Self-directed support (direct payments) policy - Adult Social Care

1. Purpose and scope of this policy

1.1 The aim of the policy is to help ensure that staff, the public and health and care partners have the information they need about self-directed support and direct payments. We are committed to promoting personalisation and ensuring self-directed support is offered appropriately and direct payments are delivered safely, efficiently and effectively

1.2 This policy describes the standards, guidelines and regulations that Devon County Council adheres to in the administration of direct payments.

1.3 The legislative context for direct payments is set out in the following:

The Care Act 2014
Care and Support (Direct Payments) Regulations 2014
Section 117(2C) of the Mental Health Act 1983 (the 1983 Act)

2. Promoting independence

2.1 The Care Act states that we need to consider promoting independence and reducing the needs that a person has at every opportunity.

2.2 The Act emphasises the importance of ‘preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced, or other needs could be delayed from arising.’

2.3 Our promoting independence vison and policy set the framework for how we work with people.

‘Promoting independence’ means enabling as many residents as possible learn how to stay healthy and active in their communities for as long as possible with the minimal necessary reliance on publicly funded health and care services.

There are four key aspects to promoting independence:

Personal strengths and preferences
We will focus on people’s strengths and the things that matter to them, encouraging them to draw on their own resources to build resilience and achieve their desired outcomes.
Relationships
We will support people to maintain and develop rewarding social and family relationships.
Community links
We will enable people to make connections with other people, groups and universal services in their communities.
Supportive communities
We will work with partners to develop communities and community groups, and encourage them to make the most of their ability to support people

2.4 The support and outcomes described in the support plan will wherever possible aim to reduce needs that already exist and to prevent or delay the developments of additional needs for care and support.

2.5 Self-directed support promotes people’s independence by increasing the level of choice and control they have over the support services they receive, improves their experience of these services and improves the benefits and outcomes of these services for their health and wellbeing.

3. What is self-directed support?

3.1 When a person has support needs assessed by a health or social care professional, and the support is funded by Devon County Council Integrated Adult Social Care or jointly with the NHS, the anticipated cost of that support will be described as a personal budget. The support can be delivered in a number of ways. Self-directed support is where the person takes responsibility for managing their own support arrangements. One of the aims of self-directed support is to enable people to find more creative, personalised and effective ways of getting their needs met. The person will develop the support plan with their health or social care professional and they will take charge of the money required to meet the eligible care and support needs that have been identified.

3.2 The money, called a direct payment will usually be accessible to them through a Devon Card, the council’s way of giving people direct access to their personal budget. The person, or an appropriate person acting on their behalf (see section 8), will take full responsibility for arranging the support they need with providers. The personal budget can only be spent on activities that meet the person’s health and social care needs but by taking control of their personal budget, they can explore more creative and innovative ways of achieving the goals agreed in their support plan. This means more choice about who provides their support and more control over how it is provided to them.

3.3 Having more choice and control means having more responsibilities and having more decisions to make. The person managing the direct payment must be able to understand the contractual arrangements with individual providers and have contingency plans in place to try to ensure that support needs are always covered. The responsibilities increase if the person is directly employing a personal assistant because they take on all the responsibilities of an employer and need to be able to understand and manage them efficiently and legally.

3.4 If a person would not be able to manage this themselves, someone else can do it for them but that person must be capable and understand and agree to the responsibilities they are taking on. There is some financial support available for administering the personal budget but, by self-directing their own support, all the responsibilities for the support arrangements and their management transfer from the council to the person.

4. What is a direct payment?

4.1 A direct payment is how a person accesses the money in their personal budget so they can buy their own care and support. The direct payment may be managed by the person with support needs or by someone acting on their behalf.

4.2 Direct payments can give access to council-funded personal budgets or NHS personal health budgets. For more information on personal health budgets in Devon see NHS Devon policy for personal health budgets. Some people may have their health and care needs jointly funded by the council and the NHS. When joint funding is agreed, the Council will take responsibility for overseeing the administration of the direct payment.

