5.1.2 Personal Budgets and Direct Payments

1. What is a Personal Budget?

A personal budget is the overall cost of care and support the local authority and/or health service provides for a disabled child or young person who has extra needs.

A personal budget can be used for:

• Employing a personal assistant (PA) or for purchasing care and support services;
• Buying specialist equipment not provided by the NHS;
• Paying for leisure or educational activities and transport costs.

2. What are Direct Payments?

Direct payments are monetary payments made to assist with meeting a child or young person’s assessed need by the relevant body to fund part or all services as an alternative to commissioned services.

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/practitioner must be satisfied that the parent, nominated person  or young person (who is over the age of 16):

• Is able and capable of manging the Direct Payment either by themselves or with whatever help the authority thinks will be  appropriate;
• Is the most appropriate way of arranging the required support or services rather than commissioned services from the relevant body;
• Will use the direct payment in an appropriate way to meet the needs of the child/young person and will act in the best interests of the child or young person.

The options of controlling the personal budget/direct payment are the following:

1. Direct payments – where the young person/parents/ nominated person buys, employs and arranges the services themselves such as employing a personal assistant, taking on certain responsibilities as an employer;
2. An arrangement – where the Local Authority, school or college hold the funds and arranges the services (also known as notional budgets);
3. Third party arrangements – where the funding is paid to a person or organisation who acts on behalf of the parents, nominated person or young person.

Direct payments for education are monetary payments to parents of a child with an Education, Health and Care Plan (EHCP) and should be specified in the EHCP. These include requirements to consider the impact on other service users, taking account of value for money and to seek agreement from educational establishment 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 Integrated Care Board (ICB) and the recipient. Direct payments and Personal Budgets also apply to young people who require Aftercare under Section 117 of the Mental Health Act 1983, children and young people receiving Continuing Health Care funding  and people eligible for an NHS wheelchair (personal wheelchair budgets).

3. Who can get Direct Payments/Personal Budget?

A direct payment may be agreed if a disabled  child/ young  person  is eligible through a Care Plan, children in need plan or short breaks plan (LA funded), or the family’s needs (by virtue of their role as carers assessed through a carers assessment for a disabled child) or who have Education, Health and Care Plans (EHCP), which may contain elements of education, social care and health funding. Under the Children and Families Act 2014, this covers those aged 0-25 having special educational needs and disabilities.

Direct Payments for People with Parental responsibility for a Disabled Child:

The responsibilities of parenting a disabled child are often made more difficult by the barriers that exist in accessing mainstream services. Families with Disabled Children may feel the services offered by Sheffield City Council Social Care Services are not the best way of meeting their child's needs and may well wish to make more suitable arrangements themselves. Direct Payments may allow parents to make these arrangements.

Parents should be encouraged to use direct payments in a way that enables their disabled children to access the same opportunities and activities as their  non-disabled peers. A local authority cannot insist that a family has a Direct Payment.

If a parent or carer as a result of their own disability has their own social care needs then a referral should be made to Adults Services to assess their needs as a disabled person and parent.

Direct Payments can be made to parents or other carers with parental responsibility for a disabled child to meet:

• Their own assessed needs as parent carers;
• The disabled child's assessed need;
• The families assessed need.

Direct Payments for Young People aged 16+

Young people aged 16+ can have a Direct Payment in their own right.

4. How Often are Direct Payments Made?

Direct Payments are usually paid in advance into a bank or building society account specifically set up for this purpose, as a one off payment or on a 4 weekly basis and this bank account should not be used for any other purpose. If the direct payment is assessed as being needed at key times e.g. school holidays, then payment will be made accordingly.

5. 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.

A local authority cannot insist that a family has a Direct Payment.

6. 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;
• To stay overnight to give respite to parents;
• Or a registered childminder or child home carer (for children aged under 8).

