Direct Payments

1. What are Direct Payments?

Direct Payments are payments made when a child or young person has a disability. They are given directly to the child's parent, the young person if over 16, or their nominee, if they have been assessed as needing support and they enable them to arrange provision themselves, instead of the authority providing the support through their own services. Direct Payments offer more flexibility, choice and control in the way support is provided. Direct Payments are not means tested and will not affect any benefits and are not counted as taxable income.

Direct Payments in respect of educational, social care and / or healthcare provision specified in an Education, Health & Care (EHC) Plan may only be agreed where a valid request has been made for a personal budget, including a request for Direct Payments.

Direct payments are available for social care and / or healthcare without having an EHC plan:

• Social care provision - must satisfy relevant disabled children's services eligibility criteria and have been assessed as having a qualifying social care need over and above what universal and targeted services can provide;
• Healthcare provision - where the child or young person has been assessed as requiring continuing care (Personal Health Budget).

2. Who can get Direct Payments?

Parents of a child with a disability under 18 years of age and/or young people between 16 and 18 years old with a disability who has been assessed as meeting the criteria for disabled children's services. 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.

For social care and / or educational Direct Payments, a child becomes a young person when they cease to be of compulsory school age, which is on the last Friday in June in the school year that they become 16 years of age, for healthcare Direct Payments, a child becomes a young person on their 16th birthday.

Children and young people who have an Education, Health and Care Plan and their parents, have the right to request a Personal Budget. The Personal Budget may contain elements of education, social care and health funding which may be delivered by way of Direct Payments.

Direct Payments in respect of educational provision may continue up to the age of 25, if the young person remains in full time education or training and has an EHC plan.

Direct Payments for social care and/or healthcare could continue up to the age of 18. However, as long as children's services remain appropriate, they may continue beyond this age while the Local Authorities Adult Services and / or the Clinical Commissioning Group's (CCG) NHS Continuing Healthcare reach a conclusion about whether the young person has any eligible needs that will be met by them.

Local authorities must offer Direct Payments for social care services. For both education and social care the local authority must be satisfied that the person who receives the Direct Payments will use them in an appropriate way 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.

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; and
• Will use them in an appropriate way; and
• They will act in the best interests of the child or young person.

Direct Payments give greater control and independence, but this increased freedom must inevitably be accompanied by increased responsibilities. Recipients take on the responsibility for purchasing the services to which the payments relate. This involves Children's Social Care in partnership with carers and young people ensuring that the services they commission meet the needs identified in the assessment and that the standard is acceptable. It may also involve taking on legal responsibilities e.g. as an employer. The Recipient is also accountable to the Local Authority for the way in which the money is spent; this will involve accounts being audited. An annual Public Liability Insurance Policy must be taken out, an additional payment will be added to assist with the first annual policy, following this, the policy must be funded by the Recipient, which must be taken from the Direct Payment account. The Recipient may also wish to fund a Payroll Provider, this can be funded/topped up from the Direct Payment if available.

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.

It should also be made clear to parents/carers/young people requesting Direct Payments that if they change their mind, at any stage, services to meet their needs will be arranged in the usual way.

3. How Often are Direct Payments Made?

Direct Payments are paid in advance into a bank or building society account specifically set up for this purpose on a 4-weekly basis. If the Direct Payment is assessed as being needed at key times e.g. school holidays, then payment will be made accordingly. In some circumstances the LA can intervene and autonomously make the decision to ensure that payments are made through a Managed Account where it has been identified that the parents require additional support. In cases where there is a need for Direct Payments over a shorter period for example to assist with a specific short-term circumstance, the Direct Payment can have an agreed end date, with Panel oversight. The Finance Officer will inform the young person/parent/carer of the end date 30 days prior, and parents will be able to discuss any issues with this end date should they feel this is necessary.

4. What is the Process?

A Social Worker will undertake an assessment of need. When the Social Worker has identified needs which are the responsibility of Children's Social Care to meet, and considered the carer's or 16 and 17 year olds ability to manage the role as an employer then the worker will offer the option of Direct Payments.

There may be recommendations for Direct Payments from Tribunals following cases being heard. These cases will be presented to Direct Payment Panel and decisions made on the basis of the information presented. The Direct Payment Panel will need to be attended by the named Social Worker wherever possible. A decision will be made on the number of hours required based on individual cases taking into consideration the individual child/young person's needs, the type of activity they are required for and the presumed duration of the activity. Decision making will be recorded in the Panel Minutes.

The Assessment will identify whether there are issues in relation to physical moving and handling or whether a risk assessment in relation to behaviour is required in order to establish appropriate levels of support needed as this may impact on the amount of Direct Payment hours required.

Where payments are made to a person with parental responsibility for a disabled child/ young person, they are being made on behalf of the disabled child/young person and for the benefit of that child/young person. It should be recognised that the person with parental responsibility will benefit from the flexibility and independence which direct payments can provide. The parent's assessment (carried out as part of the Child and Family Assessment (C&FA) or the Early Help Assessment (EHA)) is therefore an essential tool in ensuring that the needs of both the person with parental responsibility and the child are met.

The Child in Need Plan needs to have all the details of all proposed provision. The Child in Need Plan should indicate which resources are to be provided through Direct Payments e.g. number of hours of personal assistance per week. The Social Worker will highlight any moving and handling and health and safety issues from the assessment on the child in need plan.

The Direct Payments Finance Officer will cost the requested hours provision.