5. Eligibility, suitability and conditions for self-directed support and direct payments

5.1 The council will enable self-directed support and provide a direct payment to anyone who:

meets eligible care and support needs
requests self-directed support
is considered suitable

Suitability for self-directed support

5.2 A person’s care manager will be responsible for agreeing their suitability to direct their own support.

5.3 The care manager will consider the safety of the proposed package and the likelihood of the plans to meet the person’s assessed health and social care outcomes.

5.4 The care manager will also follow the principles of personalisation and self-directed support, promoting independence and positive risk taking.

5.5 If the care manager considers the person should not self-direct some or all of their support, they should give clear reasons why against the outcomes within the support plan.

Conditions for making a direct payment

5.6 The Council considers that there are three general conditions for a direct payment to be made:

a) Self-directed support must be an appropriate way of meeting the person’s needs as specified in their support plan

b) There must be an appropriate person to manage the direct payment, whether that is the person receiving care themselves or, someone else who is capable and willing to act in this role

c) The money must be used in ways that are appropriate and not prohibited by the Care Act regulations.

5.7 For more information the Care Act 2014 conditions for the making of a direct payment see Care Act sections 31-34 , Care and Support Statutory Guidance and Care Act Regulations on conditions for making a direct payment.

5.8 The Council is entitled to add conditions to a direct payment. These may include:

a) a requirement that the direct payment is not used to pay a person identified by the council as unsuitable to provide care and support to the person with eligible needs.

b) a requirement that the direct payment recipient must provide information to the council at reasonable intervals so the council can judge if self-directed support continues to be an appropriate way to meet the needs in question and that any conditions are being complied with.

c) if the council discovered evidence, following a reasonable investigation, to suggest that any condition of a direct payment had been breached, it may stop the direct payment and may require repayment of all or some of the money.

d) if a direct payment recipient has any concerns about compliance with the conditions for a direct payment, they seek advice from the council.

5.9 There are a number of reasons a person may be deemed unsuitable to manage a direct payment, for example:

they do not appear to be capable of managing the direct payment themselves or of managing with support
they do not comply with a condition imposed under the regulations for direct payments
there is evidence to suggest that, in the past, such funds have not been used to achieve the outcomes specified in the support plan or there is evidence to suggest the direct payment would not be used for the agreed purposes
the person has a history of mis-use or mis-management of a direct payment which presents too great a risk
there are legal restrictions
the person does not have capacity to consent and there is no one who could manage the direct payment on their behalf
someone proposed to manage the direct payment on their behalf is not deemed appropriate
the anticipated benefit to the person does not represent value for money in line with the council’s Fair and Affordable Care policy

5.10 A direct payment can be spent on a broad range of support services that will enable the person to meet their assessed social care and wellbeing needs. It empowers the person to choose more bespoke resources and activities to achieve their identified outcomes.

5.11 The council will encourage the person’s choice and control over their support arrangements wherever possible so funding can be used flexibly to create innovative, personalised packages of care that meet their identified outcomes.

5.12 A direct payment recipient will be subject to terms and conditions of use which will be set out in the direct payment agreement. The terms and conditions mainly require that the payments are used to meet the needs specified in their care and support plan.

5.13 The money cannot be used to fund goods or services that would normally be part of existing public services or the responsibility of other public bodies, including health service, public amenities and housing authorities.

5.14 The use of a direct payment to pay a family member living in the same household as the person with care and support needs will not be permitted except in exceptional circumstances. Where the care manager believes these exceptional circumstances exist, they can submit a request to their line manager. The request must evidence clear reasons for the request. Any agreement for exceptional circumstances in one case will not set a precedent for future cases and must be approved in writing by the council before any such payments are made to the family member.

5.15 All exceptional circumstances agreed will be as a short-term solution for up to three months after which the arrangements will be reviewed. The agreement should be recorded with an agreed review date. In this situation the council would require the direct payment recipient to use a payroll and financial administration service that separates the person being paid to deliver support from the person paying the invoices for the support being delivered.

6. Calculating the amount of the personal budget

6.1 Funding decisions made for self-directed support will comply with the principles of the Fair and Affordable Care Policy.

6.2 The council calculates estimated personal budgets based on comparative costs for equivalent care options. The personal budget will be calculated by the care manager.

