).
In instances where the authorised or nominated person requires hospital treatment, the local authority must conduct an urgent review to ensure the holder continues to receive the care and support they need. This might include the duties to be carried out by a temporary nominated person, or through short-term authority arranged care/support.
8. Direct Payments Can Not be Spent On
- Full time residential care;
- Health Care;
- Nursing Care;
- Permanent residential accommodation, though they can be used for occasional short breaks, if the local authority agrees, for up to 120 days in any 12 month period. (NOTE: where two periods of short –term care are 4 weeks or less apart, then the cumulative total of the stays should be added and not exceed 4 weeks if the stay is to be funded by Direct Payments).
9. What are the Benefits of Direct Payments?
Direct Payments enable parents and young people to design their own care package, increasing their independence and allowing them greater choice and control over the support to meet their assessed needs. Payments made do not affect welfare benefits.
10. Decisions Not to Make Direct Payments
Where the local authority decides not to make Direct Payments it must inform in writing the child's parent or the young person of its decision and reasons in a format that is accessible to them and in line with the Data Protection Act. It must also advise of their right to request a review of the decision.
11. Monitoring and Review of Direct Payments
The local authority must monitor and review the use of Direct Payments by the recipient at least once within the first three months of Direct Payments being made, and when conducting a review or a re-assessment of an Education, Health and Care Plan. In addition, a recipient may make a request for the local authority to review the making and use of Direct Payments and the local authority must then consider whether to carry out a review (see also Section 7, Hospital Stays).
When carrying out a review, the local authority must consider whether:
- It should continue to secure the agreed provision by means of Direct Payments;
- The Direct Payments have been used effectively;
- The amount of direct payments continues to be sufficient to secure the agreed provision;
- The recipient has complied with their obligations on the use of the Direct Payment.
Following a review the local authority may:
- Substitute the person receiving the Direct Payments with a nominee, the child's parent or the young person, as appropriate;
- Increase, maintain or reduce the amount of Direct Payments;
- Require the recipient to comply with either or both of the following conditions:
- Not to secure a service from a particular person;
- To provide such information as the local authority considers necessary.
- Stop making Direct Payments.
12. Reducing the Amount of Direct Payments
Where the local authority decides to reduce the amount of Direct Payments, it must provide reasonable notice to the recipient, and must set out in the notice the reasons for its decision.
The local authority must reconsider its decision, where requested to do so by the recipient, but is not required to undertake more than one reconsideration of a decision. When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or the young person) and must then provide written reasons to the recipient (and to the child's parent or young person, where the recipient is a nominee) of its decision following the reconsideration. The local authority may reduce Direct Payments following reasonable notice despite the fact that a request for reconsideration has been made.
13. Repayment and Recovery of Direct Payments
The local authority may require the recipient to repay part or all of the direct payments, where:
- The circumstances of the child or young person have changed in a manner which has an impact on the appropriateness of the agreed provision;
- All or part of the Direct Payments have not been used to secure the agreed provision;
- Theft, fraud or another offence may have occurred in connection with the Direct Payments;
- The child or young person has died.
It must give notice in writing to the recipient, setting out the reasons for the decision, the amount to be repaid and a reasonable timescale within which the amount must be repaid.
The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child's parent or young person, where the recipient is a nominee).
The local authority may only seek repayment of any portion of the Direct Payments that has not already been spent on the agreed provision.
14. Ceasing Direct Payments
The local authority must stop making Direct Payments if:
- The recipient has notified the local authority in writing that he or she no longer consents to receive the Direct Payments;
- The recipient ceases to be a person to whom a Direct Payments may be made;
- Following a review, it appears to the local authority that:
- The recipient is not using the payment to secure the agreed provision;
- The agreed provision can no longer be secured by means of Direct Payments.
- At any point the local authority becomes aware that the making of Direct Payments is:
- Having an adverse impact on other services which the local authority provides or arranges for children and young people with an Education, Health and Care Plan which the authority maintains; or
- No longer compatible with the authority's efficient use of its resources.
- It has taken reasonable steps to ascertain whether the young person consents to Direct Payments and the young person has not notified the local authority of their consent.
Where the local authority decides to stop making Direct Payments, the local authority must first give notice in writing to the recipient setting out the reasons for its decision.The local authority must reconsider its decision where requested to do so by the recipient (but is not required to undertake more than one reconsideration of a decision). When conducting its reconsideration, the local authority must consider the representations made by the recipient (and where the recipient is a nominee, any representations made by the child's parent or young person) and must then provide written reasons of its decision following the reconsideration to the recipient (and to the child's parent or young person, where the recipient is a nominee).