The Social Worker will submit the budget authorisation form and a copy of the CIN Plan to the Direct Payment Panel for consideration and approval for locality cases. All approvals for Direct payments for all children within Wirral will be made by the Direct Payments Panel.

The Finance Officer will make sure arrangements are in place for insurance cover, the initial 12 months will be paid for by the local authority. All Direct Payments recipients who will be employing a personal assistant to meet their care needs must ensure that they have the appropriate personal and public liability insurance cover before any staff they employ begin working for them. The Finance Officer should remind Direct Payments recipients of this and check that they have taken out the initial insurance cover. If it is found that a carer is employing a PA without Personal and Public insurance the Local Authority reserve the right to suspend funding.

The Finance Officer will make arrangements for an Enhanced Disclosure and Barring Service (DBS) check.

When a Child in Need Plan is approved then the Finance Officer will monitor progress and ensure checks are done when staff are identified. The Finance Officer will relay the results of checks to the service user and remind the service user that repeat DBS checks are required after 3 years; this will be triggered by the review system.

Social Workers will ensure that carers are fully alerted to the potential risks for children and are provided with advice to minimise those risks; the available UK evidence on the extent of abuse amongst disabled children suggests that disabled children are at increased risk of abuse.

The Finance Officer will ensure that the Direct Payments recipient opens a separate bank account.

Once the Direct Payments Finance Officer has confirmed that all the checks are satisfactory then they will ensure that the Direct Payments agreement is completed and signed. A copy will be retained on the child's electronic file. It is important that the Direct Payments Finance Officer ensures that the Direct Payments recipient understands the agreement before signing it.

The Social Worker will revise the Child in Need Plan prior to the commencement of the service. Direct Payments will cease once the Recipients financial responsibility for the personal assistant has ended.

(See Appendix for Direct Payments Process Map)

5. What can Direct Payments be spent on?

Direct Payments can be spent on employing a Personal Assistant (PA) to:

• 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;
• To stay overnight to give respite to parents;
• Or a registered childminder or child home carer (for children aged under 8).

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;
• Residential overnight breaks for your disabled child;
• By agreement with the Team Manager for Direct Payments, any service which meets your assessed need for a short break;
• Special educational provision specified in an education, health and care plan.

Direct Payment Recipients may wish to top up the payments from their own means if required.

6. What can Direct Payments NOT be spent on?

• Employing someone without Disclosure and Barring Service and Child Protection Plan checks; someone subject to a drug or alcohol treatment requirement, youth rehabilitation order or released on National Offender Management licence conditions, or references;
• Any services already provided by the council e.g. Residential or Outreach support services;
• 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);
• Funding a school place or post 16 institutions;
• Where provision is already available through a block contract - it is unlikely that a Direct Payment (as part of a Personal Budget) would be available to access alternative services as this would be determined to be 'double funding' and therefore an inefficient use of resources;
• Anything that has not been identified as meeting any agreed outcomes in the assessment or EHC plan;
• Anything identified as illegal; gambling, alcohol or tobacco; everyday living costs (e.g. rent/bills etc.); health services (e.g. vaccinations, dental charges, prescriptions etc.).

Not using Direct Payments for their intended purpose is classed as Fraud and needs to be reported if suspected. If you suspect that Direct Payments are being used incorrectly, please contact the Fraud Team by text 07491 163806, starting your message with 'fraud', or call free on 0800 731 5783.

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 does 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 payment 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. What are the benefits of Direct Payments?

Direct Payments allow parents and young people greater choice flexibility and control, to employ their own workers at times convenient to them and in the way they wish, to provide an individual service to meet their needs. Direct Payments are not means tested and will not affect any benefits and are not counted as taxable income.

9. Decisions not to make Direct Payments and disagreement on amount of Direct Payments to be received

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. If a parent or young person does not agree to this decision, they may consult the Children and Young People's Complaints Procedure and follow the Complaints process.

If the child's parent, or the young person disagree with the amount of Direct Payments allocated, they may also follow the complaints process. The complaint may then be reviewed independently as part of the complaints process.

Where there is no agreement within the panel process, the matter will need be escalated by staff to the Operational Lead within Fostering or Head of Service (Permanence and Fostering) as appropriate so oversight and resolution can take place.

10. Monitoring and review of Direct Payments

Direct Payments will be reviewed by the Local Authority, on at least an annual basis, the audit will be carried out by the Finance Officer, usually at the point at which the child or young person's support or EHC plan is reviewed. In cases coming to an end there will be Panel oversight in the decision. If there is a need for reassessment, this will be completed by a Social Worker.

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.

An annual review of the Direct Payment hourly rate will be undertaken to ensure the Authority complies with National Minimum Wage, this will be done in agreement with the Head of Service.

11. 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. If a parent or young person does not agree to this decision, they should discuss this with the Social Worker in the first instance. They may consult the Children and Young People's Complaints Procedure and follow the Complaints process.

12. Repaying 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 (unless it is part of a fraud or theft investigation in which case payment may cease with immediate effect whilst the investigation is ongoing), 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.

13. 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;
• A significant change in family circumstances occurs (for example child/young person moves to live with another family member or becomes Looked After);
• 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 (minimum 30 days) 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).

14. Complaints

Direct payments users should be made aware of the Department's Complaints Procedure and given a copy of the "Complaints and Compliments" leaflet.

Appendix 1: Direct Payment Process Map

See Appendix 1: Direct Payment Process Map