6.3 A personal budget will be calculated using the following principles and policies:

eligibility
fair and affordable care
equality and fairness
cost-effective use of public funds
promoting independence, including promoting employment

The personal budget will be shared with the person so their support plan can be written and agreed.

6.4 There may be a requirement to add a ‘one off’ amount on top of the estimated budget to allow for employment-related costs including training, insurance, advertising for staff and other such requirements. Where this is included, the cost should be broken down as a weekly cost to give an indication of the true cost of the support needs.

Respite and contingency payments

6.5 If a respite or contingency payment is required or requested this should only be considered for inclusion on a case by case basis when generating a personal budget. This may be important to consider where family members or others are providing a level of informal care. Where this is included, the cost should be broken down as a weekly cost to give an indication of the true cost of the support needs.

7. Calculating a direct payment – contributions and top ups

7.1 The council will carry out a financial assessment to gauge whether the person should pay all the cost of their support, or contribute to the cost of their support, or make no contribution. The person’s contribution will be calculated in line with the Councils financial assessments policies and procedures.

7.2 If the person is assessed as having to pay the total cost of their support then the direct payment will be stopped and the Council’s Client Financial Services Team will take any repayment action needed.

7.3 If the person is assessed as having to contribute to the cost of their support, then the value of the direct payment into a Devon Card account will be for the total value of the personal budget. The person will then be invoiced for them to pay their assessed contribution to the personal budget.

7.4 If the needs of the person require that the direct payment is made into an account other than a Devon Card account then the amount paid by the council will be the personal budget minus any assessed financial contribution.

7.5 Services and support over and above the assessed needs, for example, cleaning and shopping or because the person chooses a more expensive care provider, can be purchased with the person’s own funds. Financial top-ups like this should be managed separately with clear accountability.

8. Who can be an appropriate person to manage a direct payment?

8.1 An appropriate person to manage a direct payment can be:

(a) the person with care and support needs if they have the capacity needed to understand and make the decisions involved in managing their own support arrangements and the direct payment

(b) someone who has been nominated by the person with care and support needs where they have capacity to do so

c) where the person does not have capacity to make the decisions involved, an authorised person under the Mental Capacity Act (MCA) to make welfare decisions for the person with care needs through having either; lasting power of attorney (LPA) or enduring power of attorney (EPA) – or is a court appointed deputy (CAD)

d) someone who has been identified as suitable by the funding authority and by an authorised person where there is one.

8.2 Any appropriate person must be:

18 or over
willing to manage the direct payment
deemed by the council as able to manage the money and support arrangements in the person’s best interests

8.3 A person will be considered to have capacity to consent to a direct payment unless a mental capacity assessment shows they do not. Capacity to consent to a direct payment must not be confused with the ability to manage their support arrangements as they may decide to have an appropriate person to manage their support.

8.4. The person with care and support needs or their appropriate person will still be capable of managing the direct payment even if they choose or need any additional support made available by the council.

8.5. The appropriate person will arrange the support, administer the payments and keep records of any expenditure. In their support plan, the person can still make decisions about how their personal budget is used where they have capacity to do so.

8.6. If someone would require an appropriate person to manage their direct payment but no one can be identified, the council would work with them to arrange and commission the support services needed.

8.7 An additional support can be agreed by the council, so that another person can access direct payment account to help the person manage the money for their support needs. To avoid confusion with other terminology used in this policy, someone in this position can be referred to as an additional (DP) account user.

8.8 A direct payment must be used in ways that meet the person’s support needs and are not prohibited by the Care Act.

8.9 The council will consider the following criteria when agreeing an appropriate person:

a) they are not currently a paid personal assistant or carer for the service user (however they may be in receipt of carer’s allowance)
b) they have no substantiated record of financial abuse against another individual recorded at the council or elsewhere
c) there is no reason to believe they would not act in the person’s best interests
d) they understand their responsibilities (with support if required)
e) they are prepared to work with the council and other professionals.

9. Accessing the direct payment

9.1 The council’s preferred method for providing direct payment funding is through the Devon Card. The card will be ordered and supplied at no cost to the person. The benefits of using the Devon Card are:

a) it is a secure and easy way to make payments to support providers, including same day bank transfers

b) financial transactions are accessible online and bank statements do not need to be sent to the council

c) immediate access to funds and balances using a computer, tablet or smartphone

d) a trusted person can be an additional (DP) account user to help run the account

e) support is available to learn how to use the Devon card.