Employing family members

• The person you are looking after cannot normally use the direct payment to pay a family member they live with to provide them with care. However, if the local council agree that this is the most effective way of meeting their needs then it is sometimes possible. For example, it might be necessary if there are religious reasons or communication reasons (other reasons may also count as necessary);
• The person you are looking after can use the direct payment to pay a family member who does not live with them to provide them with care (as long as the local council agree that this family member will meet their needs);
• The person you are looking after can use the direct payment to pay a family member (regardless as to whether or not they live with them) to provide the management and administration of the direct payments, where the local council think that this is necessary.

Employing Minors (under 18)

Direct payment recipients may employ staff between the ages of 16 and 18 in some circumstances. If this is the case the employer must ensure that the PA is suitably mature and that the service provided does not involve any personal/intimate care.

Intimate Care

Parents may purchase care services of an intimate nature for their children however as the child matures his/her wishes should be taken into account regarding intimate care.

Childminders

Advise parents that OFSTED states: You must register with Ofsted or a childminder agency if you want to be paid to look after children under 8 for more than 2 hours a day in England. Details of how to register as a childminder can be found at OFSTED.

7. 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. The residential unit cannot be owned and run by the Local Authority. With agreement from a Decision Maker the payments can be used to purchase overnight care from a friend or personal assistant under Section 17 (6) of the Children  Act 1989, and the child will not be regarded as looked after, as long as this does not exceed 75 nights per year; (For further information on short breaks for disabled children, see the Short Breaks Procedures);
• 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.

8. Hospital Stays

It could well be that those in receipt of Direct Payments require stays in hospital. This would 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.

9. Direct Payments Can Not be Spent On

• Employing someone without Disclosure and Barring Service and CPR checks or references, or someone subject to a drug or alcohol treatment requirement, youth rehabilitation order or released on licence; Sheffield City Council will cover the cost of the initial check;

• 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).

10. 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. Payments made do not affect welfare benefits as they are not classed as income.

11. 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 and the right to request a review of the decision.

12. 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.

If there is Social Care Involvement the Direct Payment should be looked at within part of the child's plan and reviewed in line with appropriate standards.

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.

Monitoring is completed and undertaken by the Direct Payment Audits Team.

Monitoring will comprise of annotated bank statements for corresponding periods. Any anomalies are flagged up to the Direct Payment Support Officer who has a duty to ensure that the monies are not being misspent and speak to the families for clarification and checked against the Direct Payment Plan.

13. 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.

14. 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.

15. Ceasing Direct Payments

The local authority must stop making Direct Payments if:

• The recipient has notified the local authority in writing that they 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).

Other relevant information

Backdating Pay

Families are eligible to receive monies from the service agreement date however these payments will only be backdated to a specific date when a family was ready to start using the direct payment but they were delayed due to council/third party processes. Families are asked to sign an F8 which holds the Direct Payment Agreement which also includes an agreed start date.

Employer's Responsibilities

The direct payment recipient must be made aware of their legal responsibilities as an employer (terms & conditions of employment) and the family should be given a Direct Payment Handbook. Families are asked to sign an Agreement that states that they are aware of these responsibilities.

Parents and Young people aged 16/17 will be required to sign an agreement that they accept their responsibilities and the conditions under which a direct payment is made. Should the child or young person be at risk from the arrangements or if monies are being used fraudulently then an immediate termination may be sought.

A separate bank account will be required for the purpose of direct payments. Families may opt to have a managed account should they not wish to be involved with managing the money themselves however this decision needs to be made by management.

16. Tranferring the Direct Payments to Adult Social Care

Before a young person is 18, it is important that a young person is assessed through the transition process to meet the statutory duty of both the Care Act and the Children and Families Act and to decide if Adult Social Care is needed and to establish what care and support is still needed or required. This will include whether a direct payment is being offered.

It is important to note once a young person reaches 18, the care and support package is means tested and a financial assessment will be completed by the local authority to look at what contribution is necessary from the young person’s finances (which does include benefits).