9.2 The council, in partnership with the NHS, holds contracts with providers for the provision of the Devon Card and cardholders are subject to their terms and conditions.

9.3 The Devon Card cannot be used to withdraw cash. If, in exceptional circumstances, the person needs access to cash from their personal budget to meet outcomes identified in their support plan, the council will work with the person to identify a solution.

9.4 Use of the Devon Card is encouraged to mitigate the additional administrative burdens related to monitoring spend on individual bank accounts for both the council and the direct payment recipient. It facilitates the return of surplus money and the appropriate oversight of public funds.

9.5 Where a direct payment recipient maintains an existing bank account for their direct payment funding, they must send statements to the council’s finance team on a three, six or twelve – monthly basis, as required by the council, for account monitoring, or on request of the council if these are required more frequently.

9.6 Where a separate bank account is used and a surplus of unspent direct payment has built up without any agreed plan for how it would be used to meet eligible needs, the surplus must be repaid to the council. Any surplus identified and requested for repayment by the council must be repaid within 14 days of a request being received. failure to do so will result in action being taken by the council through the misspend of direct payments process.

9.7 Where a direct payment recipient has problems managing their separate bank account or using their direct payment or if adequate returns are not provided to the council in a timely manner, they may be required to transfer the account to a Devon Card to enable the direct payment to continue. When this is required the council would give reasons for the transfer.

9.8 If a direct payment recipient maintaining an existing bank account were to die, remaining funds must be returned immediately to the council to avoid becoming part of the person’s estate. This requirement is stipulated in the agreement with the council signed by the direct payment recipient.

10. Developing a self-directed support plan

10.1 The person’s support plan describes in detail the planned ways for meeting their assessed needs and the support they will have to achieve them. For example, enabling, personal care, equipment provision, support with daily domestic tasks and to access community facilities. The support may need to include any additional support needs for the person while their carer has a break.

10.2 The support plan can be developed by the person with their care manager, their family, an independent agency or a combination of these. The plan must be agreed by the council.

11. Positive risk taking

11.1 The council is committed to promoting choice while supporting people to manage risk positively, proportionately and realistically. The council acknowledges that supporting people to make informed decisions with an awareness of risks in their daily lives enables them to achieve their full potential and to do the things that most people take for granted.

11.2 A person who has the mental capacity to decide to live with a level of risk is entitled to do so as long as other duties and requirements in this policy are complied with.

11.3 Ways of mitigating the risk should be explored with the person. Depending on the situation and the risk, it may be possible to agree a trial period with the person that includes more frequent monitoring and reviews.

11.4 The council needs to ensure that a person’s eligible needs are provided in a safe and appropriate way when they choose to self-direct their own support.

11.5 The council requires support providers to record evidence and reasons for decision making relating to the management and reduction of risk. This will be considered as part of the direct payment approval process by the council. Support providers also have a duty to practice safely, including in moving and handling people with care and support needs. For example, if a support provider knowingly provided single-handed moving and handling and the person was assessed as needing double-handed moving and handling, they may be liable for any harm caused and may risk being referred by the Council to the Care Quality Commission (CQC).

12. Safeguarding

12.1 The person, their appropriate person, carer and family should know how they can prevent, recognise and report abuse, neglect and exploitation, and any other concerns they may have about the safety or welfare of someone with care and support needs. For further information on safeguarding, go to Devon Safeguarding pages.

13. Help with managing a direct payment for the first time

13.1 The council’s arranging support team will provide initial support to new direct payment recipients. If after three months the person or someone managing the direct payment on their behalf is still unable to manage independently, the person will be recommended for commissioned services.

13.2 The council will provide funding for some financial support services where this is agreed within the support plan.

13.3 The person will still maintain responsibility for the direct payment and their support arrangements.

14. Support providers

Agencies

14.1 The direct payment recipient will contract directly with any agency they use for their support. The council recommends a formal contract established for the support provided to protect the person’s interests.

14.2 Where the direct payment is used to pay for a regulated care service, the direct payment recipient must use an agency registered with the Care Quality Commission in respect of that activity. Regulated care is any form of personal care service in the person’s own home and it is an offence for any commercial provider to offer such personal care without a CQC registration.

14.3 Where a direct payment recipient intends to use an agency other than a care agency to meet their needs, they should be mindful of any regulation or quality standards which they might need to consider in choosing where to spend their fund. Further advice can be sought from Trading Standards.

14.4 If the council can commission support from a provider that would charge a direct payment recipient more, the council retains the right to commission that support directly with the agency or set the personal budget at the amount that the council would pay were it to commission the care directly with the provider. This could result in part-commissioned support but would ensure best value for the person’s personal budget.

Personal assistants (PAs)

14.5 A PA is an individual support worker who works on a one-to-one basis. If they support just one person on a full-time basis under their direct control, they would be ‘employed’. If they work part-time with a number of different people, they could be ‘self-employed’. Government guidance on employment status for employed or self-employed.

14.6 The person should bear in mind that if they become eligible for continuing health care funded by NHS Devon, any PA supporting them with healthcare through a personal health budget must be directly employed by them.

14.7 The council requires direct payment recipients to purchase and maintain appropriate employer’s liability insurance for all PAs and the cost will be included in their personal budget. The council may ask to see the insurance policy and premium receipts.

14.8 The employer’s liability insurance must have the appropriate level of cover for the support the PA will be providing, for example, to include healthcare tasks where relevant. New staff must be added to the policy where required and the insurance must be renewed annually using the accrued amount within the personal budget. Inadequate level of cover would be a breach of the direct payment recipient’s agreement with the council. The Council will verify that insurance is in place at 8 weeks and annually thereafter.

14.9 All PAs engaged must be suitably qualified to provide the support identified in the person’s support plan. Further training needs should be considered to ensure the employer’s liability insurance cover is valid.

14.10 Personal assistants (PAs) are not subject to the same regulatory requirements as other care providers. The cared-for person or the nominated/authorised person must be prepared to have oversight and monitoring of the quality of care provided by a PA. If any concerns arise, these should be dealt with by the person responsible for managing the direct payment in the first instance. If there is evidence of abuse or neglect of someone who is unable to protect themselves because of their care and support needs this must be reported to Devon County Council, contact details here.

14.11 It is the direct payment recipient’s responsibility to make sure they have contingency support plans in place to cover emergency situations, for example, when their PA is off sick, and to cover their PA’s annual leave.

14.12 If contingency arrangements were to break down, the council would endeavour to provide interim support. The council would recover monies already paid and detail the amount in writing.

14.13 The direct payment recipient must ensure any PA they engage understands they are not an employee or agent of the council. The council will not at any time be responsible for payments to or for responsibilities in connection with the PA. It must be clearly stated in their contract of employment (employed) or written statement of work (self-employed) that their working conditions and arrangements are the sole responsibility of the direct payment recipient.

Employed PAs

14.14 The direct payment recipient must comply with all legal duties and obligations as an employer in the United Kingdom, including those required by HM Revenue and Customs (HMRC) and the UK Border Agency. (See HMRC regulations and advice pages)

14.15 When a PA is employed, the council requires the recipient of the direct payments to use a payroll advice service, or equivalent, to ensure that wages, National Insurance and HMRC requirements are fulfilled. The cost of this service will be included in the personal budget.

Self-employed PAs

14.15 In cases where a PA is legitimately self-employed under HMRC regulations they must be clear about whether their role and duties come within the requirements for registration with CQC.

14.16 Where a direct payment recipient uses a self-employed PA, it is their responsibility to ensure the PA has a unique taxpayer reference number (UTR) that verifies their self-employed status.

14.17 For further advice on when a PA does and does not need to be registered with the Care Quality Commission.

Rates of pay for PAs

14.18 The council will pay an amount for a PA that is sufficient to cover their income tax, national insurance, holiday and pension contribution (if applicable). This will be reviewed to ensure it always meets the national minimum wage.

14.19 The direct payment recipient is responsible for paying a PA a fair and appropriate rate taking into account the relevant contributions they must pay.

Pre-employment checks and disclosure and barring service

14.20 The council recommends the direct payment recipient carries out some pre-employment checks, for example, taking up references, checking training certificates (to ensure employers liability insurance cover is appropriate), a Disclosure and Barring Service (DBS) check. On request, the Council will carry out the DBS check and cover the cost of the check.

14.21 Further information and guidance can be found on the DBS website.

Other providers – different ways to meet eligible needs and outcomes

14.22 Whilst a personal budget can only be spent on support and activities that meet the persons’ health and social care needs, taking a direct payment gives them the opportunity to explore more creative and innovative ways of achieving the goals agreed in their support plan. This means more choice about who provides their support and more control over how it is provided so other bespoke options for provision within the personal budget can be agreed.

15. Support for the ongoing management of a direct payment

Financial administration service

15.1 The council can offer direct payment recipients a financial administration service and will cover the cost. The service will hold the direct payment on their behalf and pay invoices and payroll as relevant. Where a PA is directly employed, the direct payment recipient still retains all their responsibilities as an employer.

15.2 The council uses a single provider to keep rates consistent, to monitor quality and value for money essential with the distribution of public funds.

15.3 The direct payment recipient could choose an alternative financial administration service at the same or lesser cost than the council would pay for its existing service. The council would expect the direct payment recipient to detail how auditing spend through the financial administration service would be managed, along with quality and value for money monitoring.

15.4 The service can just provide advice to assist the direct payment recipient who wishes to pay invoices or wages themselves. Any advice given should be followed to ensure payments are made appropriately, for example those to HMRC or related to redundancy, pregnancy and sickness.

16. Monitoring of direct payments

16.1 The council will periodically monitor transactions on Devon Card accounts

16.2 At any time, where there are transactions that appear to be outside the parameters of the support plan and the agreement, the council will request immediate evidence of spend.

16.3 Where a misspend has occurred and is the result of a genuine mistake, the council will liaise with the direct payment recipient to arrange for the repayment of misspent funds.

16.4 Where the council identifies misspends that amount to a deliberate breach of the direct payment agreement (e.g. spending on items that do not go towards meeting the needs referred to on the care and support plan), a referral will be made to the Office of the County Solicitor for a civil claim to be commenced if the funds are not paid back voluntarily.

16.5 The council will provide funding of four weeks in advance on each Devon Card account. The council will contact the direct payment recipient if a surplus has accrued to find out why and to request these funds are returned where necessary.

16.6 If the underspend is because the direct payment recipient is struggling to manage their funds or they have not been able to arrange the support to meet their eligible needs, the council will consider any appropriate support or recommend a needs review.

16.7 If the person’s support is in place and seems to be meeting the requirements of the support plan, but there is considerable underspend, the council will recommend a review of the persons care plan. This is to ensure the support provision at better value is suitable to achieve the outcomes and, if so, this would reflect in a reduced personal budget.

17. Review of direct payments

17.1 The council will review the management of the direct payment at 8 weeks and annually thereafter.

17.2 If the direct payment recipient is employing PAs directly, the council will check if the employer obligations are being maintained, for example submitting PAYE returns and paying tax and National Insurance deductions to HMRC.

17.3 It is the responsibility of the direct payment recipient to ensure they are available to engage with the review process. They must take all reasonable steps to provide information and evidence as requested to enable the council to review the direct payment. The council will provide reasonable notice of an intended review.

18. Review of support needs

18.1 A review of the person’s support needs should be carried out annually and will be either face-to-face or over the telephone, whichever is deemed the most appropriate and proportionate.

18.2 A review will also be triggered if the monitoring and review of the direct payment raise concerns about whether the person’s support needs are in fact being met.

18.3 During the review, the council will look at how self-directed support is working for the person, the quality of the support they are receiving, and whether they are achieving the outcomes set out in their support plan.

18.4 The value of the direct payment may change following a review of needs. For example, their support has helped to reduce their eligible needs and therefore the need for the same level of support, or their personal budget no longer represents best value.

19. Ending a direct payment

By the person or a direct payment recipient

19.1 If a direct payment recipient wishes to end the direct payment, a needs’ review would be triggered so the council could plan with the person how their assessed eligible needs would be alternatively met.

19.2 The council would expect 4 weeks’ notice to carry out the needs’ review.

19.3 The council would need to ensure there were no outstanding contractual liabilities for the self-directed support before the direct payment ended.

By the council

19.4 The council will consider ending a direct payment in the following circumstances:

a) if the person no longer appeared to be capable of managing the direct payment even with support

b) when a person no longer needed the support for which the personal budget was created, for example in the case of short-term packages

c) when a direct payment recipient did not require assistance for a short period because their condition had improved

d) if the person failed to comply with a condition imposed under the Care Act regulations covering direct payments

e) if there were evidence to suggest the fund had not been used to achieve the outcomes described in the support plan

f) if the council no longer believed it was appropriate to make the direct payment

g) the person lost capacity to consent and there was no appropriate person to manage the direct payment and support arrangements for them

h) the appropriate person no longer wished to manage the direct payment or was no longer deemed appropriate by the council, and no alternative appropriate person could be found.

19.5 The council will discuss with the person, their appropriate person and carer as relevant, the proposal to end the self-directed support and why.

19.6 A needs’ review would consider alternative support arrangements.

19.7 The council would be mindful if there were outstanding contractual liabilities for the self-directed support that needed to be managed by the person or someone on their behalf.

Death of the direct payment recipient

19.8 In the event of the death of the direct payment recipient, any funds in the Devon Card account would be recovered by the council following a discussion with the appropriate person, care or family as relevant.

19.9 Any amount due to the estate of the direct payment recipient for the fulfilment of contractual and legal obligations relating to any provider or to HMRC relating to an employed PA will be paid by the council on receipt of supporting documentary evidence or an invoice relating to the support received.

20. Challenges to direct payment decision-making

20.1 If a person or their representative chooses to challenge a decision made by the council in relation to a direct payment, they should speak to their care manager in the first instance.

20.2 If they are not satisfied with the response, they receive from their care manager and they wish to challenge further, they should follow the council complaints policy.

20.3 Their challenge will be based upon the procedure applied to reach the decision or the application of a policy in relation to their specific case, for example, the Fair and Affordable Care Policy.

20.4 If the person considers the direct payment is insufficient to meet their assessed needs, they should request a review of the support package by the council.

Appendices

1. Guide to allowable use of direct payments

2. Direct payments service user guidance

Guide to allowable use of direct payments – appendix 1

Purchase of the below items is not permitted:

Item/spend:
Alcohol, gambling, payment for sex or escort services

Item/spend:
Transport costs
Rationale/explanation:
The council would expect that transport to and from appointments would be met through existing resources (DLA, Patient Transport Services Motability vehicles, their own resources).

Item/spend:
Utilities
Description/examples:
The council will not usually agree to fund utility bills/costs through a direct payment
Rationale/explanation:
It is expected that in most cases where direct payment recipients have higher utility costs due to the nature of their condition, these additional costs should be met through existing benefits.

Item/spend:
Holidays
Rationale/explanation:
The council would not routinely agree to pay for holidays or trips, in terms of travel costs or accommodation.

Item/spend:
Non care-related tasks
Rationale/explanation:
The council would not expect to pay tasks that are not related to the outcomes specified on the care and support plan.

Item/spend:
Accommodation costs
Description/examples:
Rent payments, mortgage payments, personal assistant’ accommodation costs.
Rationale/explanation:
A direct payment should not be used to fund accommodation for direct payment recipients as it is expected that accommodation costs should be met through existing benefits or other income.

The below items are not normally permitted by may be allowed under specific circumstances, if they are linked to outcomes in your support plan. Please check with your care manager or social worker in advance of making a payment or purchase. Your care manager will need to record any items agreed below on our support plan.

Item/spend:
Consumables
Rationale/explanation:
The council would expect that all options for consumable delivery through commissioned contracts are explored through the persons care and support plan before agreeing a set cost for this in the direct payment (for example, through commissioned continence services). Where consumables cannot be provided through existing community services or prescriptions, the council will discuss with the direct payment recipient an appropriate weekly amount to be included in the direct payment. The council’s principle is that the direct payment will cover the cost of consumables equivalent to what a person receiving a contracted personal care service would receive.

Item/spend:
Administrative costs
Description/ examples:
Administrative costs may include printer ink, paper, diaries, stationary, related to the administration of running a direct payment and employing staff.
Rationale/explanation:
Where these costs are requested by the budget holder, the council will apply a test of reasonable towards the request and whether the items required relate specifically and exclusively to the cost of maintaining the direct payment.

In all cases the council would expect the budget holder to appropriately source cost-effective methods of meeting administrative costs, bearing in mind the spend of public monies.

Item/spend:
Mileage and transport
Description/ examples:
The council would not routinely agree to pay transport or mileage to direct payment recipients or to allocate mileage funding for their personal assistants. An allowance for mileage forms part of the council’s hourly rates which are reviewed annually.

The council would not usually allocate funding for mileage for personal assistants to get to their place of work.

The council may consider mileage payments in exceptional circumstances.

Rationale/explanation:
However, the council would need clear reasoning as to why this cost could not be covered through mobility benefits such as Disability Living Allowance.

Where the council does agree to pay mileage in exceptional circumstances, the HMRC mileage rate will be applied.

Item/spend:
Transport to and from day care.
Rationale/explanation:
Transport to and from respite and day care will be considered on an exceptional circumstances basis where there is clear evidence available to support delivery of an assessed health outcome as a result.

Item/spend:
Accommodation based respite.
Description/ examples:
The council will not fund accommodation for personal assistants but may fund their hours worked to support a direct payment recipient during a period of respite.
Rationale/explanation:
The council may consider funding accommodation for the person where this represents respite provision and will review this on an individual basis. This would be considered under the exceptional circumstances procedure.

Item/spend:
Equipment
Rationale/explanation:
It is not expected that direct payments for care and support should be used to purchase equipment.

The council can offer a direct payment for equipment or minor adaptations in some circumstances, please see the Direct payments for equipment and adaptations policy. The council will follow the usual process for agreement of funding for equipment.

Item/spend:
Support in hospital
Description/ examples:
The council may consider a ‘retainer’ payment to personal assistants where the direct payment recipient is admitted to hospital to retain the staff; although would expect that annual leave options are also explored by the personal assistants.

The council may pay personal assistants for up to 28 days at the minimum hours outlined in the employment contract. If an employment contract does not exist, or the contract is zero hours, the council will use its discretion over the appropriateness of the retainer period, taking into account the established staff team and difficulty in starting a new package should the personal assistants need to find new employment while the direct payment recipient is in hospital.

After the initial 28 days, the arrangement will be reviewed and any amendments will be made on a case by case basis.

Rationale/explanation:
The council would not expect to pay personal assistants to undertake care tasks while a direct payment recipient is in hospital.

There may be circumstances where it is appropriate for a personal assistant to support a direct payment recipient in hospital (for example, where the person has challenging behaviours or specific communication approaches); however, this will be at the discretion of the council and the hospital as to the appropriateness.

Item/spend:
Increased support for a fixed period of time to support an agreed activity or outcome.
Description/examples:
More PA hours to support someone whilst they are on holiday.
Rationale/explanation:
The council may agree as part of a person’s care and support plan to fund increased personal assistant hours to support the direct payment recipient whilst they are away – this will be requested through a person’s support plan and agreed on a case by case basis.

The below items are normally permitted:

Item/spend:
Respite/replacement care
Rationale/explanation:
Respite allocation should be identified in the persons care and support plan and agreed through usual processes. Respite funding can be added into the direct payment account but should only be used in the way described in the care plan/ user agreement.

Direct payments service user guidance – appendix 2

Guide to self-directed support and direct payments available here.

Policy details

Version	2.0
Strategic owner	Keri Storey, Head of Adult Social Care
Business owner	Tina Ramage, Principal Social Worker
Author	Paul Grimsey, Policy Manager
Date of approval and commencement	July 2020
Last review date	Sept 2023
Last reviewer	James Martin, DCC Policy Manager
Next review date	Sept 2024
Changes at last review	Minor terminology updates and links updated. References to temporary COVID-19 guidance removed.

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